Bio


Joshua Salomon is a Professor of Health Policy, a core faculty member in the Center for Health Policy, and Senior Fellow at the Freeman Spogli Institute for International Studies. His research focuses on public health policy and priority-setting, within three main substantive areas: (1) modeling patterns and trends in major causes of global mortality and disease burden; (2) evaluation of health interventions and policies; and (3) measurement and valuation of health outcomes.

Dr. Salomon is an investigator on projects funded by the Centers for Disease Control and Prevention, National Institutes of Health and the Bill & Melinda Gates Foundation, relating to modeling of infectious and chronic diseases and associated intervention strategies; methods for economic evaluation of public health programs; measurement of the global burden of disease; and assessment of the potential impact and cost effectiveness of new health technologies.

He is Director of the Prevention Policy Modeling Lab, which is a multi-institution research consortium that conducts health and economic modeling relating to infectious disease. Prior to joining the Stanford faculty, Dr. Salomon was Professor of Global Health at Harvard T.H. Chan School of Public Health.

For more information on the Prevention Policy Modeling Lab visit ppml.stanford.edu.

2021-22 Courses


Stanford Advisees


All Publications


  • Adventures in COVID-19 Policy Modeling: Education Edition. Current HIV/AIDS reports Gonsalves, G. S., Salomon, J. A., Thornhill, T., Paltiel, A. D. 2021

    Abstract

    PURPOSE OF REVIEW: To introduce readers to policy modeling, a multidisciplinary field of quantitative analysis, primarily used to help guide decision-making. This review focuses on the choices facing educational administrators, from K-12 to universities in the USA, as they confronted the COVID-19 pandemic. We survey three key model-based approaches to mitigation of SARS-CoV-2 spread in schools and on university campuses.RECENT FINDINGS: Frequent testing, coupled with strict attention to behavioral interventions to prevent further transmission can avoid large outbreaks on college campuses. K-12 administrators can greatly reduce the risks of severe outbreaks of COVID-19 in schools through various mitigation measures including classroom infection control, scheduling and cohorting strategies, staff and teacher vaccination, and asymptomatic screening. Safer re-opening of college and university campuses as well as in-person instruction for K-12 students is possible, under many though not all epidemic scenarios if rigorous disease control and screening programs are in place.

    View details for DOI 10.1007/s11904-021-00592-9

    View details for PubMedID 34826066

  • Balancing health and financial protection in health benefit package design. Health economics Lofgren, K. T., Watkins, D. A., Memirie, S. T., Salomon, J. A., Verguet, S. 2021

    Abstract

    Policymakers face difficult choices over which health interventions to publicly finance. We developed an approach to health benefits package design that accommodates explicit tradeoffs between improvements in health and provision of financial risk protection (FRP). We designed a mathematical optimization model to balance gains in health and FRP across candidate interventions when publicly financed. The optimal subset of interventions selected for inclusion was determined with bi-criterion integer programming conditional on a budget constraint. The optimal set of interventions to publicly finance in a health benefits package varied according to whether the objective for optimization was population health benefits or FRP. When both objectives were considered jointly, the resulting optimal essential benefits package depended on the weights placed on the two objectives. In the Sustainable Development Goals era, smart spending toward universal health coverage is essential. Mathematical optimization provides a quantitative framework for policymakers to design health policies and select interventions that jointly prioritize multiple objectives with explicit financial constraints.

    View details for DOI 10.1002/hec.4434

    View details for PubMedID 34626032

  • Quantifying and Benchmarking Disparities in COVID-19 Vaccination Rates by Race and Ethnicity. JAMA network open Reitsma, M. B., Goldhaber-Fiebert, J. D., Salomon, J. A. 2021; 4 (10): e2130343

    View details for DOI 10.1001/jamanetworkopen.2021.30343

    View details for PubMedID 34668949

  • Cost Effectiveness of Computed Tomography Versus Ultrasound-Based Surveillance Following Endovascular Aortic Repair of Intact Abdominal Aortic Aneurysms Ho, V. T., Nguyen, A. T., Stern, J. R., Asch, S. M., Owens, D. K., Salomon, J. A., Dalman, R. L., Lee, J. T. MOSBY-ELSEVIER. 2021: E414-E415
  • Multimorbidity and mortality in an older, rural black South African population cohort with high prevalence of HIV findings from the HAALSI Study. BMJ open Wade, A. N., Payne, C. F., Berkman, L., Chang, A., Gomez-Olive, F. X., Kabudula, C., Kahn, K., Salomon, J. A., Tollman, S., Witham, M., Davies, J. 2021; 11 (9): e047777

    Abstract

    OBJECTIVES: Multimorbidity is associated with mortality in high-income countries. Our objective was to investigate the relationship between multimorbidity (≥2 of the following chronic medical conditions: hypertension, diabetes, dyslipidaemia, anaemia, HIV, angina, depression, post-traumatic stress disorder, alcohol dependence) and all-cause mortality in an older, rural black South African population. We further investigated the relationship between HIV multimorbidity (HIV as part of the multimorbidity cluster) and mortality, while testing for the effect of frailty in all models.DESIGN: Population cohort study.SETTING: Agincourt subdistrict of Mpumalanga province, South Africa.PARTICIPANTS: 4455 individuals (54.7% female), aged ≥40 years (median age 61 years, IQR 52-71) and resident in the study area.PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was time to death and the secondary outcome measure was likelihood of death within 2 years of the initial study visit. Mortality was determined during annual population surveillance updates.RESULTS: 3157 individuals (70.9%) had multimorbidity; 29% of these had HIV. In models adjusted for age and sociodemographic factors, multimorbidity was associated with greater risk of death (women: HR 1.72; 95% CI: 1.18 to 2.50; men: HR 1.46; 95% CI: 1.09 to 1.95) and greater odds of dying within 2 years (women: OR 2.34; 95% CI: 1.32 to 4.16; men: OR 1.51; 95% CI: 1.02 to 2.24). HIV multimorbidity was associated with increased risk of death compared with non-HIV multimorbidity in men (HR 1.93; 95% CI: 1.05 to 3.54), but was not statistically significant in women (HR 1.85; 95% CI: 0.85 to 4.04); when detectable, HIV viral loads were higher in men (p=0.021). Further adjustment for frailty slightly attenuated the associations between multimorbidity and mortality risk (women: HR 1.55; 95% CI: 1.06 to 2.26; men: HR 1.36; 95% CI: 1.01 to 1.82), but slightly increased associations between HIV multimorbidity and mortality risk.CONCLUSIONS: Multimorbidity is associated with mortality in this older black South African population. Health systems which currently focus on HIV should be reorganised to optimise identification and management of other prevalent chronic diseases.

    View details for DOI 10.1136/bmjopen-2020-047777

    View details for PubMedID 34526338

  • Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019 LANCET Paulson, K. R., Kamath, A. M., Alam, T., Bienhoff, K., Abady, G., Abbas, J., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abd-Elsalam, S. M., Abdoli, A., Abedi, A., Abolhassani, H., Abreu, L., Abu-Gharbieh, E., Abu-Rmeileh, N. E., Abushouk, A., Adamu, A. L., Adebayo, O. M., Adegbosin, A., Adekanmbi, V., Adetokunboh, O. O., Adeyinka, D., Adsuar, J. C., Afshari, K., Aghaali, M., Agudelo-Botero, M., Ahinkorah, B., Ahmad, T., Ahmadi, K., Ahmed, M., Aji, B., Akalu, Y., Akinyemi, O., Aklilu, A., Al-Aly, Z., Alam, K., Alanezi, F., Alanzi, T. M., Alcalde-Rabanal, J., Al-Eyadhy, A., Ali, T., Alicandro, G., Alif, S., Alipour, V., Alizade, H., Aljunid, S., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alumran, A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Ameyaw, E., Amini, S., Amini-Rarani, M., Amit, A. L., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Andrei, C., Ansari, F., Ansari-Moghaddam, A., Antonio, C. T., Antriyandarti, E., Anvari, D., Anwer, R., Aqeel, M., Arabloo, J., Arab-Zozani, M., Aripov, T., Arnlov, J., Artanti, K., Arzani, A., Asaad, M., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Jafarabadi, M., Athari, S., Athari, S., Atnafu, D., Atreya, A., Atteraya, M., Ausloos, M., Awan, A., Quintanilla, B., Ayano, G., Ayanore, M., Aynalem, Y., Azari, S., Azarian, G., Azene, Z., Darshan, B. B., Babaee, E., Badiye, A. D., Baig, A., Banach, M., Banik, P., Barker-Collo, S., Barqawi, H., Bassat, Q., Basu, S., Baune, B. T., Bayati, M., Bedi, N., Beghi, E., Beghi, M., Bell, M. L., Bendak, S., Bennett, D. A., Bensenor, I. M., Berhe, K., Berman, A. E., Bezabih, Y., Bhagavathula, A., Bhandari, D., Bhardwaj, N., Bhardwaj, P., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bikbov, B., Biondi, A., Birihane, B., Biswas, R., Bohlouli, S., Bragazzi, N., Breusov, A., Brunoni, A. R., Burkart, K., Nagaraja, S., Busse, R., Butt, Z. A., dos Santos, F., Cahuana-Hurtado, L., Camargos, P., Camera, L., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J., Castaneda-Orjuela, C. A., Castelpietra, G., Cerin, E., Chang, J., Chanie, W., Charan, J., Chatterjee, S., Chattu, S., Chattu, V., Chaturvedi, S., Chen, S., Cho, D., Choi, J., Chu, D., Ciobanu, L. G., Cirillo, M., Conde, J., Costa, V., Couto, R. S., Dachew, B., Dahlawi, S. A., Dai, H., Dai, X., Dandona, L., Dandona, R., Daneshpajouhnejad, P., Darmstadt, G. L., Das, J. K., Davila-Cervantes, C., Davis, A. C., Davletov, K., De la Hoz, F., De Leo, D., Deeba, F., Denova-Gutierrez, E., Dervenis, N., Desalew, A., Deuba, K., Dey, S., Dharmaratne, S., Dhingra, S., Dhungana, G., da Silva, D., Diaz, D., Dorostkar, F., Doshmangir, L., Dubljanin, E., Duraes, A., Eagan, A., Edinur, H., Efendi, F., Eftekharzadeh, S., El Sayed, I., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., El-Jaafary, S., Emami, A., Enany, S., Eyawo, O., Ezzikouri, S., Faris, P., Farzadfar, F., Fattahi, N., Fauk, N., Fazlzadeh, M., Feigin, V. L., Ferede, T. Y., Fereshtehnejad, S., Fernandes, E., Ferrara, P., Filip, I., Fischer, F., Fisher, J. L., Foigt, N. A., Folayan, M., Foroutan, M., Franklin, R., Freitas, M., Friedman, S. D., Fukumoto, T., Gad, M. M., Gaidhane, A., Gaidhane, S., Gaihre, S., Gallus, S., Garcia-Basteiro, A. L., Garcia-Gordillo, M., Gardner, W. M., Fonseca, M., Gebremedhin, K., Getacher, L., Ghashghaee, A., Gholamian, A., Gilani, S., Gill, T. K., Giussani, G., Gnedovskaya, E., Godinho, M., Goel, A., Golechha, M., Gona, P. N., Gopalani, S., Goudarzi, H., Grivna, M., Gugnani, H., Guido, D., Guimaraes, R., Das Gupta, R., Gupta, R., Hafezi-Nejad, N., Haider, M., Haj-Mirzaian, A., Hamidi, S., Hanif, A., Hankey, G. J., Hargono, A., Hasaballah, A., Hasan, M., Hasan, S., Hassan, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hayat, K., Heidari-Soureshjani, R., Henry, N. J., Herteliu, C., Hole, M. K., Holla, R., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Huang, J., Humayun, A., Hwang, B., Iavicoli, I., Ibitoye, S., Ikuta, K. S., Ilesanmi, O., Ilic, I. M., Ilic, M. D., Inamdar, S., Inbaraj, L., Iqbal, K., Iqbal, U., Islam, M., Islam, S., Iso, H., Iwagami, M., Iwu, C. D., Jaafari, J., Jacobsen, K. H., Jagnoor, J., Jain, V., Janodia, M., Javaheri, T., Javanmardi, F., Jayaram, S., Jayatilleke, A., Jenabi, E., Jha, R., Ji, J. S., John, O., Jonas, J. B., Joo, T., Joseph, N., Joukar, F., Jozwiak, J., Jurisson, M., Kabir, A., Kabir, Z., Kalankesh, L. R., Kamyari, N., Kanchan, T., Kapoor, N., Matin, B., Karch, A., Karimi, S., Kassahun, G., Kayode, G. A., Karyani, A., Kemmer, L., Khalid, N., Khalilov, R., Khammarnia, M., Khan, E., Khan, G., Khan, M., Khan, M., Khang, Y., Khatab, K., Khater, A. M., Khater, M. M., Khayamzadeh, M., Khosravi, A., Kim, D., Kim, Y., Kim, Y., Kimokoti, R. W., Kisa, A., Kisa, S., Kissoon, N., Kopec, J. A., Kosen, S., Koul, P. A., Laxminarayana, S., Koyanagi, A., Krishan, K., Krishnamoorthy, V., Defo, B., Bicer, B., Kulkarni, V., Kumar, G., Kumar, M., Kumar, N., Kurmi, O. P., Kusuma, D., La Vecchia, C., Lacey, B., Lalloo, R., Lami, F., Landires, I., Larsson, A. O., Lasrado, S., Lassi, Z. S., Lauriola, P., Lee, P. H., Lee, S., Lee, Y., Leigh, J., Leonardi, M., Lewycka, S., Li, B., Li, S., Liang, J., Lim, L., Limenih, M., Lin, R., Liu, X., Lodha, R., Lopez, A. D., Lozano, R., Lugo, A., Lunevicius, R., Mackay, M. T., Kunjathur, S., Magnani, F., Prasad, D., Maheri, M., Mahmoudi, M., Majeed, A., Maled, V., Maleki, A., Maleki, S., Malekzadeh, R., Malik, A., Malta, D., Mamun, A. A., Mansouri, B., Mansournia, M., Martinez, G., Martini, S., Martins-Melo, F., Masoumi, S., Maulik, P. K., McAlinden, C., McGrath, J. J., Medina-Solis, C., Nasab, E., Mejia-Rodriguez, F., Memish, Z. A., Mendoza, W., Menezes, R. G., Mengesha, E., Mensah, G. A., Meretoja, A., Meretoja, T. J., Mersha, A. M., Mestrovic, T., Miazgowski, B., Miazgowski, T., Michalek, I., Miller, T. R., Mini, G. K., Miri, M., Mirica, A., Mirrakhimov, E. M., Mirzaei, H., Mirzaei, M., Moazen, B., Moghadaszadeh, M., Mohajer, B., Mohamad, O., Mohammad, Y., Mohammadi, S., Mohammadian-Hafshejani, A., Mohammed, S., Mokdad, A. H., Molokhia, M., Monasta, L., Mondello, S., Moni, M., Moore, C. E., Moradi, G., Moradi, M., Moradzadeh, R., Moraga, P., Morawska, L., Morrison, S., Mosser, J. F., Khaneghah, A., Mustafa, G., Naderi, M., Nagarajan, A., Nagaraju, S., Naghavi, M., Naghshtabrizi, B., Naimzada, M., Nangia, V., Swamy, S., Nascimento, B., Naveed, M., Nazari, J., Ndejjo, R., Negoi, I., Negoi, R., Nena, E., Nepal, S., Netsere, H., Nguefack-Tsague, G., Ngunjiri, J. W., Chi Thi Yen Nguyen, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Nigatu, Y. T., Nigussie, S., Nixon, M. R., Nnaji, C. A., Nomura, S., Noor, N. M., Noubiap, J., Nunez-Samudio, V., Nwatah, V., Oancea, B., Odukoya, O., Ogbo, F., Olusanya, B., Olusanya, J., Bali, A., Onwujekwe, O. E., Ortiz, A., Otoiu, A., Otstavnov, N., Otstavnov, S. S., Owolabi, M. O., Mahesh, P. A., Padubidri, J., Pakhale, S., Pakshir, K., Pal, P., Palladino, R., Pana, A., Panda-Jonas, S., Pandey, A., Pandey, A., Pandi-Perumal, S. R., Pangaribuan, H., Pardo-Montano, A., Park, E., Patel, S., Patton, G. C., Pawar, S., Toroudi, H., Peden, A. E., Pepito, V., Peprah, E. K., Pereira, J., Perez-Gomez, J., Perico, N., Pesudovs, K., Pilgrim, T., Pinheiro, M., Piradov, M. A., Pirsaheb, M., Platts-Mills, J. A., Pokhrel, K., Postma, M. J., Pourjafar, H., Prada, S., Prakash, S., Pupillo, E., Syed, Z., Rabiee, N., Radfar, A., Rafiee, A., Rafiei, A., Raggi, A., Rahimzadeh, S., Rahman, M., Rahmani, A., Ramezanzadeh, K., Rana, J., Ranabhat, C., Rao, S. J., Rasella, D., Rastogi, P., Rathi, P., Rawaf, D., Rawaf, S., Rawasia, W., Rawassizadeh, R., Jr, R., Remuzzi, G., Renzaho, A. N., Reshmi, B., Resnikoff, S., Rezaei, N., Rezaei, N., Rezapour, A., Riahi, S., Ribeiro, D., Rickard, J., Roever, L., Ronfani, L., Rothenbacher, D., Rubagotti, E., Rumisha, S., Ryan, P., Saddik, B., Sadeghi, E., Moghaddam, S., Sagar, R., Sahebkar, A., Salahshoor, M., Salehi, S., Salem, M., Salimzadeh, H., Salomon, J. A., Samodra, Y., Samy, A. M., Sanabria, J., Santric-Milicevic, M. M., Saraswathy, S., Sarker, A., Sarrafzadegan, N., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Saxena, S., Saya, G., Saylan, M., Schiavolin, S., Schlaich, M. P., Schwebel, D. C., Schwendicke, F., Senthilkumaran, S., Sepanlou, S. G., Servan-Mori, E., Sha, F., Shafaat, O., Shahabi, S., Shahbaz, M., Shaheen, A. A., Shahid, I., Shaikh, M., Shakiba, S., Shalash, A. S., Shams-Beyranvand, M., Shannawaz, M., Sharafi, K., Sheikh, A., Sheikhbahaei, S., Shiferaw, W., Shigematsu, M., Shin, J., Shiri, R., Shiue, I., Shuval, K., Siddiqi, T., Sidemo, N., Sigfusdottir, I., Sigurvinsdottir, R., Silva, J., Silverberg, J. S., Simonetti, B., Singh, B., Singh, J. A., Singhal, D., Sinha, D., Skiadaresi, E., Skryabin, V., Skryabina, A., Sleet, D. A., Sobaih, B., Sobhiyeh, M., Soltani, S., Soriano, J. B., Spurlock, E., Sreeramareddy, C. T., Steiropoulos, P., Stokes, M. A., Stortecky, S., Sufiyan, M., Abdulkader, R., Sulo, G., Swope, C. B., Sykes, B. L., Szeto, M. D., Szocska, M., Tabares-Seisdedos, R., Tadesse, E., Taherkhani, A., Tamiru, A., Tareque, M., Tehrani-Banihashemi, A., Temsah, M., Tesfay, F., Tessema, G., Tessema, Z., Thankappan, K., Thapar, R., Tolani, M., Tovani-Palone, M., Traini, E., Bach Xuan Tran, Tripathy, J., Tsapparellas, G., Tsatsakis, A., Car, L., Uddin, R., Ullah, A., Umeokonkwo, C., Unim, B., Unnikrishnan, B., Upadhyay, E., Usman, M., Vacante, M., Vaezi, M., Tahbaz, S., Valdez, P. R., Vasankari, T., Venketasubramanian, N., Verma, M., Violante, F. S., Vlassov, V., Vo, B., Giang Thu Vu, Wado, Y., Waheed, Y., Wamai, R. G., Wang, Y., Wang, Y., Wang, Y., Ward, P., Werdecker, A., Westerman, R., Wickramasinghe, N., Wilner, L. B., Wiysonge, C., Wu, A., Wu, C., Xie, Y., Jabbari, S., Yamagishi, K., Yandrapalli, S., Yaya, S., Yazdi-Feyzabadi, V., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yousefi, Z., Yousefinezhadi, T., Yu, C., Yusuf, S., Zaidi, S., Bin Zaman, S., Zamani, M., Zamanian, M., Zastrozhin, M., Zastrozhina, A., Zhang, Y., Zhang, Z., Zhao, X., Ziapour, A., Hay, S., Murray, C. L., Wang, H., Kassebaum, N. J., GBD 2019 Under-5 Mortality Collabo 2021; 398 (10303): 870-905

    Abstract

    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.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 (U5MR). 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.Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 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 U5MR 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 3·53-4·02]) 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.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 U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(21)01207-1

    View details for Web of Science ID 000692628000023

    View details for PubMedID 34416195

    View details for PubMedCentralID PMC8429803

  • Refining global HIV estimates for decision-making: advances in analytic and modelling methods used by the Joint United Nations Programme on HIV/AIDS. Journal of the International AIDS Society Maheu-Giroux, M., Ciaranello, A. L., Salomon, J. A., Sohn, A. H. 2021; 24 Suppl 5: e25790

    View details for DOI 10.1002/jia2.25790

    View details for PubMedID 34546663

  • Cost Effectiveness of Computed Tomography Versus Ultrasound-Based Surveillance After Endovascular Aortic Repair of Intact Abdominal Aortic Aneurysms Ho, V. T., Nguyen, A. T., Stern, J. R., Asch, S. M., Owens, D. K., Salomon, J. A., Dalman, R. L., Lee, J. T. MOSBY-ELSEVIER. 2021: E190-E191
  • Trends, mechanisms, and racial/ethnic differences of tuberculosis incidence in the US-born population aged 50 years or older in the United States. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Kim, S., Cohen, T., Horsburgh, C. R., Miller, J. W., Hill, A. N., Marks, S. M., Li, R., Kammerer, J. S., Salomon, J. A., Menzies, N. A. 2021

    Abstract

    BACKGROUND: Older age is a risk factor for TB in low incidence settings. Using data from the U.S. National TB Surveillance System and American Community Survey, we estimated trends and racial/ethnic differences in TB incidence among US-born cohorts aged ≥50 years.METHODS: 42,000 TB cases among US-born persons ≥50 years were reported during 2001-2019. We used generalized additive regression models to decompose the effects of birth cohort and age on TB incidence rates, stratified by sex and race/ethnicity. Using genotype-based estimates of recent transmission (available 2011-2019), we implemented additional models to decompose incidence trends by estimated recent versus remote infection.RESULTS: Estimated incidence rates declined with age, for the overall cohort and most sex and race/ethnicity strata. Average annual percentage declines flattened for older individuals, from 8.80% (95% confidence interval 8.34-9.23) in 51-year-olds to 4.51% (3.87-5.14) in 90-year-olds. Controlling for age, incidence rates were lower for more recent birth cohorts, dropping 8.79% (6.13-11.26) on average between successive cohort years. Incidence rates were substantially higher for racial/ethnic minorities, and these inequalities persisted across all birth cohorts. Rates from recent infection declined at approximately 10% per year as individuals aged. Rates from remote infection declined more slowly with age, and this annual percentage decline approached zero for the oldest individuals.CONCLUSIONS: TB rates were highest for racial/ethnic minorities and for the earliest birth cohorts and declined with age. For the oldest individuals, annual percentage declines were low, and most cases were attributed to remote infection.

    View details for DOI 10.1093/cid/ciab668

    View details for PubMedID 34323959

  • COVID-19 Policy Impact Evaluation: A guide to common design issues. American journal of epidemiology Haber, N. A., Clarke-Deelder, E., Salomon, J. A., Feller, A., Stuart, E. A. 2021

    Abstract

    Policy responses to COVID-19, particularly those related to non-pharmaceutical interventions, are unprecedented in scale and scope. However, policy impact evaluations require a complex combination of circumstance, study design, data, statistics, and analysis. Beyond the issues that are faced for any policy, evaluation of COVID-19 policies is complicated by additional challenges related to infectious disease dynamics and a multiplicity of interventions. The methods needed for policy-level impact evaluation are not often used or taught in epidemiology, and differ in important ways that may not be obvious. Methodological complications of policy evaluations can make it difficult for decision-makers and researchers to synthesize and evaluate strength of evidence in COVID-19 health policy papers. We (1) introduce the basic suite of policy impact evaluation designs for observational data, including cross-sectional analyses, pre/post, interrupted time-series, and difference-in-differences analysis, (2) demonstrate key ways in which the requirements and assumptions underlying these designs are often violated in the context of COVID-19, and (3) provide decision-makers and reviewers a conceptual and graphical guide to identifying these key violations. The overall goal of this paper is to help epidemiologists, policy-makers, journal editors, journalists, researchers, and other research consumers understand and weigh the strengths and limitations of evidence.

    View details for DOI 10.1093/aje/kwab185

    View details for PubMedID 34180960

  • Concordance between fasting plasma glucose and HbA1c in the diagnosis of diabetes in black South African adults: a cross-sectional study. BMJ open Wade, A. N., Crowther, N. J., Abrahams-Gessel, S., Berkman, L., George, J. A., Gomez-Olive, F. X., Manne-Goehler, J., Salomon, J. A., Wagner, R. G., Gaziano, T. A., Tollman, S. M., Cappola, A. R. 2021; 11 (6): e046060

    Abstract

    OBJECTIVES: We investigated concordance between haemoglobin A1c (HbA1c)-defined diabetes and fasting plasma glucose (FPG)-defined diabetes in a black South African population with a high prevalence of obesity.DESIGN: Cross-sectional study.SETTING: Rural South African population-based cohort.PARTICIPANTS: 765 black individuals aged 40-70 years and with no history of diabetes.PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was concordance between HbA1c-defined diabetes and FPG-defined diabetes. Secondary outcome measures were differences in anthropometric characteristics, fat distribution and insulin resistance (measured using Homoeostatic Model Assessment of Insulin Resistance (HOMA-IR)) between those with concordant and discordant HbA1c/FPG classifications and predictors of HbA1c variance.RESULTS: The prevalence of HbA1c-defined diabetes was four times the prevalence of FPG-defined diabetes (17.5% vs 4.2%). Classification was discordant in 15.7% of participants, with 111 individuals (14.5%) having HbA1c-only diabetes (kappa 0.23; 95% CI 0.14 to 0.31). Median body mass index, waist and hip circumference, waist-to-hip ratio, subcutaneous adipose tissue and HOMA-IR in participants with HbA1c-only diabetes were similar to those in participants who were normoglycaemic by both biomarkers and significantly lower than in participants with diabetes by both biomarkers (p<0.05). HOMA-IR and fat distribution explained additional HbA1c variance beyond glucose and age only in women.CONCLUSIONS: Concordance was poor between HbA1c and FPG in diagnosis of diabetes in black South Africans, and participants with HbA1c-only diabetes phenotypically resembled normoglycaemic participants. Further work is necessary to determine which of these parameters better predicts diabetes-related morbidities in this population and whether a population-specific HbA1c threshold is necessary.

    View details for DOI 10.1136/bmjopen-2020-046060

    View details for PubMedID 34140342

  • Developing and evaluating a frailty index for older South Africans-findings from the HAALSI study. Age and ageing Barker, F. J., Davies, J. I., Gomez-Olive, F. X., Kahn, K., Matthews, F. E., Payne, C. F., Salomon, J. A., Tollman, S. M., Wade, A. N., Walker, R. W., Witham, M. D. 2021

    Abstract

    BACKGROUND: despite rapid population ageing, few studies have investigated frailty in older people in sub-Saharan Africa. We tested a cumulative deficit frailty index in a population of older people from rural South Africa.METHODS: analysis of cross-sectional data from the Health and Ageing in Africa: Longitudinal Studies of an INDEPTH Community (HAALSI) study. We used self-reported diagnoses, symptoms, activities of daily living, objective physiological indices and blood tests to calculate a 32-variable cumulative deficit frailty index. We fitted Cox proportional hazards models to test associations between frailty category and all-cause mortality. We tested the discriminant ability of the frailty index to predict one-year mortality alone and in addition to age and sex.RESULTS: in total 3,989 participants were included in the analysis, mean age 61years (standard deviation 13); 2,175 (54.5%) were women. The median frailty index was 0.13 (interquartile range 0.09-0.19); Using population-specific cutoffs, 557 (14.0%) had moderate frailty and 263 (6.6%) had severe frailty. All-cause mortality risk was related to frailty severity independent of age and sex (hazard ratio per 0.01 increase in frailty index: 1.06 [95% confidence interval 1.04-1.07]). The frailty index alone showed moderate discrimination for one-year mortality: c-statistic 0.68-0.76; combining the frailty index with age and sex improved performance (c-statistic 0.77-0.81).CONCLUSION: frailty measured by cumulative deficits is common and predicts mortality in a rural population of older South Africans. The number of measures needed may limit utility in resource-poor settings.

    View details for DOI 10.1093/ageing/afab111

    View details for PubMedID 34107011

  • Cost-effectiveness of Dapagliflozin for Treatment of Patients With Heart Failure With Reduced Ejection Fraction. JAMA cardiology Parizo, J. T., Goldhaber-Fiebert, J. D., Salomon, J. A., Khush, K. K., Spertus, J. A., Heidenreich, P. A., Sandhu, A. T. 2021

    Abstract

    Importance: In the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial, dapagliflozin was shown to reduce cardiovascular mortality and hospitalizations due to heart failure while improving patient-reported health status. However, the cost-effectiveness of adding dapagliflozin therapy to standard of care (SOC) is unknown.Objective: To estimate the cost-effectiveness of dapagliflozin therapy among patients with chronic heart failure with reduced ejection fraction (HFrEF).Design, Setting, and Participants: This Markov cohort cost-effectiveness model used estimates of therapy effectiveness, transition probabilities, and utilities from the DAPA-HF trial and other published literature. Costs were derived from published sources. Patients with HFrEF included subgroups based on diabetes status and health status impairment due to heart failure. We compiled parameters from the literature including DAPA-HF, on which our model is based, and many other sources from December 2019 to February 27, 2021. We performed our analysis in February 2021.Exposures: Dapagliflozin or SOC.Main Outcomes and Measures: Hospitalizations for heart failure, life-years, quality-adjusted life-years (QALYs), costs, and the cost per QALY gained (incremental cost-effectiveness ratio).Results: In the model, dapagliflozin therapy yielded a mean of 0.78 additional life-years and 0.46 additional QALYs compared with SOC at an incremental cost of $38 212, resulting in a cost per QALY gained of $83 650. The cost per QALY was similar for patients with or without diabetes and for patients with mild or moderate impairment of health status due to heart failure. The cost-effectiveness was most sensitive to estimates of the effect on mortality and duration of therapy effectiveness. If the cost of dapagliflozin decreased from $474 to $270 (43% decline), the cost per QALY gained would drop below $50 000.Conclusions and Relevance: These findings suggest that dapagliflozin provides intermediate value compared with SOC, based on American College of Cardiology/American Heart Association benchmarks. Additional data regarding the magnitude of mortality reduction would improve the precision of cost-effectiveness estimates.

    View details for DOI 10.1001/jamacardio.2021.1437

    View details for PubMedID 34037681

  • Impact of Treatment Duration on Mortality Among Veterans with Opioid Use Disorder in the United States Veterans Health Administration. Addiction (Abingdon, England) Ching, J. H., Owens, D. K., Trafton, J. A., Goldhaber-Fiebert, J. D., Salomon, J. A. 2021

    Abstract

    BACKGROUND AND AIMS: While long-term medication-assisted treatment (MAT) using methadone or buprenorphine is associated with significantly lower all-cause mortality for individuals with opioid use disorder (OUD), periods of initiating or discontinuing treatment are associated with higher mortality risks relative to stable treatment. This study aimed to identify the OUD treatment durations necessary for the elevated mortality risks during treatment transitions to be balanced by reductions in mortality while receiving treatment.DESIGN: Simulation model based on a compartmental model of OUD diagnosis, MAT receipt, and all-cause mortality among Veterans with OUD in the United States Veteran Health Administration (VA) in 2017-2018. We simulated methadone and buprenorphine treatments of varying durations using parameters obtained through calibration and published meta-analyses of studies from North America, Europe, and Australia.SETTING: USA PARTICIPANTS: Simulated cohorts of 10,000 individuals with OUD MEASUREMENTS: All-cause mortality over 12 months FINDINGS: Receiving methadone for 4 months or longer or buprenorphine for 2 months or longer resulted in 54 (95% CI: 5-90) and 65 (95% CI: 21-89) fewer deaths relative to not receiving MAT for the same duration, using VA-specific mortality rates. We estimated shorter treatment durations necessary to achieve net mortality benefits of 2 months or longer for methadone and 1 month or longer for buprenorphine, using non-VA population literature estimates. Sensitivity analyses demonstrated that necessary treatment durations increased more with smaller mortality reductions on treatment than with larger relative risks during treatment transitions.CONCLUSIONS: Short periods (<6 months) of treatment with either methadone or buprenorphine are likely to yield net mortality benefits for people with opioid use disorder relative to receiving no medications, despite periods of elevated all-cause mortality risk during transitions into and out of treatment. Retaining people with opioid use disorder in treatment longer can increase these benefits.

    View details for DOI 10.1111/add.15574

    View details for PubMedID 33999485

  • Modeling the Cost-Effectiveness of Express Multi-Site Gonorrhea Screening among Men Who Have Sex with Men in the United States. Sexually transmitted diseases Earnest, R., Ronn, M. M., Bellerose, M., Menon-Johansson, A. S., Berruti, A. A., Chesson, H. W., Gift, T. L., Hsu, K. K., Testa, C., Zhu, L., Malyuta, Y., Menzies, N. A., Salomon, J. A. 2021

    Abstract

    BACKGROUND: Men who have sex with men (MSM) experience high rates of gonococcal infection at extragenital (rectal and pharyngeal) anatomic sites, which often are missed without asymptomatic screening and may be important for onward transmission. Implementing an express pathway for asymptomatic MSM seeking routine screening at their clinic may be a cost-effective way to improve extragenital screening by allowing patients to be screened at more anatomic sites through a streamlined, less costly process.METHODS: We modified an agent-based model of anatomic site-specific gonococcal infection in U.S. MSM to assess the cost-effectiveness of an express screening pathway in which all asymptomatic MSM presenting at their clinic were screened at the urogenital, rectal, and pharyngeal sites but forewent a provider consultation and physical exam and self-collected their own samples. We calculated the cumulative health effects expressed as gonococcal infections and cases averted over five years, labor and material costs, and incremental cost effectiveness ratios (ICER) for express versus traditional scenarios.RESULTS: The express scenario averted more infections and cases in each intervention year. The increased diagnostic costs of triple-site screening were largely offset by the lowered visit costs of the express pathway and, from the end of year 3 onward, this pathway generated small cost savings. However, in a sensitivity analysis of assumed overhead costs, cost savings under the express scenario disappeared in the majority of simulations once overhead costs exceeded 7% of total annual costs.CONCLUSIONS: Express screening may be a cost-effective option for improving multi-site anatomic screening among U.S. MSM.

    View details for DOI 10.1097/OLQ.0000000000001467

    View details for PubMedID 33993161

  • Cost-Effectiveness of One-Time Universal Screening for Chronic Hepatitis B Infection in Adults in the United States. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Toy, M., Hutton, D., Harris, A. M., Nelson, N., Salomon, J. A., So, S. 2021

    Abstract

    BACKGROUND: An estimated 862,000 to 2.4 million people have chronic hepatitis B infection (CHB). Left undiagnosed and untreated CHB increases risk of death from liver cirrhosis or liver cancer. Hepatitis B screening is recommended for pregnant women and populations with increased CHB risk, but diagnosis rates remain low with only 33% of people with CHB aware of their infection.. This study aimed to assess the cost-effectiveness of universal adult screening for CHB.METHODS: We used a Markov model to calculate the costs, population health impact and cost-effectiveness of one-time universal screening and CHB monitoring and treatment compared to current practice. Sensitivity analysis was performed on model parameters to identify thresholds for cost-savings or cost-effectiveness based on willinness-to-pay of $50,000/QALY . The analysis assumed testing would be performed during routine healthcare visits, and generic tenofovir or entecavir would be dispensed for treatment. Testing costs were based on Medicare reimbursement rates.RESULTS: At an estimated 0.24% prevalence of undiagnosed CHB, universal HBsAg screening in adults 18-69 years old is cost-saving compared with current practice if antiviral treatment drug costs remain below $894 per year. Compared with current practice, universal screening would avert an additional 7.4 cases of compensated cirrhosis, 3.3 cases of decompensated cirrhosis, 5.5 cases of hepatocellular carcinoma, 1.9 liver transplants, and 10.3 HBV related deaths at a savings of $263,000 per 100,000 adults screened.CONCLUSION: Universal HBsAg screening of adults in the US general population for CHB is cost-effective and likely cost-saving compared to current CHB screening recommendations.

    View details for DOI 10.1093/cid/ciab405

    View details for PubMedID 33956937

  • MODELING INTERVENTIONS TO EXPAND MEDICATION-ASSISTED TREATMENT AMONG VETERANS WITH OPIOID USE DISORDER IN THE VETERANS HEALTH ADMINISTRATION Ching, J. H., Trafton, J. A., Owens, D. K., Salomon, J. A., Goldhaber-Fiebert, J. D. SAGE PUBLICATIONS INC. 2021: E189-E190
  • ADAPTIVE POLICIES FOR USE OF PHYSICAL DISTANCING INTERVENTIONS DURING THE COVID-19 PANDEMIC Yaesoubi, R., Havumaki, J., Chitwood, M., Menzies, N. A., Gonsalves, G., Salomon, J. A., Paltiel, A., Cohen, T. SAGE PUBLICATIONS INC. 2021: E332-E333
  • SPATIALLY ADAPTIVE GUIDELINES FOR THE TREATMENT OF GONORRHEA TO INCREASE THE EFFECTIVE LIFESPAN OF ANTIBIOTICS: A MATHEMATICAL MODELING STUDY Yaesoubi, R., Cohen, T., Gift, T., St Cyr, S., Salomon, J. A., Grad, Y. SAGE PUBLICATIONS INC. 2021: E214-E216
  • How do Japanese rate the severity of different diseases and injuries?-an assessment of disability weights for 231 health states by 37,318 Japanese respondents. Population health metrics Nomura, S., Yamamoto, Y., Yoneoka, D., Haagsma, J. A., Salomon, J. A., Ueda, P., Mori, R., Santomauro, D., Vos, T., Shibuya, K. 2021; 19 (1): 21

    Abstract

    BACKGROUND: Disability weights (DWs) are weight factors that reflect the severity of health states for estimates of disability-adjusted life years. A new set of global DWs was published for the Global Burden of Diseases and Injuries (GBD) 2013 study, which relied on sampling from various world regions, but included little data for countries in East Asia. This study aimed to measure DWs in Japan using comparable methods, and compare the results with previous estimates from the GBD 2013 DW study.METHODS: We conducted a web-based survey in 2019 to estimate DWs for 231 health states for the Japanese population. The survey included five new health states but otherwise followed the method of the GBD DW measurement study. The survey consisted of 15 paired comparison (PC) questions and 3 population health equivalence questions (PHE) per respondent. We analyzed PC data using probit regression and rescaled results to DW units between 0 (equivalent to full health) and 1 (equivalent to death).FINDINGS: We considered 37,318 nationally representative respondents. The values of the resulting DWs ranged from 0.707 (95% uncertainty interval (UI) 0.527-0.842) for spinal cord injury at neck level (untreated) to 0.004 (UI 0.001-0.009) for mild anemia. High correlation between Japanese DW and GBD 2013 DW was observed, but there was considerable disagreement. Out of 226 comparable health states, 55 (24.3%) showed more than a factor-of-two difference, of which 41 (74.6%) had a higher value in Japanese DW. Many of the health states with higher DW in the Japan study were injuries, including amputation and fracture, and hearing and vision loss, while mental, behavioral, and substance use disorders generally tended to be lower.CONCLUSIONS: This study has created an empirical basis for assessment of Japanese DWs of health status. The findings from this study based on the Japanese population suggest that there might be contextual differences in rating the severity of health states compared to previous surveys conducted elsewhere.

    View details for DOI 10.1186/s12963-021-00253-4

    View details for PubMedID 33892742

  • Better Late Than Never: Trends in COVID-19 Infection Rates, Risk Perceptions, and Behavioral Responses in the USA. Journal of general internal medicine Bilinski, A., Emanuel, E., Salomon, J. A., Venkataramani, A. 2021

    View details for DOI 10.1007/s11606-021-06633-8

    View details for PubMedID 33782884

  • Patterns of heavy drinking behaviour over age and birth cohorts among Chinese men: a Markov model. BMJ open Lee, K., Salomon, J., Goldhaber-Fiebert, J. 2021; 11 (3): e043261

    Abstract

    OBJECTIVES: To estimate the age patterns and cohort trends in heavy drinking among Chinese men from 1993 to 2011 and to project the future burden of heavy drinking through 2027.DESIGN: We constructed a Markov cohort model that simulates age-specific heavy drinking behaviours for a series of cohorts of Chinese men born between 1922 and 1993 and fitted the model to longitudinal data on drinking patterns (1993-2015). We projected male prevalence of heavy drinking from 2015 through 2027 with and without modification of heavy drinking behaviours.PARTICIPANTS: A cohort of Chinese men who were born between 1922 and 1993.MAIN OUTCOME MEASURES: Outcomes included age-specific and birth cohort-specific rates of initiating, quitting and reinitiating heavy drinking from 1993 through 2011, projected prevalence of heavy drinking from 2015 to 2027, and total reduction in prevalence and total averted deaths with hypothetical elimination of heavy drinking behaviours.RESULTS: Across multiple birth cohorts, middle-aged Chinese men have consistently higher risks of starting and resuming heavy drinking and lower probabilities of quitting their current heavy drinking than men in other age groups. From 1993 to 2011, the risk of starting or resuming heavy drinking continued to decrease over generations. Our model projected that the prevalence of heavy drinking among Chinese men will decrease by 33% (95% CI 11.5% to 54.6%) between 2015 and the end of 2027. Complete elimination of or acceptance of a change in heavy drinking behaviours among Chinese men could accelerate this decrease by 12percentage points (95%CI 7.8 to 18.2) and avert 377000 deaths (95%CI 228000 to 577000) in total from 2015 to 2027.CONCLUSION: Heavy drinking prevalence will continue to decrease through 2027 if current age-specific and birth cohort-specific patterns of starting, quitting and resuming heavy drinking continue. Effective mitigation policy should consider age-specific patterns in heavy drinking behaviours to further reduce the burden of heavy drinking.

    View details for DOI 10.1136/bmjopen-2020-043261

    View details for PubMedID 33653752

  • The Use and Misuse of Mathematical Modeling for Infectious Disease Policymaking: Lessons for the COVID-19 Pandemic. Medical decision making : an international journal of the Society for Medical Decision Making James, L. P., Salomon, J. A., Buckee, C. O., Menzies, N. A. 2021: 272989X21990391

    Abstract

    Mathematical modeling has played a prominent and necessary role in the current coronavirus disease 2019 (COVID-19) pandemic, with an increasing number of models being developed to track and project the spread of the disease, as well as major decisions being made based on the results of these studies. A proliferation of models, often diverging widely in their projections, has been accompanied by criticism of the validity of modeled analyses and uncertainty as to when and to what extent results can be trusted. Drawing on examples from COVID-19 and other infectious diseases of global importance, we review key limitations of mathematical modeling as a tool for interpreting empirical data and informing individual and public decision making. We present several approaches that have been used to strengthen the validity of inferences drawn from these analyses, approaches that will enable better decision making in the current COVID-19 crisis and beyond.

    View details for DOI 10.1177/0272989X21990391

    View details for PubMedID 33535889

  • Adaptive Policies to Balance Health Benefits and Economic Costs of Physical Distancing Interventions during the COVID-19 Pandemic. Medical decision making : an international journal of the Society for Medical Decision Making Yaesoubi, R., Havumaki, J., Chitwood, M. H., Menzies, N. A., Gonsalves, G., Salomon, J. A., Paltiel, A. D., Cohen, T. 2021: 272989X21990371

    Abstract

    Policy makers need decision tools to determine when to use physical distancing interventions to maximize the control of COVID-19 while minimizing the economic and social costs of these interventions. We describe a pragmatic decision tool to characterize adaptive policies that combine real-time surveillance data with clear decision rules to guide when to trigger, continue, or stop physical distancing interventions during the current pandemic. In model-based experiments, we find that adaptive policies characterized by our proposed approach prevent more deaths and require a shorter overall duration of physical distancing than alternative physical distancing policies. Our proposed approach can readily be extended to more complex models and interventions.

    View details for DOI 10.1177/0272989X21990371

    View details for PubMedID 33504258

  • Time Since Infection and Risks of Future Disease for Individuals with Mycobacterium tuberculosis Infection in the United States. Epidemiology (Cambridge, Mass.) Menzies, N. A., Swartwood, N., Testa, C., Malyuta, Y., Hill, A. N., Marks, S. M., Cohen, T., Salomon, J. A. 2021; 32 (1): 70–78

    Abstract

    BACKGROUND: Risk of tuberculosis (TB) declines over time since Mycobacterium tuberculosis infection, but progression to clinical disease is still possible decades later. In the United States, most TB cases result from the progression of latent TB infection acquired over 2 years ago.METHODS: We synthesized evidence on TB natural history and incidence trends using a transmission-dynamic model. For the 2020 US population, we estimated average time since infection and annual, cumulative, and remaining lifetime risks of progression to TB, by nativity and age.RESULTS: For a newly infected adult with no other risk factors for progression to TB, estimated rates of progression declined from 38 (95% uncertainty interval: 33, 46) to 0.38 (0.32, 0.45) per 1000 person-years between the first and 25th year since infection. Cumulative risk over 25 years from new infection was 7.9% (7.0, 8.9). In 2020, an estimated average age of individuals with prevalent infection was 62 (61, 63) for the US-born population, 55 (54, 55) for non-US-born, and 57 (56, 58) overall. Average risks of developing TB over the remaining lifetime were 1.2% (1.0, 1.4) for US-born, 2.2% (1.8, 2.6) for non-US-born, and 1.9% (1.6, 2.2) for the general population. Risk estimates were higher for younger age groups.CONCLUSIONS: Our analysis suggests that, although newly infected individuals face appreciable lifetime TB risks, most US individuals with latent TB infection were infected long ago, and face low future risks of developing TB. Better approaches are needed for identifying recently infected individuals and those with elevated progression risks.

    View details for DOI 10.1097/EDE.0000000000001271

    View details for PubMedID 33009253

  • Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae. The Lancet. Global health Menzies, N. A., Quaife, M., Allwood, B. W., Byrne, A. L., Coussens, A. K., Harries, A. D., Marx, F. M., Meghji, J., Pedrazzoli, D., Salomon, J. A., Sweeney, S., van Kampen, S. C., Wallis, R. S., Houben, R. M., Cohen, T. 2021; 9 (12): e1679-e1687

    Abstract

    Many individuals who survive tuberculosis disease face ongoing disability and elevated mortality risks. However, the impact of post-tuberculosis sequelae is generally omitted from policy analyses and disease burden estimates. We therefore estimated the global burden of tuberculosis, inclusive of post-tuberculosis morbidity and mortality.We constructed a hypothetical cohort of individuals developing tuberculosis in 2019, including pulmonary and extrapulmonary disease. We simulated lifetime health outcomes for this cohort, stratified by country, age, sex, HIV status, and treatment status. We used disability-adjusted life-years (DALYs) to summarise fatal and non-fatal health losses attributable to tuberculosis, during the disease episode and afterwards. We estimated post-tuberculosis mortality and morbidity based on the decreased lung function caused by pulmonary tuberculosis disease.Globally, we estimated 122 (95% uncertainty interval [UI] 98-151) million DALYs due to incident tuberculosis disease in 2019, with 58 (38-83) million DALYs attributed to post-tuberculosis sequelae, representing 47% (95% UI 37-57) of the total burden estimate. The increase in burden from post-tuberculosis varied substantially across countries and regions, driven largely by differences in estimated case fatality for the disease episode. We estimated 12·1 DALYs (95% UI 10·0-14·9) per incident tuberculosis case, of which 6·3 DALYs (5·6-7·0) were from the disease episode and 5·8 DALYs (3·8-8·3) were from post-tuberculosis. Per-case post-tuberculosis burden estimates were greater for younger individuals, and in countries with high incidence rates. The burden of post-tuberculosis was spread over the remaining lifetime of tuberculosis survivors, with almost a third of total DALYs (28%, 95% UI 23-34) accruing 15 or more years after incident tuberculosis.Post-tuberculosis sequelae add substantially to the overall disease burden caused by tuberculosis. This hitherto unquantified burden has been omitted from most previous policy analyses. Future policy analyses and burden estimates should take better account of post-tuberculosis, to avoid the potential misallocation of funding, political attention, and research effort resulting from continued neglect of this issue.National Institutes of Health.

    View details for DOI 10.1016/S2214-109X(21)00367-3

    View details for PubMedID 34798027

  • Passing the Test: A Model-Based Analysis of Safe School-Reopening Strategies. Annals of internal medicine Bilinski, A., Salomon, J. A., Giardina, J., Ciaranello, A., Fitzpatrick, M. C. 2021

    Abstract

    The COVID-19 pandemic has induced historic educational disruptions. In April 2021, about 40% of U.S. public school students were not offered full-time in-person education.To assess the risk for SARS-CoV-2 transmission in schools.An agent-based network model was developed to simulate transmission in elementary and high school communities, including home, school, and interhousehold interactions.School structure was parametrized to reflect average U.S. classrooms, with elementary schools of 638 students and high schools of 1451 students. Daily local incidence was varied from 1 to 100 cases per 100 000 persons.Students, faculty, staff, and adult household members.Isolation of symptomatic individuals, quarantine of an infected individual's contacts, reduced class sizes, alternative schedules, staff vaccination, and weekly asymptomatic screening.Transmission was projected among students, staff, and families after a single infection in school and over an 8-week quarter, contingent on local incidence.School transmission varies according to student age and local incidence and is substantially reduced with mitigation measures. Nevertheless, when transmission occurs, it may be difficult to detect without regular testing because of the subclinical nature of most children's infections. Teacher vaccination can reduce transmission to staff, and asymptomatic screening improves understanding of local circumstances and reduces transmission.Uncertainty exists about the susceptibility and infectiousness of children, and precision is low regarding the effectiveness of specific countermeasures, particularly with new variants.With controlled community transmission and moderate mitigation, elementary schools can open safety, but high schools require more intensive mitigation. Asymptomatic screening can facilitate reopening at higher local incidence while minimizing transmission risk.Centers for Disease Control and Prevention through the Council of State and Territorial Epidemiologists, National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, and Facebook.

    View details for DOI 10.7326/M21-0600

    View details for PubMedID 34097433

  • Passing the Test: A model-based analysis of safe school-reopening strategies. medRxiv : the preprint server for health sciences Bilinski, A., Salomon, J. A., Giardina, J., Ciaranello, A., Fitzpatrick, M. C. 2021

    Abstract

    The COVID-19 pandemic has induced historic educational disruptions. In December 2020, at least two-thirds of US public school students were not attending full-time in-person education. The Biden Administration has expressed that reopening schools is a priority.To compare risks of SARS-COV-2 transmission in schools across different school-based prevention strategies and levels of community transmission.We developed an agent-based network model to simulate transmission in elementary and high school communities, including home, school, and inter-household interactions.We parameterized school structure based on average US classrooms, with elementary schools of 638 students and high schools of 1,451 students. We varied daily community incidence from 1 to 100 cases per 100,000 population. Patients (or Participants). We simulated students, faculty/staff, and adult household members.We evaluated isolation of symptomatic individuals, quarantine of an infected individual's contacts, reduced class sizes, alternative schedules, staff vaccination, and weekly asymptomatic screening.We projected transmission among students, staff and families during one month following introduction of a single infection into a school. We also calculated the number of infections expected for a typical 8-week quarter, contingent on community incidence rate.School transmission risk varies according to student age and community incidence and is substantially reduced with effective, consistent mitigation measures. Nevertheless, when transmission occurs, it may be difficult to detect without regular, frequent testing due to the subclinical nature of most infections in children. Teacher vaccination can reduce transmission to staff, while asymptomatic screening both improves understanding of local circumstances and reduces transmission, facilitating five-day schedules at full classroom capacity.There is uncertainty about susceptibility and infectiousness of children and low precision regarding the effectiveness of specific prevention measures, particularly with emergence of new variants.With controlled community transmission and moderate school-based prevention measures, elementary schools can open with few in-school transmissions, while high schools require more intensive mitigation. Asymptomatic screening can both reduce transmission and provide useful information for decision-makers.

    View details for DOI 10.1101/2021.01.27.21250388

    View details for PubMedID 33532804

    View details for PubMedCentralID PMC7852255

  • Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies. The Lancet. Public health Ryckman, T., Chin, E. T., Prince, L., Leidner, D., Long, E., Studdert, D. M., Salomon, J. A., Alarid-Escudero, F., Andrews, J. R., Goldhaber-Fiebert, J. D. 2021

    Abstract

    Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to assess the risks and harms of COVID-19 outbreaks in prisons under a range of policies, including resumption of activities.We obtained daily resident-level data for all California state prisons from Jan 1, 2020, to May 15, 2021, describing prison layouts, housing status, sociodemographic and health characteristics, participation in activities, and COVID-19 testing, infection, and vaccination status. We developed a transmission-dynamic stochastic microsimulation parameterised by the California data and published literature. After an initial infection is introduced to a prison, the model evaluates the effect of various policy scenarios on infections and hospitalisations over 200 days. Scenarios vary by vaccine coverage, baseline immunity (0%, 25%, or 50%), resumption of activities, and use of non-pharmaceutical interventions (NPIs) that reduce transmission by 75%. We simulated five prison types that differ by residential layout and demographics, and estimated outcomes with and without repeated infection introductions over the 200 days.If a viral variant is introduced into a prison that has resumed pre-2020 contact levels, has moderate vaccine coverage (ranging from 36% to 76% among residents, dependent on age, with 40% coverage for staff), and has no baseline immunity, 23-74% of residents are expected to be infected over 200 days. High vaccination coverage (90%) coupled with NPIs reduces cumulative infections to 2-54%. Even in prisons with low room occupancies (ie, no more than two occupants) and low levels of cumulative infections (ie, <10%), hospitalisation risks are substantial when these prisons house medically vulnerable populations. Risks of large outbreaks (>20% of residents infected) are substantially higher if infections are repeatedly introduced.Balancing benefits of resuming activities against risks of outbreaks presents challenging trade-offs. After achieving high vaccine coverage, prisons with mostly one-to-two-person cells that have higher baseline immunity from previous outbreaks can resume in-person activities with low risk of a widespread new outbreak, provided they maintain widespread NPIs, continue testing, and take measures to protect the medically vulnerable.Horowitz Family Foundation, National Institute on Drug Abuse, Centers for Disease Control and Prevention, National Science Foundation, Open Society Foundation, Advanced Micro Devices.

    View details for DOI 10.1016/S2468-2667(21)00162-6

    View details for PubMedID 34364404

  • Health Disparities And COVID-19: The Authors Reply. Health affairs (Project Hope) Goldhaber-Fiebert, J. D., Salomon, J. A., Vargo, J. 2021; 40 (9): 1514

    View details for DOI 10.1377/hlthaff.2021.01203

    View details for PubMedID 34495717

  • COVID-19 in the California State Prison System: an Observational Study of Decarceration, Ongoing Risks, and Risk Factors. Journal of general internal medicine Chin, E. T., Ryckman, T., Prince, L., Leidner, D., Alarid-Escudero, F., Andrews, J. R., Salomon, J. A., Studdert, D. M., Goldhaber-Fiebert, J. D. 2021

    Abstract

    Correctional institutions nationwide are seeking to mitigate COVID-19-related risks.To quantify changes to California's prison population since the pandemic began and identify risk factors for COVID-19 infection.For California state prisons (March 1-October 10, 2020), we described residents' demographic characteristics, health status, COVID-19 risk scores, room occupancy, and labor participation. We used Cox proportional hazard models to estimate the association between rates of COVID-19 infection and room occupancy and out-of-room labor, respectively.Residents of California state prisons.Changes in the incarcerated population's size, composition, housing, and activities. For the risk factor analysis, the exposure variables were room type (cells vs. dormitories) and labor participation (any room occupant participating in the prior 2 weeks) and the outcome variable was incident COVID-19 case rates.The incarcerated population decreased 19.1% (119,401 to 96,623) during the study period. On October 10, 2020, 11.5% of residents were aged ≥60, 18.3% had high COVID-19 risk scores, 31.0% participated in out-of-room labor, and 14.8% lived in rooms with ≥10 occupants. Nearly 40% of residents with high COVID-19 risk scores lived in dormitories. In 9 prisons with major outbreaks (6,928 rooms; 21,750 residents), dormitory residents had higher infection rates than cell residents (adjusted hazard ratio [AHR], 2.51 95% CI, 2.25-2.80) and residents of rooms with labor participation had higher rates than residents of other rooms (AHR, 1.56; 95% CI, 1.39-1.74).Despite reductions in room occupancy and mixing, California prisons still house many medically vulnerable residents in risky settings. Reducing risks further requires a combination of strategies, including rehousing, decarceration, and vaccination.

    View details for DOI 10.1007/s11606-021-07022-x

    View details for PubMedID 34291377

  • The health and economic benefits of tests that predict future progression to tuberculosis disease. Epidemiology (Cambridge, Mass.) Menzies, N. A., Shrestha, S., Parriott, A., Marks, S. M., Hill, A. N., Dowdy, D. W., Shete, P. B., Cohen, T., Salomon, J. A. 2021

    Abstract

    Effective targeting of latent tuberculosis infection (LTBI) treatment requires identifying those most likely to progress to tuberculosis (TB). We estimated the potential health and economic benefits of diagnostics with improved discrimination for LTBI that will progress to TB.A base-case scenario represented current LTBI testing and treatment services in the United States in 2020, with diagnosis via interferon-gamma release assay (IGRA). Alternative scenarios represented tests with higher positive predictive value (PPV) for future TB but similar price to IGRA, and scenarios that additionally assumed higher treatment initiation and completion. We predicted outcomes using multiple transmission-dynamic models calibrated to different geographic areas, and estimated costs from a societal perspective.In 2020, 2.1% (range across model results: 1.1%-3.4%) of individuals with LTBI were predicted to develop TB in their remaining lifetime. For IGRA, we estimated the PPV for future TB as 1.3% (0.6%-1.8%). Relative to IGRA, we estimated a test with 10% PPV would reduce treatment volume by 87% (82%-94%), reduce incremental costs by 30% (15%-52%), and increase quality-adjusted life years by 3% (2%-6%). Cost reductions and health improvements were substantially larger for scenarios in which higher PPV for future TB was associated with greater initiation and completion of treatment.We estimated that tests with better predictive performance would substantially reduce the number of individuals treated to prevent TB, but would have a modest impact on incremental costs and health impact of TB prevention services, unless accompanied by greater treatment acceptance and completion.

    View details for DOI 10.1097/EDE.0000000000001418

    View details for PubMedID 34669631

  • Effectiveness of the mRNA-1273 Vaccine during a SARS-CoV-2 Delta Outbreak in a Prison. The New England journal of medicine Chin, E. T., Leidner, D., Zhang, Y., Long, E., Prince, L., Li, Y., Andrews, J. R., Studdert, D. M., Goldhaber-Fiebert, J. D., Salomon, J. A. 2021

    View details for DOI 10.1056/NEJMc2114089

    View details for PubMedID 34670040

  • Dependence of COVID-19 Policies on End-of-Year Holiday Contacts in Mexico City Metropolitan Area: A Modeling Study. MDM policy & practice Alarid-Escudero, F., Gracia, V., Luviano, A., Roa, J., Peralta, Y., Reitsma, M. B., Claypool, A. L., Salomon, J. A., Studdert, D. M., Andrews, J. R., Goldhaber-Fiebert, J. D. 2021; 6 (2): 23814683211049249

    Abstract

    Background. Mexico City Metropolitan Area (MCMA) has the largest number of COVID-19 (coronavirus disease 2019) cases in Mexico and is at risk of exceeding its hospital capacity in early 2021. Methods. We used the Stanford-CIDE Coronavirus Simulation Model (SC-COSMO), a dynamic transmission model of COVID-19, to evaluate the effect of policies considering increased contacts during the end-of-year holidays, intensification of physical distancing, and school reopening on projected confirmed cases and deaths, hospital demand, and hospital capacity exceedance. Model parameters were derived from primary data, literature, and calibrated. Results. Following high levels of holiday contacts even with no in-person schooling, MCMA will have 0.9 million (95% prediction interval 0.3-1.6) additional COVID-19 cases between December 7, 2020, and March 7, 2021, and hospitalizations will peak at 26,000 (8,300-54,500) on January 25, 2021, with a 97% chance of exceeding COVID-19-specific capacity (9,667 beds). If MCMA were to control holiday contacts, the city could reopen in-person schools, provided they increase physical distancing with 0.5 million (0.2-0.9) additional cases and hospitalizations peaking at 12,000 (3,700-27,000) on January 19, 2021 (60% chance of exceedance). Conclusion. MCMA must increase COVID-19 hospital capacity under all scenarios considered. MCMA's ability to reopen schools in early 2021 depends on sustaining physical distancing and on controlling contacts during the end-of-year holiday.

    View details for DOI 10.1177/23814683211049249

    View details for PubMedID 34660906

    View details for PubMedCentralID PMC8512280

  • Covid-19 Vaccine Acceptance in California State Prisons. The New England journal of medicine Chin, E. T., Leidner, D. n., Ryckman, T. n., Liu, Y. E., Prince, L. n., Alarid-Escudero, F. n., Andrews, J. R., Salomon, J. A., Goldhaber-Fiebert, J. D., Studdert, D. M. 2021

    View details for DOI 10.1056/NEJMc2105282

    View details for PubMedID 33979505

  • Racial/Ethnic Disparities In COVID-19 Exposure Risk, Testing, And Cases At The Subcounty Level In California. Health affairs (Project Hope) Reitsma, M. B., Claypool, A. L., Vargo, J. n., Shete, P. B., McCorvie, R. n., Wheeler, W. H., Rocha, D. A., Myers, J. F., Murray, E. L., Bregman, B. n., Dominguez, D. M., Nguyen, A. D., Porse, C. n., Fritz, C. L., Jain, S. n., Watt, J. P., Salomon, J. A., Goldhaber-Fiebert, J. D. 2021: 101377hlthaff202100098

    Abstract

    With a population of forty million and substantial geographic variation in sociodemographics and health services, California is an important setting in which to study disparities. Its population (37.5 percent White, 39.1 percent Latino, 5.3 percent Black, and 14.4 percent Asian) experienced 59,258 COVID-19 deaths through April 14, 2021-the most of any state. We analyzed California's racial/ethnic disparities in COVID-19 exposure risks, testing rates, test positivity, and case rates through October 2020, combining data from 15.4 million SARS-CoV-2 tests with subcounty exposure risk estimates from the American Community Survey. We defined "high-exposure-risk" households as those with one or more essential workers and fewer rooms than inhabitants. Latino people in California are 8.1 times more likely to live in high-exposure-risk households than White people (23.6 percent versus 2.9 percent), are overrepresented in cumulative cases (3,784 versus 1,112 per 100,000 people), and are underrepresented in cumulative testing (35,635 versus 48,930 per 100,000 people). These risks and outcomes were worse for Latino people than for members of other racial/ethnic minority groups. Subcounty disparity analyses can inform targeting of interventions and resources, including community-based testing and vaccine access measures. Tracking COVID-19 disparities and developing equity-focused public health programming that mitigates the effects of systemic racism can help improve health outcomes among California's populations of color.

    View details for DOI 10.1377/hlthaff.2021.00098

    View details for PubMedID 33979192

  • Nationwide Cost-Effectiveness Analysis of Surgical Stabilization of Rib Fractures by Flail Chest Status and Age Groups Journal of Trauma and Acute Care Surgery Choi, J., Mulaney, B., Laohavinij, W., Trimble, R., Tennakoon, L., Spain, D. A., Salomon, J. A., Goldhaber-Fiebert, J. D., Forrester, J. D. 2021
  • Mapping Inequality in SARS-CoV-2 Household Exposure and Transmission Risk in the USA. Journal of general internal medicine Reitsma, M. B., Salomon, J. A., Goldhaber-Fiebert, J. D. 2021

    View details for DOI 10.1007/s11606-021-06603-0

    View details for PubMedID 33604818

    View details for PubMedCentralID PMC7891469

  • Alternative Dose Allocation Strategies to Increase Benefits From Constrained COVID-19 Vaccine Supply. Annals of internal medicine Tuite, A. R., Zhu, L. n., Fisman, D. N., Salomon, J. A. 2021

    View details for DOI 10.7326/M20-8137

    View details for PubMedID 33395334

  • Mapping routine measles vaccination in low- and middle-income countries NATURE Graetz, N., Woyczynski, L., Wilson, K. F., Hall, J. B., Abate, K., Abd-Allah, F., Adebayo, O. M., Adekanmbi, V., Afshari, M., Ajumobi, O., Akinyemiju, T., Alahdab, F., Al-Aly, Z., Alcalde Rabanal, J., Alijanzadeh, M., Alipour, V., Altirkawi, K., Amiresmaili, M., Anber, N., Andrei, C., Anjomshoa, M., Antonio, C. T., Arabloo, J., Aremu, O., Aryal, K. K., Asadi-Aliabadi, M., Atique, S., Ausloos, M., Awasthi, A., Ayala Quintanilla, B., Azari, S., Badawi, A., Banoub, J., Barker-Collo, S., Barnett, A., Bedi, N., Bennett, D. A., Bhattacharjee, N. V., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bijani, A., Bikbov, B., Britton, G., Burstein, R., Butt, Z. A., Cardenas, R., Carvalho, F., Castaneda-Orjuela, C. A., Castro, F., Cerin, E., Chang, J., Collison, M. L., Cooper, C., Cork, M. A., Daoud, F., Das Gupta, R., Weaver, N., De Neve, J., Deribe, K., Desalegn, B., Deshpande, A., Desta, M., Dhimal, M., Diaz, D., Dinberu, M., Djalalinia, S., Dubey, M., Dubljanin, E., Duraes, A. R., Dwyer-Lindgren, L., Earl, L., Kalan, M., El-Khatib, Z., Eshrati, B., Faramarzi, M., Fareed, M., Faro, A., Fereshtehnejad, S., Fernandes, E., Filip, I., Fischer, F., Fukumoto, T., Garcia, J. A., Gill, P., Gill, T. K., Gona, P. N., Gopalani, S., Grada, A., Guo, Y., Gupta, R., Gupta, V., Haj-Mirzaian, A., Haj-Mirzaian, A., Hamadeh, R. R., Hamidi, S., Hasan, M., Hassen, H., Hendrie, D., Henok, A., Henry, N. J., Hernandez Prado, B., Herteliu, C., Hole, M. K., Hossain, N., Hosseinzadeh, M., Hu, G., Ilesanmi, O., Irvani, S., Islam, S., Izadi, N., Jakovljevic, M., Jha, R., Ji, J. S., Jonas, J. B., Shushtari, Z., Jozwiak, J., Kanchan, T., Kasaeian, A., Karyani, A., Keiyoro, P., Kesavachandran, C., Khader, Y., Khafaie, M., Khan, E., Khater, M. M., Kiadaliri, A. A., Kiirithio, D. N., Kim, Y., Kimokoti, R. W., Kinyoki, D. K., Kisa, A., Kosen, S., Koyanagi, A., Krishan, K., Defo, B., Kumar, M., Kumar, P., Lami, F., Lee, P. H., Levine, A. J., Li, S., Liao, Y., Lim, L., Listl, S., Lopez, J. F., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Mansournia, M., Martins-Melo, F., Masaka, A., Massenburg, B., Mayala, B. K., Mehta, K. M., Mendoza, W., Mensah, G. A., Meretoja, T. J., Mestrovic, T., Miller, T. R., Mini, G. K., Mirrakhimov, E. M., Moazen, B., Mohammad, D. K., Darwesh, A., Mohammed, S., Mohebi, F., Mokdad, A. H., Monasta, L., Moodley, Y., Moosazadeh, M., Moradi, G., Moradi-Lakeh, M., Moraga, P., Morawska, L., Morrison, S., Mosser, J. F., Mousavi, S., Murray, C. L., Mustafa, G., Nahvijou, A., Najafi, F., Nangia, V., Ndwandwe, D., Negoi, I., Negoi, R., Ngunjiri, J. W., Cuong Tat Nguyen, Long Hoang Nguyen, Ningrum, D., Noubiap, J., Shiadeh, M., Nyasulu, P. S., Ogbo, F., Olagunju, A. T., Olusanya, B., Olusanya, J., Onwujekwe, O. E., Ortega-Altamirano, D. V., Ortiz-Panozo, E., Overland, S., Mahesh, P. A., Pana, A., Panda-Jonas, S., Pati, S., Patton, G. C., Perico, N., Pigott, D. M., Pirsaheb, M., Postma, M. J., Pourshams, A., Prakash, S., Puri, P., Qorbani, M., Radfar, A., Rahim, F., Rahimi-Movaghar, V., Rahman, M., Rajati, F., Ranabhat, C., Rawaf, D., Rawaf, S., Reiner, R. C., Remuzzi, G., Renzaho, A. N., Rezaei, S., Rezapour, A., Rios-Gonzalez, C., Roever, L., Ronfani, L., Roshandel, G., Rostami, A., Rubagotti, E., Sadat, N., Sadeghi, E., Safari, Y., Sagar, R., Salam, N., Salamati, P., Salimi, Y., Salimzadeh, H., Samy, A. M., Sanabria, J., Milicevic, M., Sartorius, B., Sathian, B., Sawant, A. R., Schaeffer, L. E., Schipp, M. F., Schwebel, D. C., Senbeta, A., Sepanlou, S. G., Shaikh, M., Shams-Beyranvand, M., Shamsizadeh, M., Sharafi, K., Sharma, R., She, J., Sheikh, A., Shigematsu, M., Siabani, S., Silveira, D., Singh, J. A., Sinha, D., Skirbekk, V., Sligar, A., Sobaih, B., Soofi, M., Soriano, J. B., Soyiri, I. N., Sreeramareddy, C. T., Sudaryanto, A., Sufiyan, M., Sutradhar, I., Sylaja, P., Tabares-Seisdedos, R., Tadesse, B., Temsah, M., Terkawi, A., Tessema, B., Tessema, Z., Thankappan, K., Topor-Madry, R., Tovani-Palone, M., Tran, B., Car, L., Ullah, I., Uthman, O. A., Valdez, P. R., Veisani, Y., Violante, F. S., Vlassov, V., Vollmer, S., Vu, G., Waheed, Y., Wang, Y., Wilkinson, J. C., Winkler, A., Wolfe, C. A., Yamada, T., Yeshaneh, A., Yip, P., Yisma, E., Yonemoto, N., Younis, M. Z., Yousefifard, M., Yu, C., Bin Zaman, S., Zhang, J., Zhang, Y., Zodpey, S., Gakidou, E., Hay, S. I., Local Burden Dis Educ Attainment C 2020

    Abstract

    The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1-4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5-8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.

    View details for DOI 10.1038/s41586-020-03043-4

    View details for Web of Science ID 000599489600008

    View details for PubMedID 33328634

    View details for PubMedCentralID PMC7739806

  • Five insights from the Global Burden of Disease Study 2019 LANCET Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abedi, A., Abedi, P., Abegaz, K., Abolhassani, H., Abosetugn, A., Aboyans, V., Abrams, E. M., Abreu, L., Abrigo, M. M., Abu Haimed, A., Abualhasan, A., Abu-Gharbieh, E., Abu-Raddad, L., Abushouk, A. I., Acebedo, A., Ackerman, I. N., Adabi, M., Adair, T., Adamu, A. A., Adebayo, O. M., Adedeji, I., Adekanmbi, V., Adelson, J. D., Adeoye, A., Adetokunboh, O. O., Adham, D., Advani, S. M., Afarideh, M., Afshari, M., Afshin, A., Agardh, E. E., Agarwal, G., Agasthi, P., Agesa, K. M., Aghaali, M., Aghamir, S., Agrawal, A., Ahmad, T., Ahmadi, A., Ahmadi, K., Ahmadi, M., Ahmadieh, H., Ahmadpour, E., Ahmed, M., Aji, B., Akalu, T., Akinyemi, R., Akinyemiju, T., Akombi, B., Akunna, C., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alam, S., Alam, T., Alanezi, F., Alanzi, T. M., Albertson, S. B., Alcalde-Rabanal, J., Alema, N., Alemu, B., Alemu, Y., Alhabib, K. F., Alhassan, R., Ali, M., Ali, S., Alicandro, G., Alijanzadeh, M., Alinia, C., Alipour, V., Alizade, H., Aljunid, S., Alla, F., Allebeck, P., Almadi, M., Almasi, A., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Almulhim, A. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alumran, A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amare, A. T., Amare, B., Amini, S., Amini-Rarani, M., Aminorroaya, A., Amiri, F., Amit, A. L., Amugsi, D. A., Amul, G., Anbesu, E., Ancuceanu, R., Anderlini, D., Anderson, J. A., Andrei, C., Andrei, T., Androudi, S., Angus, C., Anjomshoa, M., Ansari, F., Ansari, I., Ansari-Moghaddam, A., Antonazzo, I., Antonio, C. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Appiah, S., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Arba, A., Aremu, O., Ariani, F., Aripov, T., Armoon, B., Arnlov, J., Arowosegbe, O., Aryal, K. K., Arzani, A., Asaad, M., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Asgari, S., Asghari, B., Jafarabadi, M., Ashbaugh, C., Assmus, M., Atafar, Z., Athari, S., Atnafu, D., Atout, M., Atre, S. R., Atteraya, M., Ausloos, F., Ausloos, M., Avila-Burgos, L., Avokpaho, E., Quintanilla, B., Ayano, G., Ayanore, M., Aynalem, G., Aynalem, Y., Ayza, M., Azari, S., Azarian, G., Azene, Z., Azhar, G., Azzopardi, P. S., Darshan, B. B., Babaee, E., Badawi, A., Badiye, A. D., Bagherzadeh, M., Bagli, E., Bahrami, M., Baig, A., Bairwa, M., Bakhshaei, M., Bakhtiari, A., Bakkannavar, S. M., Balachandran, A., Balakrishnan, S., Balalla, S., Balassyano, S., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Banik, P., Bannick, M. S., Bante, A., Bante, S., Baraki, A., Barboza, M. A., Barker-Collo, S., Barnighausen, T., Barrero, L. H., Barthelemy, C. M., Barua, L., Barzegar, A., Basaleem, H., Bassat, Q., Basu, S., Baune, B. T., Bayati, M., Baye, B., Bazmandegan, G., Becker, J. S., Bedi, N., Beghi, E., Behzadifar, M., Bejot, Y., Bekuma, T., Bell, M. L., Bello, A. K., Bender, R. G., Bennett, D. A., Bennitt, F. B., Bensenor, I. M., Benziger, C. P., Berhe, K., Berman, A. E., Bernabe, E., Bernstein, R. S., Bertolacci, G. J., Bhagavathula, A., Bhageerathy, R., Bhala, N., Bhandari, D., Bhardwaj, P., Bhat, A., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bibi, S., Biehl, M. H., Bijani, A., Bikbov, B., Bilano, V., Bin Sayeed, M., Biondi, A., Birihane, B., Bisanzio, D., Bisignano, C., Biswas, R., Bitew, H., Bjorge, T., Bockarie, M., Bohlouli, S., Bohluli, M., Bojia, H., Bolla, S., Boloor, A., Boon-Dooley, A. S., Borges, G., Borzi, A., Borzouei, S., Bose, D., Bosetti, C., Boufous, S., Bourne, R., Brady, O. J., Braithwaite, D., Brauer, M., Brayne, C., Breitborde, N. K., Breitner, S., Brenner, H., Breusov, A. V., Briant, P., Briggs, A. M., Briko, A., Briko, N., Britton, G. B., Brugha, T., Bryazka, D., Buchbinder, R., Bumgarner, B. R., Burkart, K., Burnett, R., Nagaraja, S., Busse, R., Butt, Z. A., Caetano dos Santos, F., Cahill, L. E., Cahuana-Hurtado, L., Cai, T., Callender, C. H., Camera, L., Campos-Nonato, I. R., Rincon, J., Cao, J., Car, J., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J., Castaneda-Orjuela, C. A., Castelpietra, G., Castle, C. D., Castro, E., Castro, F., Catala-Lopez, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chalek, J., Chandan, J., Chang, A. R., Chang, A. Y., Chang, J., Chang, K., Charan, J., Charlson, F. J., Chattu, V., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Chin, K., Chirinos-Caceres, J., Cho, D., Choi, J., Christensen, H., Chu, D., Chung, M. T., Chung, S., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Cislaghi, B., Classen, T., Cohen, A. J., Collins, E. L., Comfort, H., Compton, K., Conti, S., Cooper, O. R., Corso, B., Cortesi, P., Costa, V., Cousin, E., Cowden, R. G., Cowie, B. C., Cromwell, E. A., Croneberger, A. J., Cross, D. 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S., Wu, A., Wu, C., Wu, J., Hanson, S., Wunrow, H., Xie, Y., Xu, G., Xu, R., Yadgir, S., Jabbari, S., Yamada, T., Yamagishi, K., Yaminfirooz, M., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yearwood, J. A., Yeheyis, T. Y., Yeshitila, Y., Yilgwan, C., Yilma, M., Yip, P., Yonemoto, N., Yoon, S., Lebni, J., York, H. W., Younis, M. Z., Younker, T., Yousefi, B., Yousefi, Z., Yousefifard, M., Yousefinezhadi, T., Yousuf, A., Yu, C., Yu, Y., Yuan, C., Yuce, D., Yusefzadeh, H., Zadey, S., Moghadam, T., Zaidi, S., Zaki, L., Zakzuk, J., Bin Zaman, S., Zamani, M., Zamanian, M., Zandian, H., Zangeneh, A., Zarafshan, H., Zastrozhin, M., Zewdie, K., Zhang, J., Zhang, Y., Zhang, Z., Zhao, J. T., Zhao, X., Zhao, Y., Zheleva, B., Zheng, P., Zhou, M., Zhu, C., Ziapour, A., Zimsen, S. M., Zlavog, B. S., Zodpey, S., Lim, S. S., Murray, C. L., Global Burden Dis 2019 2020; 396 (10258): 1135–59

    Abstract

    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.

    View details for Web of Science ID 000579154000005

    View details for PubMedID 33069324

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    Abstract

    In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries.GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution.Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI.As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000579154000007

    View details for PubMedID 33069326

    View details for PubMedCentralID PMC7567026

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G., Weiss, J., Werdecker, A., Westerman, R., Whisnant, J. L., Whiteford, H. A., Wiens, K. E., Wolfe, C. A., Wozniak, S. S., Wu, A., Wu, J., Hanson, S., Xu, G., Xu, R., Yadgir, S., Jabbari, S., Yamagishi, K., Yaminfirooz, M., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yeheyis, T. Y., Yilgwan, C., Yilma, M., Yip, P., Yonemoto, N., Younis, M. Z., Younker, T., Yousefi, B., Yousefi, Z., Yousefinezhadi, T., Yousuf, A., Yu, C., Yusefzadeh, H., Moghadam, T., Zamani, M., Zamanian, M., Zandian, H., Zastrozhin, M., Zhang, Y., Zhang, Z., Zhao, J. T., Zhao, X., Zhao, Y., Zhou, M., Ziapour, A., Zimsen, S. M., Brauer, M., Afshin, A., Lim, S. S., GBD 2019 Risk Factors 2020; 396 (10258): 1223–49

    Abstract

    Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden.The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older.Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000579154000008

    View details for PubMedID 33069327

    View details for PubMedCentralID PMC7566194

  • Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 LANCET Lozano, R., Fullman, N., Mumford, J., Knight, M., Barthelemy, C. M., Abbafati, C., Abbastabar, H., Abd-Allah, F., Abdollahi, M., Abedi, A., Abolhassani, H., Abosetugn, A., Abreu, L., Abrigo, M. M., Abu Haimed, A., Abushouk, A. I., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adelson, J. D., Adetokunboh, O. O., Adham, D., Advani, S. M., Afshin, A., Agarwal, G., Agasthi, P., Aghamir, S., Agrawal, A., Ahmad, T., Akinyemi, R., Alahdab, F., Al-Aly, Z., Alam, K., Albertson, S. B., Alemu, Y., Alhassan, R., Ali, M., Ali, S., Alipour, V., Aljunid, S., Alla, F., Almadi, M., Almasi, A., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Almulhim, A. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amiri, F., Amit, A. L., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Andrei, C., Androudi, S., Ansari, F., Ansari-Moghaddam, A., Antonio, C. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Aremu, O., Arnlov, J., Asaad, M., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Ashbaugh, C., Athari, S., Atout, M., Ausloos, M., Avila-Burgos, L., Quintanilla, B., Ayano, G., Ayanore, M., Aynalem, G., Aynalem, Y., Ayza, M., Azari, S., Azzopardi, P. S., Darshan, B. B., Babaee, E., Badiye, A. D., Bahrami, M., Babaee, E., Badiye, A. D., Bahrami, M., Baig, A., Bakhshaei, M., Bakhtiari, A., Bakkannavar, S. M., Balachandran, A., Balassyano, S., Banach, M., Banerjee, S. K., Banik, P., Bante, A., Bante, S., Barker-Collo, S., Barnighausen, T., Barrero, L. H., Bassat, Q., Basu, S., Baune, B. T., Bayati, M., Baye, B., Bedi, N., Beghi, E., Behzadifar, M., Bekuma, T., Bell, M. L., Bensenor, I. M., Berman, A. E., Bernabe, E., Bernstein, R. S., Bhagavathula, A., Bhandari, D., Bhardwaj, P., Bhat, A., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bijani, A., Bikbov, B., Bilano, V., Biondi, A., Birihane, B., Bockarie, M., Bohlouli, S., Bojia, H., Bolla, S., Boloor, A., Brady, O. J., Braithwaite, D., Briant, P., Briggs, A. M., Briko, N., Nagaraja, S., Busse, R., Butt, Z. A., Luciano Caetano dos Santos, F., Cahuana-Hurtado, L., Camera, L., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Catala-Lopez, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J., Chang, A. Y., Charan, J., Chattu, V., Chaturvedi, S., Chin, K., Cho, D., Choi, J., Christensen, H., Chu, D., Chung, M. T., Ciobanu, L. G., Cirillo, M., Comfort, H., Compton, K., Cortesi, P., Costa, V., Cousin, E., Dahlawi, S. A., Damiani, G., Dandona, L., Dandona, R., Gela, J., Darwesh, A., Daryani, A., Dash, A., Davey, G., Davila-Cervantes, C., Davletov, K., De Neve, J., Denova-Gutierrez, E., Deribe, K., Dervenis, N., Desai, R., Dharmaratne, S., Dhungana, G., Dianatinasab, M., da Silva, D., Diaz, D., Dippenaar, I. N., Hoa Thi Do, Dorostkar, F., Doshmangir, L., Duncan, B. B., Duraes, A., Eagan, A., Edvardsson, D., El Sayed, I., El Tantawi, M., Elgendy, I. Y., Elyazar, I. F., Eskandari, K., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Ezekannagha, O., Farag, T., Farahmand, M., Faraon, E. A., Sofia e Sa Farinha, C., Farioli, A., Faris, P., Faro, A., Fazlzadeh, M., Feigin, V. L., Fernandes, E., Ferrara, P., Feyissa, G., Filip, I., Fischer, F., Fisher, J. L., Flor, L., Foigt, N. A., Folayan, M., Fomenkov, A., Foroutan, M., Francis, J., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gaidhane, A., Gakidou, E., Galles, N. C., Gallus, S., Gardner, W. M., Geberemariyam, B., Gebrehiwot, A., Gebremeskel, G., Gebremeskel, L. G., Gesesew, H., Ghadiri, K., Ghafourifard, M., Ghashghaee, A., Ghith, N., Gholamian, A., Gilani, S., Gill, P., Gill, T. K., Ginindza, T. G., Gitimoghaddam, M., Giussani, G., Glagn, M., Gnedovskaya, E. V., Godinho, M., Goharinezhad, S., Gopalani, S., Goudarzian, A., Goulart, B., Gubari, M., Guimaraes, R., Guled, R., Gultie, T., Guo, Y., Gupta, R., Gupta, R., Hafezi-Nejad, N., Hafiz, A., Haile, T., Hamadeh, R. R., Hameed, S., Hamidi, S., Han, C., Han, H., Handiso, D., Hanif, A., Hankey, G. J., Haro, J., Hasaballah, A. I., Hasan, M., Hashi, A., Hassan, A., Hassan, S., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Hendrie, D., Herteliu, C., Hird, T. R., Ho, H., Hole, M. K., Holla, R., Hoogar, P., Hopf, K., Horita, N., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsieh, V., Hu, G., Huda, T. M., Humayun, A., Hwang, B., Iavicoli, I., Ibitoye, S., Ikeda, N., Ilesanmi, O., Ilic, I. M., Ilic, M. D., Inbaraj, L., Iqbal, U., Irvani, S., Irvine, C., Islam, M., Islam, S., Islami, F., Iso, H., Iwu, C. D., Iwu, C., Jaafari, J., Jadidi-Niaragh, F., Jafarinia, M., Jahagirdar, D., Jahani, M., Jahanmehr, N., Jakovljevic, M., Janjani, H., Javaheri, T., Jayatilleke, A., Jenabi, E., Jha, R., Jha, V., Ji, J. S., Jia, P., John-Akinola, Y. O., Jonas, J. B., Joukar, F., Jozwiak, J., Jurisson, M., Kabir, Z., Kalankesh, L. R., Kalhor, R., Kamath, A. M., Kanchan, T., Kapoor, N., Matin, B., Karanikolos, M., Karimi, S. M., Kassebaum, N. J., Katikireddi, S., Kayode, G. A., Keiyoro, P., Khader, Y., Khammarnia, M., Khan, E., Khan, M., Khang, Y., Khatab, K., Khater, A. M., Khater, M. M., Khatib, M., Khayamzadeh, M., Khubchandani, J., Kianipour, N., Kim, Y., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kissimova-Skarbek, K., Kivimaki, M., Kneib, C. J., Kocarnik, J. M., Kochhar, S., Kohler, S., Kopec, J. A., Korotkova, A. V., Korshunov, V., Kosen, S., Kotlo, A., Koul, P. A., Koyanagi, A., Krishan, K., Krohn, K. J., Kugbey, N., Kulkarni, V., Kumar, G., Kumar, M., Kumar, N., Kurmi, O. P., Kusuma, D., Kyu, H., La Vecchia, C., Lacey, B., Lal, D., Lalloo, R., Landires, I., Lansingh, V., Larsson, A. O., Lasrado, S., Lau, K., Lauriola, P., Lazarus, J. V., Ledesma, J. R., Lee, P. H., Lee, S., Leever, A. T., LeGrand, K. E., Leigh, J., Leonardi, M., Li, S., Lim, L., Lim, S. S., Liu, X., Logroscino, G., Lopez, A. D., Lopukhov, P. D., Lotufo, P. A., Lu, A., Ma, J., Madadin, M., Mahasha, P., Mahmoudi, M., Majeed, A., Malagon-Rojas, J. N., Maleki, S., Malta, D., Mansouri, B., Mansournia, M., Martini, S., Martins-Melo, F., Martopullo, I., Massenburg, B., Mastrogiacomo, C. I., Mathur, M., McAlinden, C., McKee, M., Medina-Solis, C., Meharie, B., Mehndiratta, M., Nasab, E., Mehri, F., Mehrotra, R., Mekonnen, T., Melese, A., Memiah, P. N., Mendoza, W., Menezes, R. G., Mensah, G. A., Meretoja, A., Meretoja, T. J., Mestrovic, T., Miazgowski, B., Michalek, I., Mirrakhimov, E. M., Mirzaei, M., Mirzaei-Alavijeh, M., Mitchell, P. B., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, D. K., Mohammad, Y., Mezerji, N., Mohammadian-Hafshejani, A., Mohammed, J., Mohammed, S., Mokdad, A. H., Monasta, L., Mondello, S., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morgado-da-Costa, J., Morrison, S., Mosapour, A., Mosser, J. F., Khaneghah, A., Muriithi, M. K., Mustafa, G., Nabhan, A. F., Naderi, M., Nagarajan, A., Naghavi, M., Naghshtabrizi, B., Naimzada, M., Nangia, V., Nansseu, J., Nayak, V. C., Nazari, J., Ndejjo, R., Negoi, I., Negoi, R., Neupane, S., Ngari, K. N., Nguefack-Tsague, G., Ngunjiri, J. W., Cuong Tat Nguyen, Diep Ngoc Nguyen, Huong Lan Thi Nguyen, Nnaji, C. A., Nomura, S., Norheim, O. F., Noubiap, J., Nowak, C., Nunez-Samudio, V., Oiu, A. O., Ogbo, F., Oghenetega, O., Oh, I., Okunga, E., Oladnabi, M., Olagunju, A. T., Olusanya, B., Olusanya, J., Oluwasanu, M., Bali, A., Omer, M., Ong, K., Onwujekwe, O. E., Ortega-Altamirano, D. V., Ortiz, A., Ostojic, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., Padubidri, J., Pakhale, S., Palladino, R., Pana, A., Panda-Jonas, S., Pangaribuan, H., Pathak, M., Patton, G. C., Paudel, S., Toroudi, H., Pease, S. A., Peden, A. E., Pennini, A., Peprah, E. K., Pereira, J., Pigott, D. M., Pilgrim, T., Pilz, T. M., Pinheiro, M., Piradov, M. A., Pirsaheb, M., Pokhrel, K., Postma, M. J., Pourjafar, H., Pourmalek, F., Kalhori, R., Pourshams, A., Prada, S. I., Pribadi, D., Pupillo, E., Syed, Z., Radfar, A., Rafiee, A., Rafiei, A., Raggi, A., Rahim, F., Rahman, M., Rajabpour-Sanati, A., Rana, S., Ranabhat, C., Rao, S. J., Rasella, D., Rashedi, V., Rath, G., Rathi, P., Rawaf, D., Rawaf, S., Rawal, L., Rawassizadeh, R., Razo, C., Renjith, V., Renzaho, A. N., Reshmi, B., Rezaei, N., Riahi, S., Ribeiro, D., Rickard, J., Roberts, N. S., Roever, L., Romoli, M., Ronfani, L., Roshandel, G., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Safari, Y., Sagar, R., Sahebkar, A., Sahraian, M., Sajadi, S., Salahshoor, M., Salem, H., Salem, M., Salomon, J. A., Kafil, H., Samy, A. M., Sanabria, J., Santric-Milicevic, M. M., Saraswathy, S., Sarmiento-Suarez, R., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Savic, M., Sawyer, S. M., Saxena, D., Sbarra, A. N., Schaeffer, L. E., Schiavolin, S., Schmidt, M., Schutte, A., Schwebel, D. C., Schwendicke, F., Seedat, S., Sha, F., Shahabi, S., Shaheen, A. A., Shaikh, M., Shamsizadeh, M., Shannawaz, M., Sharafi, K., Sharara, F., Sharifi, H., Shaw, D. H., Sheikh, A., Sheikhtaheri, A., Shetty, B., Shibuya, K., Shiferaw, W., Shigematsu, M., Shin, J., Shiri, R., Shirkoohi, R., Shivakumar, K. M., Shrime, M. G., Shuval, K., Siabani, S., Sierpinski, R., Sigfusdottir, I., Sigurvinsdottir, R., Silva, D., Silva, J., Simonetti, B., Simpson, K. E., Singh, J. A., Singh, P., Sinha, D., Skryabin, V., Smith, E. R., Soheili, A., Soltani, S., Soofi, M., Sorensen, R. D., Soriano, J. B., Sorrie, M., Soyiri, I. N., Spurlock, E., Sreeramareddy, C. T., Stanaway, J. D., Steel, N., Stein, C., Stokes, M. A., Sufiyan, M., Suleria, H., Sultan, I., Szumowski, L., Tabares-Seisdedos, R., Tabuchi, T., Tadakamadla, S., Taddele, B., Tadesse, D., Taherkhani, A., Tamiru, A., Tanser, F. C., Tareque, M., Tarigan, I., Teagle, W. L., Tediosi, F., Tefera, Y., Tela, F. G., Tessema, Z., Thakur, B., Titova, M., Tonelli, M., Topor-Madry, R., Topouzis, F., Tovani-Palone, M., Tran, B., Travillian, R. S., Troeger, C. E., Car, L., Uddin, R., Ullah, I., Umeokonkwo, C., Unnikrishnan, B., Upadhyay, E., Uthman, O. A., Vacante, M., Valdez, P. R., Varughese, S., Vasankari, T., Vasseghian, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S., Vongpradith, L., Vos, T., Waheed, Y., Walters, M. K., Wamai, R. G., Wang, H., Wang, Y., Weintraub, R. G., Weiss, J., Werdecker, A., Westerman, R., Wilner, L. B., Woldu, G., Wolfe, C. A., Wu, A., Hanson, S., Xie, Y., Xu, R., Jabbari, S., Yamagishi, K., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yearwood, J. A., Yeshitila, Y., Yip, P., Yonemoto, N., Younis, M. Z., Yousefi, Z., Yousefinezhadi, T., Yusefzadeh, H., Zadey, S., Moghadam, T., Zaidi, S., Zaki, L., Bin Zaman, S., Zamani, M., Zamanian, M., Zandian, H., Zastrozhin, M., Zewdie, K., Zhang, Y., Zhao, X., Zhao, Y., Zheng, P., Zhu, C., Ziapour, A., Zlavog, B. S., Zodpey, S., Murray, C. L., Gbd Universal Hlth Coverage 2020; 396 (10258): 1250–84

    Abstract

    Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages.Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023.Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2-47·5) in 1990 to 60·3 (58·7-61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9-3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6-421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0-3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5-1040·3]) residing in south Asia.The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(20)30750-9

    View details for Web of Science ID 000579154000009

    View details for PubMedID 32861314

    View details for PubMedCentralID PMC7562819

  • Policy Implications of Mathematical Modeling of Latent Tuberculosis Infection Testing and Treatment Strategies to Accelerate Tuberculosis Elimination. Public health reports (Washington, D.C. : 1974) Marks, S. M., Dowdy, D. W., Menzies, N. A., Shete, P. B., Salomon, J. A., Parriott, A. n., Shrestha, S. n., Flood, J. n., Hill, A. N. ; 135 (1_suppl): 38S–43S

    View details for DOI 10.1177/0033354920912710

    View details for PubMedID 32735183

  • An evaluation of 6-month versus continuous isoniazid preventive therapy for M. tuberculosis in adults living with HIV/AIDS in Malawi. Journal of acquired immune deficiency syndromes (1999) Hsieh, Y. L., Jahn, A., Menzies, N. A., Yaesoubi, R., Salomon, J. A., Girma, B., Gunde, L., Eaton, J. W., Auld, A., Odo, M., Kiyiika, C. N., Kalua, T., Chiwandira, B., Mpunga, J. U., Mbendra, K., Corbett, L., Hosseinipour, M. C., Cohen, T., Kunkel, A. 2020

    Abstract

    BACKGROUND: To assist the Malawi Ministry of Health to evaluate two competing strategies for scale-up of isoniazid preventive therapy (IPT) among HIV-positive adults receiving ART.SETTING: Malawi.METHODS: We used a multi-district, compartmental model of the Malawi TB/HIV epidemic to compare the anticipated health impacts of 6-month versus continuous IPT programs over a 12-year horizon, while respecting a US$10.8 million constraint on drug costs in the first three years.RESULTS: The 6-month IPT program could be implemented nationwide while the continuous IPT alternative could be introduced in 14 (out of 27) districts. By the end of year 12, the continuous IPT strategy was predicted to avert more TB cases than the 6-month alternative, although not statistically significantly (2368 additional cases averted; 95%PI, -1459, 5023). The 6-month strategy required fewer person-years of IPT to avert a case of TB or death than the continuous strategy. For both programs, the mean reductions in TB incidence among PLHIV by year 12 were expected to be <10%, and the cumulative numbers of IPT-related hepatotoxicity to exceed the number of all-cause deaths averted in the first three years.CONCLUSION: With the given budgetary constraint, nationwide implementation of 6-month IPT would be more efficient and yield comparable health benefits than implementing continuous IPT program in fewer districts. The anticipated health effects associated with both IPT strategies suggested a combination of different TB intervention strategies would likely be required to yield greater impact on TB control in settings like Malawi, where ART coverage is relatively high.

    View details for DOI 10.1097/QAI.0000000000002497

    View details for PubMedID 32925361

  • Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3 LANCET Micah, A. E., Su, Y., Bachmeier, S. D., Chapin, A., Cogswell, I. E., Crosby, S. W., Cunningham, B., Harle, A. C., Maddison, E. R., Moitra, M., Sahu, M., Schneider, M. T., Simpson, K. E., Stutzman, H. N., Tsakalos, G., Zende, R. R., Zlavog, B. S., Abbafati, C., Abebo, Z., Abolhassani, H., Abrigo, M. M., Ahmed, M., Akinyemi, R., Alam, K., Ali, S., Alinia, C., Alipour, V., Aljunid, S., Almasi, A., Alvis-Guzman, N., Ancuceanu, R., Andrei, T., Andrei, C., Anjomshoa, M., Antonio, C. T., Arabloo, J., Arab-Zozani, M., Aremu, O., Atnafu, D., Ausloos, M., Avila-Burgos, L., Ayanore, M., Azari, S., Babalola, T., Bagherzadeh, M., Baig, A., Bakhtiari, A., Banach, M., Banerjee, S. K., Barnighausen, T., Basu, S., Baune, B. T., Bayati, M., Berman, A. E., Bhageerathy, R., Bhardwaj, P., Bohluli, M., Busse, R., Cahuana-Hurtado, L., Camera, L., Castaneda-Orjuela, C. A., Catala-Lopez, F., Cevik, M., Chattu, V., Dandona, L., Dandona, R., Dianatinasab, M., Hoa Thi Do, Doshmangir, L., El Tantawi, M., Eskandarieh, S., Esmaeilzadeh, F., Faraj, A., Farzadfar, F., Fischer, F., Foigt, N. A., Fullman, N., Gad, M. M., Ghafourifard, M., Ghashghaee, A., Gholamian, A., Goharinezhad, S., Grada, A., Bidgoli, H., Hamidi, S., Harb, H. L., Hasanpoor, E., Hay, S. I., Hendrie, D., Henry, N. J., Herteliu, C., Hole, M. K., Hosseinzadeh, M., Hostiuc, S., Huda, T. M., Humayun, A., Hwang, B., Ilesanmi, O., Iqbal, U., Irvani, S., Islam, S., Islam, M., Jahani, M., Jakovljevic, M., James, S. L., Javaheri, Z., Jonas, J. B., Joukar, F., Jozwiak, J., Jurisson, M., Kalhor, R., Matin, B., Karimi, S., Kayode, G. A., Karyani, A., Kinfu, Y., Kisa, A., Kohler, S., Komaki, H., Kosen, S., Kotlo, A., Koyanagi, A., Kumar, G., Kusuma, D., Lansingh, V. C., Larsson, A. O., Lasrado, S., Lee, S., Lim, L., Lozano, R., Abd El Razek, H., Mahdavi, M., Maleki, S., Malekzadeh, R., Mansour-Ghanaei, F., Mansournia, M., Mantovani, L., Martinez, G., Masoumi, S., Massenburg, B., Menezes, R. G., Mengesha, E., Meretoja, T. J., Meretoja, A., Mestrovic, T., Kostova, N., Miller, T. R., Mirica, A., Mirrakhimov, E. M., Moghadaszadeh, M., Mohajer, B., Mohamadi, E., Darwesh, A., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mohebi, F., Mokdad, A. H., Morrison, S., Mosser, J. F., Mousavi, S., Muriithi, M. K., Muthupandian, S., Myint, C., Naderi, M., Nagarajan, A., Cuong Tat Nguyen, Huong Lan Thi Nguyen, Nonvignon, J., Noubiap, J., Oh, I., Olagunju, A. T., Olusanya, J., Olusanya, B., Bali, A., Onwujekwe, O. E., Otstavnov, S. S., Otstavnov, N., Owolabi, M., Padubidri, J., Palladino, R., Panda-Jonas, S., Pandey, A., Postma, M. J., Prada, S. I., Pribadi, D., Rabiee, M., Rabiee, N., Rahim, F., Ranabhat, C., Rao, S. J., Rathi, P., Rawaf, S., Rawaf, D., Rawal, L., Rawassizadeh, R., Rezapour, A., Sabour, S., Sahraian, M., Salman, O., Salomon, J. A., Samy, A. M., Sanabria, J., Santos, J., Milicevic, M., Jose, B., Savic, M., Schwendicke, F., Senthilkumaran, S., Sepanlou, S. G., Servan-Mori, E., Setayesh, H., Shaikh, M., Sheikh, A., Shibuya, K., Shrime, M. G., Simonetti, B., Singh, J. A., Singh, P., Skryabin, V., Soheili, A., Soltani, S., Stefan, S., Tabares-Seisdedos, R., Topor-Madry, R., Tovani-Palone, M., Tran, B., Travillian, R., Undurraga, E. A., Valdez, P. R., van Boven, J. M., Vasankari, T., Violante, F. S., Vlassov, V., Vos, T., Wolfe, C. A., Wu, J., Yaya, S., Yazdi-Feyzabadi, V., Yip, P., Yonemoto, N., Younis, M. Z., Yu, C., Zaidi, Z., Bin Zaman, S., Zastrozhin, M., Zhang, Z., Zhao, Y., Murray, C. L., Dieleman, J. L., Global Burden Dis Hlth Financing 2020; 396 (10252): 693–724

    Abstract

    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.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.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.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.The Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(20)30608-5

    View details for Web of Science ID 000579138700029

    View details for PubMedID 32334655

    View details for PubMedCentralID PMC7180045

  • Mathematical modeling study of school-based chlamydia screening: potential impact on chlamydia prevalence in intervention schools and surrounding communities. BMC public health Ronn, M. M., Dunville, R., Wang, L. Y., Bellerose, M., Malyuta, Y., Menzies, N. A., Aslam, M., Lewis, F., Walker-Baban, C., Asbel, L., Parchem, S., Masinter, L., Perez, E., Gift, T. L., Hsu, K., Barrios, L. C., Salomon, J. A. 2020; 20 (1): 1363

    Abstract

    BACKGROUND: Chlamydia screening in high schools offers a way to reach adolescents outside of a traditional clinic setting. Using transmission dynamic modeling, we examined the potential impact of high-school-based chlamydia screening programs on the burden of infection within intervention schools and surrounding communities, under varying epidemiological and programmatic conditions.METHODS: A chlamydia transmission model was calibrated to epidemiological data from three different settings. Philadelphia and Chicago are two high-burden cities with existing school-based screening programs. Rural Iowa does not have an existing program but represents a low-burden setting. We modeled the effects of the two existing programs to analyze the potential influence of program coverage and student participation. All three settings were used to examine a broader set of hypothetical programs with varying coverage levels and time trends in participation.RESULTS: In the modeled Philadelphia program, prevalence among the intervention schools' sexually active 15-18years old population was 4.34% (95% credible interval 3.75-4.71%)after 12 program years compared to 5.03% (4.39-5.43%) in absence of the program. In the modeled Chicago program, prevalence was estimated as 5.97% (2.60-7.88%) after 4 program years compared to 7.00% (3.08-9.29%) without the program. In the broader hypothetical scenarios including both high-burden and low-burden settings, impact of school-based screening programs was greater in absolute terms in the higher-prevalence settings, and benefits in the community were approximately proportional to population coverage of intervention schools. Most benefits were garnered if the student participation did not decline over time.CONCLUSIONS: Sustained high student participation in school-based screening programs and broad coverage of schools within a target community are likely needed to maximize program benefits in terms of reduced burden of chlamydia in the adolescent population.

    View details for DOI 10.1186/s12889-020-09466-y

    View details for PubMedID 32891137

  • Cost-effectiveness of post-treatment follow-up examinations and secondary prevention of tuberculosis in a high-incidence setting: a model-based analysis. The Lancet. Global health Marx, F. M., Cohen, T., Menzies, N. A., Salomon, J. A., Theron, G., Yaesoubi, R. 2020; 8 (9): e1223–e1233

    Abstract

    BACKGROUND: In settings of high tuberculosis incidence, previously treated individuals remain at high risk of recurrent tuberculosis and contribute substantially to overall disease burden. Whether tuberculosis case finding and preventive interventions among previously treated people are cost-effective has not been established. We aimed to estimate costs and health benefits of annual post-treatment follow-up examinations and secondary preventive therapy for tuberculosis in a tuberculosis-endemic setting.METHODS: We developed a transmission-dynamic mathematical model and calibrated it to data from two high-incidence communities of approximately 40 000 people in suburban Cape Town, South Africa. We used the model to estimate overall cost and disability-adjusted life-years (DALYs) associated with annual follow-up examinations and secondary isoniazid preventive therapy (IPT), alone and in combination, among individuals completing tuberculosis treatment. We investigated scenarios under which these interventions were restricted to the first year after treatment completion, or extended indefinitely. For each intervention scenario, we projected health system costs and DALYs averted with respect to the current status quo of tuberculosis control. All estimates represent mean values derived from 1000 epidemic trajectories simulated over a 10-year period (2019-28), with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values.FINDINGS: We estimated that a single follow-up examination at the end of the first year after treatment completion combined with 12 months of secondary IPT would avert 2472 DALYs (95% UI -888 to 7801) over a 10-year period and is expected to be cost-saving compared with current control efforts. Sustained annual follow-up and continuous secondary IPT beyond the first year after treatment would avert an additional 1179 DALYs (-1769 to 4377) over 10 years at an expected additional cost of US$18·2 per DALY averted. Strategies of follow-up without secondary IPT were dominated (ie, expected to result in lower health impact at higher costs) by strategies that included secondary IPT.INTERPRETATION: In this high-incidence setting, post-treatment follow-up and secondary preventive therapy can accelerate declines in tuberculosis incidence and potentially save resources for tuberculosis control. Empirical trials to assess the feasibility of these interventions in settings most severely affected by tuberculosis are needed.FUNDING: National Institutes of Health, Gunther Labes Foundation, Oskar Helene Heim Foundation.

    View details for DOI 10.1016/S2214-109X(20)30227-8

    View details for PubMedID 32827484

  • Cost-effectiveness of post-treatment follow-up examinations and secondary prevention of tuberculosis in a high-incidence setting: a model-based analysis LANCET GLOBAL HEALTH Marx, F. M., Cohen, T., Menzies, N. A., Salomon, J. A., Theron, G., Yaesoubi, R. 2020; 8 (9): E1223–E1233
  • Modeling Contact Tracing Strategies for COVID-19 in the Context of Relaxed Physical Distancing Measures. JAMA network open Bilinski, A., Mostashari, F., Salomon, J. A. 2020; 3 (8): e2019217

    View details for DOI 10.1001/jamanetworkopen.2020.19217

    View details for PubMedID 32821920

  • Cost-effectiveness of first-line therapy for advanced renal cell carcinoma in the immunotherapy era. Parikh, D., Serrato, P., Srinivas, S., Ryckman, T., Salomon, J., Goldhaber-Fiebert, J. D. LIPPINCOTT WILLIAMS & WILKINS. 2020
  • Population-Level Benefits of Extragenital Gonorrhea Screening among Men Who Have Sex with Men: An Exploratory Modeling Analysis. Sexually transmitted diseases Earnest, R., Ronn, M. M., Bellerose, M., Gift, T. L., Berruti, A. A., Hsu, K. K., Testa, C., Zhu, L., Malyuta, Y., Menzies, N. A., Salomon, J. A. 2020

    Abstract

    BACKGROUND: Men who have sex with men (MSM) are disproportionately burdened by gonorrhea and face high rates of extragenital (rectal and pharyngeal) infection, which is mostly asymptomatic and often missed by urogenital-only screening. Extragenital screening likely remains below CDC-recommended levels. Since increasing screening coverage is often resource-intensive, we assessed whether improved extragenital screening among men already presenting at clinics could lead to substantial reductions in prevalence and incidence.METHODS: We calibrated an agent-based model of site- and race-specific gonorrhea infection in MSM to explicitly model multi-site infection within an individual and transmission via anal, orogenital, and ororectal sex. Compared to current screening levels, we assessed the impact of increasing screening at 1) both extragenital sites, 2) only the rectal site, and 3) only the pharyngeal site among men already being urogenitally screened.RESULTS: All scenarios reduced prevalence and incidence, with improved screening at both extragenital sites having the largest effect across outcomes. Extragenitally screening 100% of men being urogenitally screened reduced site-specific prevalence by an average of 42% (black MSM) and 50% (white MSM), with these values dropping by approximately 10% and 20% for each race group when targeting only the rectum and only the pharynx, respectively. However, increasing only rectal screening was more efficient in terms of the number of screens needed to avert an infection as this avoided duplicative screens due to rectum/pharynx multi-site infection.CONCLUSIONS: Improved extragenital screening substantially reduced site-specific gonorrhea prevalence and incidence, with strategies aimed at increasing rectal screening proving the most efficient.

    View details for DOI 10.1097/OLQ.0000000000001189

    View details for PubMedID 32355108

  • Estimation and correction of bias in network simulations based on respondent-driven sampling data. Scientific reports Zhu, L., Menzies, N. A., Wang, J., Linas, B. P., Goodreau, S. M., Salomon, J. A. 2020; 10 (1): 6348

    Abstract

    Respondent-driven sampling (RDS) is widely used for collecting data on hard-to-reach populations, including information about the structure of the networks connecting the individuals. Characterizing network features can be important for designing and evaluating health programs, particularly those that involve infectious disease transmission. While the validity of population proportions estimated from RDS-based datasets has been well studied, little is known about potential biases in inference about network structure from RDS. We developed a mathematical and statistical platform to simulate network structures with exponential random graph models, and to mimic the data generation mechanisms produced by RDS. We used this framework to characterize biases in three important network statistics - density/mean degree, homophily, and transitivity. Generalized linear models were used to predict the network statistics of the original network from the network statistics of the sample network and observable sample design features. We found that RDS may introduce significant biases in the estimation of density/mean degree and transitivity, and may exaggerate homophily when preferential recruitment occurs. Adjustments to network-generating statistics derived from the prediction models could substantially improve validity of simulated networks in terms of density, and could reduce bias in replicating mean degree, homophily, and transitivity from the original network.

    View details for DOI 10.1038/s41598-020-63269-0

    View details for PubMedID 32286412

  • Cost-effectiveness and Budgetary Impact of Hepatitis C Virus Testing, Treatment, and Linkage to Care in US Prisons CLINICAL INFECTIOUS DISEASES Assoumou, S. A., Tasillo, A., Vellozzi, C., Yazdi, G., Wang, J., Nolen, S., Hagan, L., Thompson, W., Randall, L. M., Strick, L., Salomon, J. A., Linas, B. P. 2020; 70 (7): 1388–96

    View details for DOI 10.1093/cid/ciz383

    View details for Web of Science ID 000532686300022

  • HCV Testing and Treatment in a National Sample of US Federally Qualified Health Centers during the Opioid Epidemic. Journal of general internal medicine Assoumou, S. A., Wang, J., Nolen, S., Eftekhari Yazdi, G., Mayer, K. H., Puro, J., Salomon, J. A., Linas, B. P. 2020

    Abstract

    BACKGROUND: Federally qualified health centers (FQHCs) serve diverse communities in the United States (U.S.) and could function as important venues to diagnose and treat hepatitis C virus (HCV) infections.OBJECTIVE: To determine HCV testing proportion and factors associated with treatment initiation, and treatment outcomes in a large sample of FQHCs around the U.S.DESIGN: Retrospective cohort study using electronic health records of three hundred and forty-one FQHC clinical sites participating in the OCHIN network in 19 U.S. states.PARTICIPANTS: Adult patients (≥18years of age) seen between January 01, 2012, and June 30, 2017.MAIN MEASURES: HCV testing proportion, stratified by diagnosis of opioid use disorder (OUD); treatment initiation rates; and sustained virologic response (SVR), defined as undetectable HCV RNA 6months after treatment initiation.KEY RESULTS: Of the 1,508,525 patients meeting inclusion criteria, 88,384 (5.9%) were tested for HCV, and 8694 (9.8%) of individuals tested had reactive results. Of the 6357 with HCV RNA testing, 4092 (64.4%) had detectable RNA. Twelve percent of individuals with chronic HCV and evaluable data initiated treatment. Of those, 87% reached SVR. Having commercial insurance (aOR, 2.11; 95% CI, 1.46-3.05), older age (aOR, 1.07; 95% CI, 1.06-1.09), and being Hispanic/Latino (aOR, 1.87; 95% CI, 1.38-2.53) or Asian/Pacific Islander (aOR, 2.47; 95% CI, 1.46-4.19) were independently associated with higher odds of treatment initiation after multivariable adjustment. In contrast, women (aOR, 0.76; 95% CI, 0.60-0.97) and the uninsured (aOR, 0.15; 95% CI, 0.09-0.25) were less likely to initiate treatment. Only 8% of individuals with chronic HCV were tested for HIV, and 15% of individuals with identified OUD were tested for HCV.CONCLUSIONS: Fewer than 20% of individuals with identified OUD were tested for HCV. SVR was lower than findings in other real-world cohorts. Measures to improve outcomes should be considered with the expansion of HCV management into community clinics.

    View details for DOI 10.1007/s11606-020-05701-9

    View details for PubMedID 32133577

  • Limitations of the UNAIDS 90-90-90 metrics: a simulation-based comparison of cross-sectional and longitudinal metrics for the HIV care continuum. AIDS (London, England) Haber, N. A., Lesko, C. R., Fox, M. P., Powers, K. A., Harling, G., Edwards, J., Salomon, J., Lippman, S. A., Bor, J., Chang, A. Y., Anglemyer, A., Pettifor, A. 2020

    Abstract

    OBJECTIVES: The UNAIDS 90-90-90 and other cross-sectional metrics can lead to potentially counterintuitive conclusions when used to evaluate health systems' performance. This study demonstrates how time and population dynamics impact UNAIDS 90-90-90 metrics in comparison with a longitudinal analogue.DESIGN: A simplified simulation representing a hypothetical population was used to estimate and compare inference from UNAIDS 90-90-90 metrics and a longitudinal metrics based on Kaplan-Meier-estimated 2-year probability of transition between stages.METHODS: We simulated a large cohort over 15 years. Everyone started out at risk for HIV, and then transitioned through the HIV care continuum based on fixed daily probabilities of acquiring HIV, learning status, entering care, initiating ART, and becoming virally suppressed, or dying. Within simulations we only varied the probability of ART initiation. We repeated the simulation with an increased probability of death.RESULTS: The cross-sectional probability of being on ART among persons who were diagnosed responded relatively slowly to changes in the rate of ART initiation. Increases in ART initiation rates caused apparent declines in the cross-sectional probability of being virally suppressed among persons who had initiated ART, despite no changes in the rate of viral suppression. In some cases, higher mortality resulted in the cross-sectional metrics implying improved healthcare system performance. The longitudinal continuum was robust to these issues.CONCLUSION: The UNAIDS 90-90-90 care continuum may lead to incorrect inference when used to evaluate health systems performance. We recommend that evaluation of HIV care delivery include longitudinal care continuum metrics wherever possible.

    View details for DOI 10.1097/QAD.0000000000002502

    View details for PubMedID 32044844

  • ESTIMATED MORTALITY RATES AMONG TREATED AND UNTREATED VETERANS WITH OPIOID USE DISORDER IN THE VETERANS HEALTH ADMINISTRATION Ching, J. H., Trafton, J. A., Goldhaber-Fiebert, J. D., Owens, D. K., Salomon, J. A. SAGE PUBLICATIONS INC. 2020: E105–E106
  • Hepatitis C Management at Federally Qualified Health Centers during the Opioid Epidemic: A Cost-Effectiveness Study. The American journal of medicine Assoumou, S. A., Nolen, S. n., Hagan, L. n., Wang, J. n., Eftekhari Yazdi, G. n., Thompson, W. W., Mayer, K. H., Puro, J. n., Zhu, L. n., Salomon, J. A., Linas, B. P. 2020

    Abstract

    The opioid epidemic has been associated with an increase in hepatitis C virus (HCV) infections. Federally qualified health centers (FQHCs) have a high burden of hepatitis C disease and could serve as venues to enhance testing and treatment.We estimated clinical outcomes and the cost-effectiveness of hepatitis C testing and treatment at US FQHCs using individual-based simulation modeling. We used individual-level data from 57 FQHCs to model 9 strategies including permutations of HCV antibody testing modality, person initiating testing and testing approach. Outcomes included life expectancy, quality adjusted life years (QALY), hepatitis C cases identified, treated and cured, and incremental cost-effectiveness ratios (ICERs).Compared to current practice (risk-based with laboratory-based testing), routine rapid point-of-care testing initiated and performed by a counselor identified 68% more cases after (non-reflex) RNA testing in the first month of the intervention, led to a 17% reduction in cirrhosis cases, and a 22% reduction in liver deaths among those with cirrhosis over a lifetime. Routine rapid testing initiated by a counselor or a clinician provided better outcomes at either lower total cost or at lower cost per QALY gained, when compared to all other strategies. Findings were most influenced by the proportion of patients informed of their anti-HCV test results.Routine anti-HCV testing followed by prompt RNA testing for positives is recommended at FQHCs to identify infections. If using dedicated staff or point-of-care testing is not feasible, then measures to improve immediate patient knowledge of antibody status should be considered.

    View details for DOI 10.1016/j.amjmed.2020.05.029

    View details for PubMedID 32603791

  • The household secondary attack rate of SARS-CoV-2: A rapid review. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Fung, H. F., Martinez, L. n., Alarid-Escudero, F. n., Salomon, J. A., Studdert, D. M., Andrews, J. R., Goldhaber-Fiebert, J. D. 2020

    Abstract

    Although much of the public health effort to combat COVID-19 has focused on disease control strategies in public settings, transmission of SARS-CoV-2 within households remains an important problem. The nature and determinants of household transmission are poorly understood.To address this gap, we gathered and analyzed data from 22 published and pre-published studies from 10 countries (20,291 household contacts) that were available through September 2, 2020. Our goal was to combine estimates of the SARS-CoV-2 household secondary attack rate (SAR) and explore variation in estimates of the household SAR.The overall pooled random-effects estimate of the household SAR was 17.1% (95% CI: 13.7-21.2%). In study-level, random-effects meta-regressions stratified by testing frequency (1 test, 2 tests, >2 tests), SAR estimates were 9.2% (95% CI: 6.7-12.3%), 17.5% (95% CI: 13.9-21.8%), and 21.3% (95% CI: 13.8-31.3%), respectively. Household SAR tended to be higher among older adult contacts and among contacts of symptomatic cases.These findings suggest that SAR reported using a single follow-up test may be underestimated and that testing household contacts of COVID-19 cases on multiple occasions may increase the yield for identifying secondary cases.

    View details for DOI 10.1093/cid/ciaa1558

    View details for PubMedID 33045075

  • Adaptive guidelines for the treatment of gonorrhea to increase the effective life span of antibiotics among men who have sex with men in the United States: A mathematical modeling study. PLoS medicine Yaesoubi, R. n., Cohen, T. n., Hsu, K. n., Gift, T. L., Chesson, H. n., Salomon, J. A., Grad, Y. H. 2020; 17 (4): e1003077

    Abstract

    The rise of gonococcal antimicrobial resistance highlights the need for strategies that extend the clinically useful life span of antibiotics. Because there is limited evidence to support the current practice of switching empiric first-line antibiotic when resistance exceeds 5% in the population, our objective was to compare the impact of alternative strategies on the effective life spans of antibiotics and the overall burden of gonorrhea.We developed and calibrated a mathematical model of gonorrhea transmission among men who have sex with men (MSM) in the United States. We calibrated the model to the estimated prevalence of gonorrhea, the rate of gonorrhea cases, and the proportion of cases presenting symptoms among MSM in the US. We used this model to project the effective life span of antibiotics and the number of gonorrhea cases expected under current and alternative surveillance strategies over a 50-year simulation period. We demonstrate that compared to the current practice, a strategy that uses quarterly (as opposed to yearly) surveillance estimates and incorporates both the estimated prevalence of resistance and the trend in the prevalence of resistance to determine treatment guidelines could extend the effective life span of antibiotics by 0.83 years. This is equivalent to successfully treating an additional 80.1 (95% uncertainty interval: [47.7, 111.9]) gonorrhea cases per 100,000 MSM population each year with the first-line antibiotics without worsening the burden of gonorrhea. If the annual number of isolates tested for drug susceptibility is doubled, this strategy could increase the effective life span of antibiotics by 0.94 years, which is equivalent to successfully treating an additional 91.1 (54.3, 127.3) gonorrhea cases per 100,000 MSM population each year without increasing the incidence of gonorrhea. Study limitations include that our conclusions might not be generalizable to other settings because our model describes the transmission of gonorrhea among the US MSM population, and, to better capture uncertainty in the characteristics of current and future antibiotics, we chose to model hypothetical drugs with characteristics similar to the antibiotics commonly used in gonorrhea treatment.Our results suggest that use of data from surveillance programs could be expanded to prolong the clinical effectiveness of antibiotics without increasing the burden of the disease. This highlights the importance of maintaining effective surveillance systems and the engagement of policy makers to turn surveillance findings into timely and effective decisions.

    View details for DOI 10.1371/journal.pmed.1003077

    View details for PubMedID 32243443

  • High-resolution estimates of tuberculosis incidence among non-U.S.-born persons residing in the United States, 2000-2016. Epidemics Hill, A. N., Cohen, T. n., Salomon, J. A., Menzies, N. A. 2020; 33: 100419

    Abstract

    In the United States, new tuberculosis cases are increasingly concentrated within non-native-born populations. We estimated trends and differences in tuberculosis incidence rates for the non-U.S.-born population, at a resolution unobtainable from raw data. We obtained non-U.S.-born tuberculosis case reports for 2000-2016 from the National Tuberculosis Surveillance System, and population data from the American Community Survey and 2000 U.S. Census. We constructed generalized additive regression models to estimate incidence rates in terms of birth country, entry year, age at entry, and number of years since entry into the United States and described how these factors contribute to overall tuberculosis risk. Controlling for other factors, tuberculosis incidence rates were lower for more recent immigration cohorts, with an incidence risk ratio (IRR) of 10.2 (95 % confidence interval 7.0, 14.7) for the 1950 entry cohort compared to its 2016 counterpart. Greater years since entry and younger age at entry were associated with substantially lower incidence rates. IRRs for birth country varied between 8.86 (6.78, 11.52) for Somalia and 0.02 (0.01, 0.03) for Canada, compared to all non-U.S.-born residents in 2016. IRRs were positively correlated with WHO predicted incidence rate and negatively associated with wealth level for the birth country. Lower country wealth level was also associated with shallower declines in tuberculosis over time. Tuberculosis risks differ by several orders of magnitude within the non-U.S.-born population. A better understanding of these differences will allow more effective targeting of tuberculosis prevention efforts. The methods presented here may also be relevant for understanding tuberculosis trends in other high-income countries.

    View details for DOI 10.1016/j.epidem.2020.100419

    View details for PubMedID 33242759

  • Evaluation of 6-Month Versus Continuous Isoniazid Preventive Therapy for Mycobacterium tuberculosis in Adults Living With HIV/AIDS in Malawi. Journal of acquired immune deficiency syndromes (1999) Hsieh, Y. L., Jahn, A. n., Menzies, N. A., Yaesoubi, R. n., Salomon, J. A., Girma, B. n., Gunde, L. n., Eaton, J. W., Auld, A. n., Odo, M. n., Kiyiika, C. N., Kalua, T. n., Chiwandira, B. n., Mpunga, J. U., Mbendra, K. n., Corbett, L. n., Hosseinipour, M. C., Cohen, T. n., Kunkel, A. n. 2020; 85 (5): 643–50

    Abstract

    To assist the Malawi Ministry of Health to evaluate 2 competing strategies for scale-up of isoniazid preventive therapy (IPT) among HIV-positive adults receiving antiretroviral therapy.Malawi.We used a multidistrict, compartmental model of the Malawi tuberculosis (TB)/HIV epidemic to compare the anticipated health impacts of 6-month versus continuous IPT programs over a 12-year horizon while respecting a US$10.8 million constraint on drug costs in the first 3 years.The 6-month IPT program could be implemented nationwide, whereas the continuous IPT alternative could be introduced in 14 (of the 27) districts. By the end of year 12, the continuous IPT strategy was predicted to avert more TB cases than the 6-month alternative, although not statistically significant (2368 additional cases averted; 95% projection interval [PI], -1459 to 5023). The 6-month strategy required fewer person-years of IPT to avert a case of TB or death than the continuous strategy. For both programs, the mean reductions in TB incidence among people living with HIV by year 12 were expected to be <10%, and the cumulative numbers of IPT-related hepatotoxicity to exceed the number of all-cause deaths averted in the first 3 years.With the given budgetary constraint, the nationwide implementation of 6-month IPT would be more efficient and yield comparable health benefits than implementing a continuous IPT program in fewer districts. The anticipated health effects associated with both IPT strategies suggested that a combination of different TB intervention strategies would likely be required to yield a greater impact on TB control in settings such as Malawi, where antiretroviral therapycoverage is relatively high.

    View details for DOI 10.1097/QAI.0000000000002497

    View details for PubMedID 33177475

  • The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-1998. BMC health services research Quattrochi, J. P., Hill, K. n., Salomon, J. A., Castro, M. C. 2020; 20 (1): 899

    Abstract

    Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates.We combined retrospective reports on 18,714 births between 1980 and 1998 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. We estimated associations between distance to nearest health facility and (i) under-5 mortality, using Cox proportional hazards models, and (ii) maternal health care utilization (antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery), using linear probability models. We also estimated the causal effect of reducing the distance to nearest facility on those outcomes, using a two-way fixed effects approach.We found that greater distance was associated with higher mortality (hazard ratio 1.007 for one additional kilometer [95%CI 1.001 to 1.014]) and lower health care utilization (for one additional kilometer: 1.2 percentage point (pp) increase in homebirth [95%CI 0.8 to 1.5]; 0.8 pp. decrease in at least three antenatal visits [95% CI - 1.4 to - 0.2]; 1.2 pp. decrease in skilled assistance during delivery [95%CI - 1.6 to - 0.8]). However, we found no effects of a decrease in distance to the nearest health facility on the hazard of death before age 5 years, nor on antenatal visits prior to delivery, place of delivery, or receiving skilled assistance during delivery. We also found that reductions in distance decrease the probability that a woman receives a check-up following delivery (2.4 pp. decrease for a 1 km decrease [95%CI 0.004 to 0.044]).Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure. Importantly, the effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.

    View details for DOI 10.1186/s12913-020-05738-w

    View details for PubMedID 32972395

  • Exploring how epidemic context influences syphilis screening impact: a mathematical modeling study. Sexually transmitted diseases Tuite, A. R., Testa, C. n., Rönn, M. n., Bellerose, M. n., Gift, T. n., Fridge, J. n., Molotnikov, L. n., Desmarais, C. n., Berruti, A. n., Menzies, N. n., Malyuta, Y. n., Hsu, K. n., Salomon, J. A. 2020

    Abstract

    The current syphilis epidemic in the United States is concentrated in gay, bisexual, and other men who have sex with men (MSM), but substantial heterosexual transmission is reported in some parts of the country. Using the U.S. states of Louisiana and Massachusetts as case studies, we investigated how epidemic context influences the impact of population screening approaches for syphilis control.We constructed a compartmental metapopulation model parameterized to describe observed patterns of syphilis transmission. We estimated the impact of different approaches to screening, including perfect adherence to current U.S. screening guidelines in MSM.In Louisiana, where syphilis cases are more evenly distributed among MSM and heterosexual populations, we projected that screening according to guidelines would contribute to no change or an increase in syphilis burden, compared to burden with current estimated screening coverage. In Massachusetts, which has a more MSM-focused outbreak, we projected that screening according to guidelines would be as or more effective than current screening coverage in most population groups.MSM-focused approaches to screening may be insufficient for control when there is substantial transmission in heterosexual populations. Epidemic characteristics may be useful when identifying at-risk groups for syphilis screening.

    View details for DOI 10.1097/OLQ.0000000000001249

    View details for PubMedID 32976353

  • Impact of Effective Global Tuberculosis Control on Health and Economic Outcomes in the United States. American journal of respiratory and critical care medicine Menzies, N. A., Bellerose, M. n., Testa, C. n., Swartwood, N. n., Malyuta, Y. n., Cohen, T. n., Marks, S. M., Hill, A. N., Date, A. A., Maloney, S. A., Bowden, S. E., Grills, A. W., Salomon, J. A. 2020

    Abstract

    Most United States residents who develop tuberculosis were born abroad, and US TB incidence is increasingly driven by infection risks in other countries.To estimate the potential impact of effective global TB control on health and economic outcomes in the United States.We estimated outcomes using linked mathematical models of TB epidemiology in the United States and migrants' birth countries. A base-case scenario extrapolated country-specific TB incidence trends. We compared this to scenarios in which countries achieve 90% TB incidence reductions between 2015 and 2035, as targeted by the Global End TB Strategy ("effective global TB control"). We also considered pessimistic scenarios of flat TB incidence trends in individual countries.We estimated TB cases, TB deaths, costs, and the total economic burden of TB in the US. Compared to the base-case, effective global TB control would avert 40,000 (95% uncertainty interval: 29,000-55,000) TB cases in the United States over 2020-2035. TB incidence rates in 2035 would be 43% (34-54) lower than the base-case, and 49% (44-55) lower than in 2020. Summed over 2020-2035, this represents $0.8 (0.6-1.0) billion dollars in averted healthcare costs and $2.5 (1.7-3.6) billion in productivity gains. The total US economic burden of TB (including the value of averted TB deaths) would be 21% (16-28) lower ($18 (8-32) billion).In addition to producing major health benefits for high-burden countries, strengthened efforts to achieve effective global TB control could produce substantial health and economic benefits for the United States.

    View details for DOI 10.1164/rccm.202003-0526OC

    View details for PubMedID 32645277

  • Partnering with Facebook on a university-based rapid turn-around global survey SURVEY RESEARCH METHODS Kreuter, F., Barkay, N., Bilinski, A., Bradford, A., Chiu, S., Eliat, R., Fan, J., Galili, T., Haimovich, D., Kim, B., LaRocca, S., Li, Y., Morris, K., Presser, S., Salomon, J. A., Sarig, T., Stewart, K., Stuart, E. A., Tibshirani, R. 2020; 14 (2): 159–62
  • ESTIMATION AND CORRECTION OF BIAS IN NETWORK SIMULATIONS BASED ON RESPONDENT-DRIVEN SAMPLING DATA Zhu, L., Menzies, N. A., Wang, J., Linas, B. P., Goodreau, S. M., Salomon, J. A. SAGE PUBLICATIONS INC. 2020: E297–E299
  • AN AGENT-BASED NETWORK MODEL OF HEPATITIS C VIRUS TRANSMISSION AMONG PEOPLE WHO INJECT DRUGS CALIBRATED TO A HIGH-BURDEN RURAL POPULATION IN THE UNITED STATES Zhu, L., Havens, J. R., Rudolph, A. E., Young, A. M., Yazdi, G., Thompson, W. W., Hagan, L., Randall, L. M., Linas, B. P., Salomon, J. A. SAGE PUBLICATIONS INC. 2020: E262–E263
  • ADAPTIVE GUIDELINES FOR THE TREATMENT OF GONORRHEA INFECTION TO INCREASE THE EFFECTIVE LIFESPAN OF ANTIBIOTICS IN THE CONTEXT OF RISING ANTIMICROBIAL RESISTANCE: A MATHEMATICAL MODELING STUDY Yaesoubi, R., Cohen, T., Hsu, K., Gift, T., Chesson, H., Salomon, J., Grad, Y. SAGE PUBLICATIONS INC. 2020: E289–E291
  • COST-EFFECTIVENESS OF POST-TREATMENT FOLLOW-UP AND SECONDARY PREVENTION OF TUBERCULOSIS IN A HIGH-INCIDENCE SETTING - A MODEL-BASED ANALYSIS Marx, F., Cohen, T., Menzies, N., Salomon, J., Yaesoubi, R. SAGE PUBLICATIONS INC. 2020: E360–E361
  • CALIBRATION TO CROSS-SECTIONAL DATA WHEN BIRTH COHORT TRENDS EXIST AS EXEMPLIFIED BY MODELS OF HEAVY DRINKING IN CHINA: CONSISTENCY WITH CALIBRATION TARGETS DESPITE MARKEDLY DIFFERENT PARAMETERS AND FUTURE PROJECTIONS Lee, K., Salomon, J. A., Goldhaber-Fiebert, J. D. SAGE PUBLICATIONS INC. 2020: E125–E126
  • CALIBRATION TO CROSS-SECTIONAL DATA WHEN BIRTH COHORT TRENDS EXIST AS EXEMPLIFIED BY MODELS OF HEAVY DRINKING IN CHINA: CONSISTENCY WITH CALIBRATION TARGETS DESPITE MARKEDLY DIFFERENT PARAMETERS AND FUTURE PROJECTIONS Lee, K., Salomon, J., Goldhaber-Fiebert, J. D. SAGE PUBLICATIONS INC. 2020: E378–E379
  • AGE- AND TIME-TRENDS IN HARMFUL ALCOHOL USE IN CHINA: PROJECTING BURDEN AND THE POTENTIAL FOR INTERVENTION BENEFIT Lee, K., Salomon, J., Goldhaber-Fiebert, J. D. SAGE PUBLICATIONS INC. 2020: E49–E50
  • META-MODELLING FOR POLICY SIMULATIONS WITH MULTIVARIATE OUTCOMES Zhong, H., Yazdi, G., Wang, J., Nolen, S., Linas, B. P., Brandeau, M. L., Salomon, J. SAGE PUBLICATIONS INC. 2020: E69–E70
  • Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 LANCET HIV Frank, T. D., Carter, A., Jahagirdar, D., Biehl, M. H., Douwes-Schultz, D., Larson, S., Arora, M., Dwyer-Lindgren, L., Steuben, K. M., Abbastabar, H., Abu-Raddad, L., Abyu, D., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adetokunboh, O. O., Ahmadi, A., Ahmadi, K., Ahmadian, E., Ahmadpour, E., Ahmed, M., Akal, C., Alahdab, F., Alam, N., Albertson, S. B., Alemnew, B. T., Alene, K., Alipour, V., Alvis-Guzman, N., Amini, S., Anbari, Z., Anber, N., Anjomshoa, M., Antonio, C. T., Arabloo, J., Aremu, O., Areri, H., Asfaw, E., Ashagre, A., Asmelash, D., Asrat, A. A., Avokpaho, E. A., Awasthi, A., Awoke, N., Ayanore, M., Azari, S., Badawi, A., Bagherzadeh, M., Banach, M., Barac, A., Barnighausen, T., Basu, S., Bedi, N., Behzadifar, M., Bekele, B., Belay, S., Belay, Y., Belayneh, Y., Berhane, A., Bhat, A., Bhattacharyya, K., Biadgo, B., Bijani, A., Bin Sayeed, M., Bitew, H., Blinov, A., Bogale, K., Bojia, H., Nagaraja, S., Butt, Z. A., Cahuana-Hurtado, L., Rincon, J., Carvalho, F., Chattu, V., Christopher, D. J., Chu, D., Crider, R., Dahiru, T., Dandona, L., Dandona, R., Daryani, A., das Neves, J., De Neve, J., Degenhardt, L., Demeke, F., Demis, A., Demissie, D., Demoz, G., Deribe, K., Des Jarlais, D., Dhungana, G., Diaz, D., Djalalinia, S., Huyen Phuc Do, Linh Phuong Doan, Duber, H., Dubey, M., Dubljanin, E., Duken, E., Adema, B., Effiong, A., Eftekhari, A., Zaki, M., El-Jaafary, S., El-Khatib, Z., Elsharkawy, A., Endries, A., Eskandarieh, S., Eyawo, O., Farzadfar, F., Fatima, B., Fentahun, N., Fernandes, E., Filip, I., Fischer, F., Folayan, M., Foroutan, M., Fukumoto, T., Fullman, N., Garcia-Basteiro, A. L., Gayesa, R., Gebremedhin, K., Gebremeskel, G., Gebreyohannes, K., Gedefaw, G., Gelaw, B. K., Gesesew, H., Geta, B., Gezae, K., Ghadiri, K., Ghashghaee, A., Ginindza, T. G., Gugnani, H., Guimares, R., Haile, M., Hailu, G., Haj-Mirzaian, A., Haj-Mirzaian, A., Hamidi, S., Handanagic, S., Handiso, D., Hanfore, L., Hasanzadeh, A., Hassankhani, H., Hassen, H., Hay, S., Henok, A., Chi Linh Hoang, Hosgood, H., Hosseinzadeh, M., Hsairi, M., Ibitoye, S., Idrisov, B., Ikuta, K. S., Ilesanmi, O., Irvani, S., Iwu, C., Jacobsen, K. H., James, S. L., Jenabi, E., Jha, R., Jonas, J. B., Shushtari, Z., Kabir, A., Kabir, Z., Kadel, R., Kasaeian, A., Kassa, B., Kassa, G., Kassa, T., Kayode, G. A., Kebede, M. M., Kefale, A., Kengne, A., Khader, Y., Khafaie, M., Khalid, N., Khan, E., Khan, G., Khan, J., Khang, Y., Khatab, K., Khazaei, S., Khoja, A. T., Kiadaliri, A. A., Kim, Y., Kisa, A., Kisa, S., Kochhar, S., Komaki, H., Koul, P. A., Koyanagi, A., Defo, B., Kumar, G., Kumar, M., Kuupiel, D., Lal, D., Lee, J., Lenjebo, T., Leshargie, C., Macarayan, E., Maddison, E. R., Abd El Razek, H., Magis-Rodriguez, C., Mahasha, P., Majdan, M., Majeed, A., Malekzadeh, R., Manafi, N., Mapoma, C., Martins-Melo, F., Masaka, A., Mayenga, E., Mehta, V., Meles, G., Meles, H., Melese, A., Melku, M., Memiah, P. N., Memish, Z. A., Mena, A., Mendoza, W., Mengistu, D., Mengistu, G., Meretoja, T. J., Mestrovic, T., Miller, T. R., Moazen, B., Mohajer, B., Mohamadi-Bolbanabad, A., Mohammad, K., Mohammad, Y., Darwesh, A., Mezerji, N., Mohammadi, M., Mohammadibakhsh, R., Mohammadoo-Khorasani, M., Mohammed, J., Mohammed, S., Mohebi, F., Mokdad, A. H., Moodley, Y., Moossavi, M., Moradi, G., Moradi-Lakeh, M., Moschos, M. M., Mossie, T., Mousavi, S., Muchie, K., Muluneh, A., Muriithi, M. K., Mustafa, G., Muthupandian, S., Nagarajan, A., Naik, G., Najafi, F., Nazari, J., Ndwandwe, D., Cuong Tat Nguyen, Huong Lan Thi Nguyen, Son Hoang Nguyen, Trang Huyen Nguyen, Ningrum, D., Nixon, M. R., Nnaji, C. A., Noroozi, M., Noubiap, J., Shiadeh, M., Obsa, M., Odame, E., Ofori-Asenso, R., Ogbo, F., Okoro, A., Oladimeji, O., Olagunju, A. T., Olagunju, T. O., Olum, S., Asante, K., Oren, E., Otstavnov, S. S., Mahesh, P. A., Padubidri, J., Pakhale, S., Pakpour, A. H., Patel, S., Paulos, K., Pepito, V., Peprah, E. K., Piroozi, B., Pourshams, A., Qorbani, M., Rabiee, M., Rabiee, N., Radfar, A., Rafay, A., Rafiei, A., Rahim, F., Rahimi-Movaghar, A., Rahimi-Movaghar, V., Rahman, S., Ranabhat, C., Rawaf, S., Reis, C., Renjith, V., Reta, M., Rezai, M., Rios Gonazlez, C., Roro, E., Rostami, A., Rubino, S., Moghaddam, S., Safari, S., Sagar, R., Sahraian, M., Salem, M., Salimi, Y., Salomon, J. A., Sambala, E., Samy, A. M., Sartorius, B., Satpathy, M., Sawhney, M., Sayyah, M., Schutte, A., Sepanlou, S. G., Seyedmousavi, S., Shabaninejad, H., Shaheen, A. A., Shaikh, M., Shallo, S., Shamsizadeh, M., Sharifi, H., Shibuya, K., Shin, J., Shirkoohi, R., Santos Silva, D., Alves Silveira, D., Singh, J. A., Sisay, M. M., Sisay, M., Sisay, S., Smith, A. E., Sokhan, A., Somayaji, R., Soshnikov, S., Stein, D. J., Sufiyan, M., Sunguya, B. F., Sykes, B. L., Tadesse, B., Tadesse, D., Tamirat, K., Taveira, N., Tekelemedhin, S., Temesgen, H., Tesfay, F., Teshale, M., Thapa, S., Tlaye, K., Topp, S. M., Tovani-Palone, M., Bach Xuan Tran, Khanh Bao Tran, Ullah, I., Unnikrishnan, B., Uthman, O. A., Veisani, Y., Vladimirov, S., Wada, F., Waheed, Y., Weldegwergs, K., Weldesamuel, G. T., Westerman, R., Wijeratne, T., Wolde, H., Wondafrash, D., Wonde, T., Wondmagegn, B., Yeshanew, A., Yilma, M., Yimer, E. M., Yonemoto, N., Yotebieng, M., Youm, Y., Yu, C., Zaidi, Z., Zarghi, A., Zenebe, Z., Zewale, T., Ziapour, A., Zodpey, S., Naghavi, M., Vollset, S., Wang, H., Lim, S. S., Kyu, H., L Murray, C. J., GBD 2017 HIV Collaborators 2019; 6 (12): E831–E859

    Abstract

    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.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.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.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.Bill & Melinda Gates Foundation, National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.

    View details for DOI 10.1016/S2352-3018(19)30196-1

    View details for Web of Science ID 000500912300019

    View details for PubMedID 31439534

  • Integrating Economic Evaluation and Implementation Science to Advance the Global HIV Response. Journal of acquired immune deficiency syndromes (1999) Salomon, J. A. 2019; 82 Suppl 3: S314–S321

    Abstract

    BACKGROUND: Numerous cost-effectiveness analyses have indicated good value for money from a wide array of interventions for treatment and prevention of HIV/AIDS. There is limited evidence, however, regarding how cost-effectiveness information contributes to better decision-making around investment and action in the global HIV response.METHODS: We review challenges for economic evaluation relevant to the global HIV response and consider how the practice of cost-effectiveness analysis could integrate approaches and insights from implementation science to enhance the impact and efficiency of HIV investments.RESULTS: In light of signals that cost-effectiveness analyses may be vulnerable to systematic bias toward overly optimistic conclusions, we emphasize two priorities for advancing the field of economic evaluation in HIV/AIDS and more broadly in global health: (1) systematic reevaluation of the cost-effectiveness literature with reference to ex-post empirical evidence on costs and effects in real-world programs and (2) development and adoption of good-practice guidelines for incorporating implementation and delivery aspects into economic evaluations. Toward the latter aim, we propose an integrative approach that focuses on comparative evaluation of strategies, which specify both technologies/interventions as well as the delivery platforms, complementary interventions, and actions needed to increase coverage, quality, and uptake of those technologies/interventions. Specific recommendations draw on several existing implementation science models that provide systematic frameworks for understanding implementation barriers and enablers, designing and choosing specific implementation and policy actions, and evaluating outcomes.DISCUSSION: These preliminary steps aimed at bridging the divide between economic evaluation and implementation science can help to advance the practice of economic evaluation toward a science of comparative strategy evaluation.

    View details for DOI 10.1097/QAI.0000000000002219

    View details for PubMedID 31764269

  • A review of network simulation models of hepatitis C virus and HIV among people who inject drugs. The International journal on drug policy Bellerose, M., Zhu, L., Hagan, L. M., Thompson, W. W., Randall, L. M., Malyuta, Y., Salomon, J. A., Linas, B. P. 2019: 102580

    Abstract

    Network modelling is a valuable tool for simulating hepatitis C virus (HCV) and HIV transmission among people who inject drugs (PWID) and assessing the potential impact of treatment and harm-reduction interventions. In this paper, we review literature on network simulation models, highlighting key structural considerations and questions that network models are well suited to address. We describe five approaches (Erdos-Renyi, Stochastic Block, Watts-Strogatz, Barabasi-Albert, and Exponential Random Graph Model) used to model partnership formation with emphasis on the strengths of each approach in simulating different features of real-world PWID networks. We also review two important structural considerations when designing or interpreting results from a network simulation study: (1) dynamic vs. static network and (2) injection only vs. both injection and sexual networks. Dynamic network simulations allow partnerships to evolve and disintegrate over time, capturing corresponding shifts in individual and population-level risk behaviour; however, their high level of complexity and reliance on difficult-to-observe data has driven others to develop static network models. Incorporating both sexual and injection partnerships increases model complexity and data demands, but more accurately represents HIV transmission between PWID and their sexual partners who may not also use drugs. Network models add the greatest value when used to investigate how leveraging network structure can maximize the effectiveness of health interventions and optimize investments. For example, network models have shown that features of a given network and epidemic influence whether the greatest community benefit would be achieved by allocating hepatitis C or HIV treatment randomly, versus to those with the most partners. They have also demonstrated the potential for syringe services and "buddy sharing" programs to reduce disease transmission.

    View details for DOI 10.1016/j.drugpo.2019.10.006

    View details for PubMedID 31740175

  • Measuring and correcting bias in indirect estimates of under-5 mortality in populations affected by HIV/AIDS: a simulation study. BMC public health Quattrochi, J., Salomon, J. A., Hill, K., Castro, M. C. 2019; 19 (1): 1516

    Abstract

    BACKGROUND: In populations that lack vital registration systems, under-5 mortality (U5M) is commonly estimated using survey-based approaches, including indirect methods. One assumption of indirect methods is that a mother's survival and her children's survival are not correlated, but in populations affected by HIV/AIDS this assumption is violated, and thus indirect estimates are biased. Our goal was to estimate the magnitude of the bias, and to create a predictive model to correct it.METHODS: We used an individual-level, discrete time-step simulation model to measure how the bias in indirect estimates of U5M changes under various fertility rates, mortality rates, HIV/AIDS rates, and levels of antiretroviral therapy. We simulated 4480 populations in total and measured the amount of bias in U5M due to HIV/AIDS. We also developed a generalized linear model via penalized maximum likelihood to correct this bias.RESULTS: We found that indirect methods can underestimate U5M by 0-41% in populations with HIV prevalence of 0-40%. Applying our model to 2010 survey data from Malawi and Tanzania, we show that indirect methods would underestimate U5M by up to 7.7% in those countries at that time. Our best fitting model to correct bias in U5M had a root median square error of 0.0012.CONCLUSIONS: Indirect estimates of U5M can be significantly biased in populations affected by HIV/AIDS. Our predictive model allows scholars and practitioners to correct that bias using commonly measured population characteristics. Policies and programs based on indirect estimates of U5M in populations with generalized HIV epidemics may need to be reevaluated after accounting for estimation bias.

    View details for DOI 10.1186/s12889-019-7780-3

    View details for PubMedID 31718615

  • Comparative Modelling of Tuberculosis Epidemiology and Policy Outcomes in California. American journal of respiratory and critical care medicine Menzies, N. A., Parriott, A., Shrestha, S., Dowdy, D. W., Cohen, T., Salomon, J. A., Marks, S. M., Hill, A. N., Winston, C. A., Asay, G., Barry, P., Readhead, A., Flood, J., Kahn, J. G., Shete, P. B. 2019

    Abstract

    Rationale Mathematical modelling is used to understand disease dynamics, forecast trends, and inform public health prioritization. We conducted a comparative analysis of tuberculosis (TB) epidemiology and potential intervention effects in California, using three previously developed epidemiologic models of TB. Measurements and Methods We compared model results between 2005 and 2050 under a base case scenario representing current TB services, and alternative scenarios including: (i) sustained interruption of Mycobacterium tuberculosis (Mtb) transmission, (ii) sustained resolution of latent TB infection (LTBI) and TB prior to entry of new residents, and (iii) one-time targeted testing and treatment of LTBI among 25% of non-US-born individuals residing in California. Results Model estimates of TB cases and deaths in California were in close agreement over the historical period but diverged for LTBI prevalence and new Mtb infections-outcomes for which definitive data are unavailable. Between 2018 and 2050, models projected average annual declines of 0.58-1.42% in TB cases, without additional interventions. A one-time LTBI testing and treatment intervention among non-US-born residents was projected to produce sustained reductions in TB incidence. Models found prevalent Mtb infection and migration to be more significant drivers of future TB incidence than local transmission. Conclusions All models projected a stagnation in the decline of TB incidence, highlighting the need for additional interventions including greater access to LTBI diagnosis and treatment for non-US-born individuals. Differences in model results reflect gaps in historical data and uncertainty in the trends of key parameters, demonstrating the need for high-quality, up-to-date TB determinant and outcome data.

    View details for DOI 10.1164/rccm.201907-1289OC

    View details for PubMedID 31626560

  • Open vs Laparoscopic vs Robotic Surgery for Rectal Cancer: A Cost-Effectiveness Analysis Chandler, J. M., Conway, A. A., Huckels, J., Pooni, R. K., Zarnett, L. J., Lee, K., Kin, C. J., Salomon, J. A., Owens, D. K. ELSEVIER SCIENCE INC. 2019: S67
  • Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Ronn, M. M., Menzies, N. A., Gift, T. L., Chesson, H. W., Trikalinos, T. A., Bellerose, M., Malyuta, Y., Berruti, A., Gaydos, C. A., Hsu, K. K., Salomon, J. A. 2019

    Abstract

    BACKGROUND: Point-of-care testing (POCT) assays for chlamydia are being developed. Their potential impact on the burden of chlamydial infection in the United States, in light of suboptimal screening coverage, remains unclear.METHODS: Using a transmission model calibrated to data in the United States, we estimated the impact of POCT on chlamydia prevalence, incidence, and chlamydia-attributable pelvic inflammatory disease (PID) incidence, assuming status quo (Analysis 1) and improved (Analysis 2) screening frequencies. We tested the robustness of results to changes in POCT sensitivity, the proportion of patients getting treated immediately, the baseline proportion lost to follow-up (LTFU), and the average treatment delay.RESULTS: In Analysis 1, high POCT sensitivity was needed to reduce the chlamydia-associated burden. With a POCT sensitivity of 90%, reductions from the baseline burden only occurred in scenarios in which over 60% of the screened individuals would get immediate treatment and the baseline LTFU proportion was 20%. With a POCT sensitivity of 99% (baseline LTFU 10%, 2-week treatment delay), if everyone were treated immediately, the prevalence reduction was estimated at 5.7% (95% credible interval [CrI] 3.9-8.2%). If only 30% of tested persons would wait for results, the prevalence reduction was only 1.6% (95% CrI 1.1-2.3). POCT with 99% sensitivity could avert up to 12 700 (95% CrI 5000-22 200) PID cases per year, if 100% were treated immediately (baseline LTFU 20% and 3-week treatment delay). In Analysis 2, when POCT was coupled with increasing screening coverage, reductions in the chlamydia burden could be realized with a POCT sensitivity of 90%.CONCLUSIONS: POCT could improve chlamydia prevention efforts if test performance characteristics are significantly improved over currently available options.

    View details for DOI 10.1093/cid/ciz519

    View details for PubMedID 31504314

  • Is knowledge of HIV status associated with sexual behaviours? A fixed effects analysis of a female sex worker cohort in urban Uganda. Journal of the International AIDS Society Ortblad, K. F., Musoke, D. K., Ngabirano, T., Salomon, J. A., Haberer, J. E., McConnell, M., Oldenburg, C. E., Barnighausen, T. 2019; 22 (7): e25336

    Abstract

    INTRODUCTION: Female sex workers (FSWs) have strong economic incentives for sexual risk-taking behaviour. We test whether knowledge of HIV status affects such behaviours among FSWs.METHODS: We used longitudinal data from a FSW cohort in urban Uganda, which was formed as part of an HIV self-testing trial with four months of follow-up. Participants reported perceived knowledge of HIV status, number of clients per average working night, and consistent condom use with clients at baseline, one month, and four months. We measured the association between knowledge of HIV status and FSWs' sexual behaviours using linear panel regressions with individual fixed effects, controlling for study round and calendar time.RESULTS: Most of the 960 participants tested for HIV during the observation period (95%) and experienced a change in knowledge of HIV status (71%). Knowledge of HIV status did not affect participants' number of clients but did affect their consistent condom use. After controlling for individual fixed effects, study round and calendar month, knowledge of HIV-negative status was associated with a significant increase in consistent condom use by 9.5 percentage points (95% CI 5.2 to 13.5, p<0.001), while knowledge of HIV-positive status was not associated with a significant change in consistent condom use (2.5 percentage points, 95% CI -8.0 to 3.1, p=0.38).CONCLUSIONS: In urban Uganda, FSWs engaged in safer sex with clients when they perceived that they themselves were not living with HIV. Even in communities with very high HIV prevalence, the majority of the population will test HIV-negative. Our results thus imply that expansion of HIV testing programmes may serve as a behavioural HIV prevention measure among FSWs.

    View details for DOI 10.1002/jia2.25336

    View details for PubMedID 31287625

  • OPTIMIZING SCREENING FOR CHLAMYDIA: IS THERE A ROLE FOR SCREENING HETEROSEXUAL MEN? Ronn, M., Gift, T., Chesson, H., Malyuta, Y., Hsu, K., Salomon, J. BMJ PUBLISHING GROUP. 2019: A70
  • HIV treatment cascade for older adults in rural South Africa. Sexually transmitted infections Rohr, J. K., Manne-Goehler, J., Gomez-Olive, F. X., Wagner, R. G., Rosenberg, M., Geldsetzer, P., Kabudula, C., Kahn, K., Tollman, S., Barnighausen, T., Salomon, J. A. 2019

    Abstract

    OBJECTIVES: The HIV treatment cascade is a powerful framework for understanding progress from initial diagnosis to successful treatment. Data sources for cascades vary and often are based on clinical cohorts, population cohorts linked to clinics, or self-reported information. We use both biomarkers and self-reported data from a large population-based cohort of older South Africans to establish the first HIV cascade for this growing segment of the HIV-positive population and compare results using the different data sources.METHODS: Data came from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) 2015 baseline survey of 5059 adults aged 40+ years. Dried blood spots (DBS) were screened for HIV, antiretroviral drugs and viral load. In-home surveys asked about HIV testing, diagnosis and antiretroviral therapy (ART) use. We calculated proportions and CIs for each stage of the cascade, conditional on attainment of the previous stage, using (1) biomarkers, (2) self-report and (3) both biomarkers and self-report, and compared with UNAIDS 90-90-90 targets.RESULTS: 4560 participants had DBS results, among whom 1048 (23%) screened HIV-positive and comprised the denominator for each cascade. The biomarker cascade showed 63% (95% CI 60 to 66) on ART and 72% (95% CI 69 to 76) of those on ART with viral suppression. Self-reports underestimated testing, diagnosis and ART, with only 47% (95% CI 44 to 50) of HIV-positive individuals reporting ART use. The combined cascade indicated high HIV testing (89% (95% CI 87 to 91)), but lower knowledge of HIV-positive status (71% (95% CI 68 to 74)).CONCLUSIONS: Older South Africans need repeated HIV testing and sustained ART to reach 90-90-90 targets. HIV cascades relying on self-reports are likely to underestimate true cascade attainment, and biomarkers provide substantial improvements to cascade estimates.

    View details for DOI 10.1136/sextrans-2018-053925

    View details for PubMedID 31243144

  • Depressive Symptoms and Their Relation to Age and Chronic Diseases Among Middle-Aged and Older Adults in Rural South Africa JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Geldsetzer, P., Vaikath, M., Wagner, R., Rohr, J. K., Montana, L., Gomez-Olive, F. X., Rosenberg, M. S., Manne-Goehler, J., Mateen, F. J., Payne, C. F., Kahn, K., Tollman, S. M., Salomon, J. A., Gaziano, T. A., Baernighausen, T., Berkman, L. F. 2019; 74 (6): 957–63
  • The Effect of HIV Self-Testing Delivery Models on Female Sex Workers' Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda AIDS AND BEHAVIOR Ortblad, K. F., Musoke, D., Ngabirano, T., Nakitende, A., Harling, G., Haberer, J. E., McConnell, M., Salomon, J. A., Oldenburg, C. E., Barnighausen, T. 2019; 23 (5): 1225–39
  • The impact of Medicare part D on income-related inequality in pharmaceutical expenditure. International journal for equity in health Carvalho, N., Petrie, D., Chen, L., Salomon, J. A., Clarke, P. 2019; 18 (1): 57

    Abstract

    BACKGROUND: Income-related inequality measures such as the concentration index are often used to describe the unequal distribution of health, health care access, or expenditure in a single measure. This study demonstrates the use of such measures to evaluate the distributional impact of changes in health insurance coverage. We use the example of Medicare Part D in the United States, which increased access to prescription medications for Medicare beneficiaries from 2006.METHODS: Using pooled cross-sectional samples from the Medical Expenditure Panel Survey for 1997-2011, we estimated income-related inequality in drug expenditures over time using the concentration and generalised concentration indices. A difference-in-differences analysis investigated the change in inequality in drug expenditures, as measured using the concentration index and generalised concentration index, between the elderly (over 65years) and near-elderly (54-63years) pre- and post-implementation of Medicare Part D.RESULTS: Medicare Part D increased public drug expenditure while out-of-pocket and private spending fell. Public drug expenditures favoured the poor during all study periods, but the degree of pro-poorness declined in the years immediately following the implementation of Part D, with the poor gaining less than the rich in both relative and absolute terms. Part D also appeared to result in a fall in the pro-richness of private insurance drug expenditure in absolute terms but have minimal distributional impact on out-of-pocket expenditure. These effects appeared to be short lived, with a return to the prevailing trends in both concentration and generalised concentration indices several years following the start of Part D.CONCLUSIONS: The implementation of Medicare Part D significantly reduced the degree of pro-poorness in public drug expenditure. The poor gained less of the increased public drug expenditure than the rich in both relative and absolute terms. This study demonstrates how income-related inequality measures can be used to estimate the impact of health system changes on inequalities in health expenditure and provides a guide for future evaluations.

    View details for PubMedID 30992000

  • The Impact of Screening and Partner Notification on Chlamydia Prevalence and Numbers of Infections Averted in the United States, 2000-2015: Evaluation of Epidemiologic Trends Using a Pair-Formation Transmission Model AMERICAN JOURNAL OF EPIDEMIOLOGY Ronn, M. M., Tuite, A. R., Menzies, N. A., Wolf, E. E., Gift, T. L., Chesson, H. W., Torrone, E., Berruti, A., Mazzola, E., Galer, K., Hsu, K., Salomon, J. A. 2019; 188 (3): 545–54

    View details for DOI 10.1093/aje/kwy272

    View details for Web of Science ID 000467881700007

  • Does Incident Circumcision Lead to Risk Compensation? Evidence From a Population Cohort in KwaZulu-Natal, South Africa JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES Ortblad, K. F., Harling, G., Chimbindi, N., Tanser, F., Salomon, J. A., Baernighausen, T. 2019; 80 (3): 269–75
  • Short-Term Effects and Long-Term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care OBSTETRICS AND GYNECOLOGY Tasillo, A., Yazdi, G., Nolen, S., Schillie, S., Vellozzi, C., Epstein, R., Randall, L., Salomon, J. A. 2019; 133 (2): 289–300
  • The Effect of HIV Self-Testing Delivery Models on Female Sex Workers' Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda. AIDS and behavior Ortblad, K. F., Kibuuka Musoke, D., Ngabirano, T., Nakitende, A., Harling, G., Haberer, J. E., McConnell, M., Salomon, J. A., Oldenburg, C. E., Barnighausen, T. 2019

    Abstract

    HIV self-testing increases recent and frequent HIV testing among female sex workers (FSWs) in urban Uganda. Using results from a randomized controlled trial, we aim to establish the effect of HIV self-testing delivery models on FSWs' sexual behaviors in this setting. Clusters of one peer educator and eight participants were 1:1:1 randomized to: (1) direct provision of an HIV self-test, (2) provision of a coupon for facility collection of an HIV self-test, or (3) referral to standard-of-care HIV testing services. Sexual behaviors were self-reported at 1 and 4months. From October to November 2016, 960 participants were enrolled and randomized. At 4months, there were no statistically significant differences in participants' sexual behaviors, including inconsistent condom use, across study arms. We do not find any changes in sexual risk-taking among FSWs in response to the delivery of HIV self-tests. Routine policies for HIV self-testing are likely a behaviorally safe component of comprehensive HIV prevention strategies.

    View details for PubMedID 30652205

  • Short-Term Effects and Long-Term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care. Obstetrics and gynecology Tasillo, A., Eftekhari Yazdi, G., Nolen, S., Schillie, S., Vellozzi, C., Epstein, R., Randall, L., Salomon, J. A., Linas, B. P. 2019

    Abstract

    OBJECTIVE: To estimate the clinical effects and cost-effectiveness of universal prenatal hepatitis C screening, and to calculate potential life expectancy, quality of life, and health care costs associated with universal prenatal hepatitis C screening and linkage to treatment.METHODS: Using a stochastic individual-level microsimulation model, we simulated the lifetimes of 250 million pregnant women matched at baseline with the U.S. childbearing population on age, injection drug use behaviors, and hepatitis C virus (HCV) infection status. Modeled outcomes included hepatitis C diagnosis, treatment and cure, lifetime health care costs, quality-adjusted life years (QALY) and incremental cost-effectiveness ratios comparing universal prenatal hepatitis C screening to current practice. We modeled whether neonates exposed to maternal HCV at birth were identified as such.RESULTS: Pregnant women with hepatitis C infection lived 1.21 years longer and had 16% lower HCV-attributable mortality with universal prenatal hepatitis C screening, which had an incremental cost-effectiveness ratio of $41,000 per QALY gained compared with current practice. Incremental cost-effectiveness ratios remained below $100,000 per QALY gained in most sensitivity analyses; notable exceptions included incremental cost-effectiveness ratios above $100,000 when assuming mean time to cirrhosis of 70 years, a cost greater than $500,000 per false positive diagnosis, or population HCV infection prevalence below 0.16%. Universal prenatal hepatitis C screening increased identification of neonates exposed to HCV at birth from 44% to 92%.CONCLUSIONS: In our model, universal prenatal hepatitis C screening improves health outcomes in women with HCV infection, improves identification of HCV exposure in neonates born at risk, and is cost-effective.

    View details for PubMedID 30633134

  • The Impact of Screening and Partner Notification on Chlamydia in the United States, 2000-2015: Evaluation of Epidemiologic Trends Using a Pair-Formation Transmission Model. American journal of epidemiology Ronn, M. M., Tuite, A. R., Menzies, N. A., Wolf, E. E., Gift, T. L., Chesson, H. W., Torrone, E., Berruti, A., Mazzola, E., Galer, K., Hsu, K., Salomon, J. A. 2019

    Abstract

    Population-level effects of chlamydia control strategies on chlamydia transmission dynamics are difficult to quantify. In this study, we calibrated a novel sex- and age-stratified pair-formation transmission model of chlamydial infection to epidemiological data in the United States for 2000-2015. We used sex- and age-specific prevalence estimates from the National Health and Nutrition Examination Surveys, case report data from national chlamydia surveillance, and survey data from the Youth Risk Behavior Survey on the proportion of sexually active 15-18 year-old population. We were able to reconcile national prevalence estimates and case report data by allowing for changes over time in screening coverage and reporting completeness. In retrospective analysis, we found that in the absence of chlamydia screening and partner notification, chlamydia prevalence would be approximately twice as great in 2015 as currently estimated levels. Although chlamydia screening and partner notification were both found to reduce chlamydia burden, the relative magnitude of their estimated impact varied in our sensitivity analyses. The variation in the model predictions highlights the need for further data collection and research to improve our understanding of the natural history of chlamydia and the pathways through which prevention strategies affect transmission dynamics.

    View details for PubMedID 30608525

  • The Estimation and Projection Package Age-Sex Model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa. AIDS (London, England) Eaton, J. W., Brown, T. n., Puckett, R. n., Glaubius, R. n., Mutai, K. n., Bao, L. n., Salomon, J. A., Stover, J. n., Mahy, M. n., Hallett, T. B. 2019; 33 Suppl 3: S235–S244

    Abstract

    Improve models for estimating HIV epidemic trends in sub-Saharan Africa (SSA).Mathematical epidemic model fit to national HIV survey and ANC sentinel surveillance (ANC-SS) data.We modified EPP to incorporate age and sex stratification (EPP-ASM) to more accurately capture the shifting demographics of maturing HIV epidemics. Secondly, we developed a new functional form for the HIV transmission rate, termed 'r-hybrid', which combines a four-parameter logistic function for the initial epidemic growth, peak, and decline followed by a first-order random walk for recent trends after epidemic stabilization. We fitted the r-hybrid model along with previously developed r-spline and r-trend models to HIV prevalence data from household surveys and ANC-SS in 177 regions in 34 SSA countries. We used leave-one-out cross validation with household survey HIV prevalence to compare model predictions.The r-hybrid and r-spline models typically provided similar HIV prevalence trends, but sometimes qualitatively different assessments of recent incidence trends because of different structural assumptions about the HIV transmission rate. The r-hybrid model had the lowest average continuous ranked probability score, indicating the best model predictions. Coverage of 95% posterior predictive intervals was 91.5% for the r-hybrid model, versus 87.2 and 85.5% for r-spline and r-trend, respectively.The EPP-ASM and r-hybrid models improve consistency of EPP and Spectrum, improve the epidemiological assumptions underpinning recent HIV incidence estimates, and improve estimates and short-term projections of HIV prevalence trends. Countries that use general population survey and ANC-SS data to estimate HIV epidemic trends should consider using these tools.

    View details for DOI 10.1097/QAD.0000000000002437

    View details for PubMedID 31800403

  • Chronic multimorbidity among older adults in rural South Africa. BMJ global health Chang, A. Y., Gomez-Olive, F. X., Payne, C., Rohr, J. K., Manne-Goehler, J., Wade, A. N., Wagner, R. G., Montana, L., Tollman, S., Salomon, J. A. 2019; 4 (4): e001386

    Abstract

    Introduction: The rapid ageing of populations around the world is accompanied by increasing prevalence of multimorbidity. This study is one of the first to present the prevalence of multimorbidity that includes HIV in the complex epidemiological setting of South Africa, thus filling a gap in the multimorbidity literature that is dominated by studies in high-income or low-HIV prevalence settings.Methods: Out of the full sample of 5059 people aged 40+, we analysed cross-sectional data on 10 conditions from 3889 people enrolled in the Health and Ageing in Africa: A longitudinal study of an INDEPTH Community in South Africa (HAALSI) Programme. Two definitions of multimorbidity were applied: the presence of more than one condition and the presence of conditions from more than one of the following categories: cardiometabolic conditions, mental disorders, HIV and anaemia. We conducted descriptive and regression analyses to assess the relationship between prevalence of multimorbidity and sociodemographic factors. We examined the frequencies of the most prevalent combinations of conditions and assessed relationships between multimorbidity and physical and psychological functioning.Results: 69.4per cent (95%CI 68.0 to 70.9) of the respondents had at least two conditions and 53.9% (52.4-55.5) of the sample had at least two categories of conditions. The most common condition groups and multimorbid profiles were combinations of cardiometabolic conditions, cardiometabolic conditions and depression, HIV and anaemia and combinations of mental disorders. The commonly observed positive relationships between multimorbidity and age and decreasing wealth were not observed in this population, namelydue to different epidemiological profiles in the subgroups, with higher prevalence of HIV and anaemia in the poorer and younger groups, and higher prevalence of cardiometabolic conditions in the richer and older groups. Both physical functioning and well-being negatively associated with multimorbidity.Discussion: More coordinated, long-term integrated care management across multiple chronic conditions should be provided in rural South Africa.

    View details for DOI 10.1136/bmjgh-2018-001386

    View details for PubMedID 31423345

  • Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study. JAMA oncology Fitzmaurice, C. n., Abate, D. n., Abbasi, N. n., Abbastabar, H. n., Abd-Allah, F. n., Abdel-Rahman, O. n., Abdelalim, A. n., Abdoli, A. n., Abdollahpour, I. n., Abdulle, A. S., Abebe, N. D., Abraha, H. N., Abu-Raddad, L. J., Abualhasan, A. n., Adedeji, I. A., Advani, S. M., Afarideh, M. n., Afshari, M. n., Aghaali, M. n., Agius, D. n., Agrawal, S. n., Ahmadi, A. n., Ahmadian, E. n., Ahmadpour, E. n., Ahmed, M. B., Akbari, M. E., Akinyemiju, T. n., Al-Aly, Z. n., AlAbdulKader, A. M., Alahdab, F. n., Alam, T. n., Alamene, G. M., Alemnew, B. T., Alene, K. A., Alinia, C. n., Alipour, V. n., Aljunid, S. M., Bakeshei, F. A., Almadi, M. A., Almasi-Hashiani, A. n., Alsharif, U. n., Alsowaidi, S. n., Alvis-Guzman, N. n., Amini, E. n., Amini, S. n., Amoako, Y. A., Anbari, Z. n., Anber, N. H., Andrei, C. L., Anjomshoa, M. n., Ansari, F. n., Ansariadi, A. n., Appiah, S. C., Arab-Zozani, M. n., Arabloo, J. n., Arefi, Z. n., Aremu, O. n., Areri, H. A., Artaman, A. n., Asayesh, H. n., Asfaw, E. T., Ashagre, A. F., Assadi, R. n., Ataeinia, B. n., Atalay, H. T., Ataro, Z. n., Atique, S. n., Ausloos, M. n., Avila-Burgos, L. n., Avokpaho, E. F., Awasthi, A. n., Awoke, N. n., Ayala Quintanilla, B. P., Ayanore, M. A., Ayele, H. T., Babaee, E. n., Bacha, U. n., Badawi, A. n., Bagherzadeh, M. n., Bagli, E. n., Balakrishnan, S. n., Balouchi, A. n., Bärnighausen, T. W., Battista, R. J., Behzadifar, M. n., Behzadifar, M. n., Bekele, B. B., Belay, Y. B., Belayneh, Y. M., Berfield, K. K., Berhane, A. n., Bernabe, E. n., Beuran, M. n., Bhakta, N. n., Bhattacharyya, K. n., Biadgo, B. n., Bijani, A. n., Bin Sayeed, M. S., Birungi, C. n., Bisignano, C. n., Bitew, H. n., Bjørge, T. n., Bleyer, A. n., Bogale, K. A., Bojia, H. A., Borzì, A. M., Bosetti, C. n., Bou-Orm, I. R., Brenner, H. n., Brewer, J. D., Briko, A. N., Briko, N. I., Bustamante-Teixeira, M. T., Butt, Z. A., Carreras, G. n., Carrero, J. J., Carvalho, F. n., Castro, C. n., Castro, F. n., Catalá-López, F. n., Cerin, E. n., Chaiah, Y. n., Chanie, W. F., Chattu, V. K., Chaturvedi, P. n., Chauhan, N. S., Chehrazi, M. n., Chiang, P. P., Chichiabellu, T. Y., Chido-Amajuoyi, O. G., Chimed-Ochir, O. n., Choi, J. J., Christopher, D. J., Chu, D. T., Constantin, M. M., Costa, V. M., Crocetti, E. n., Crowe, C. S., Curado, M. P., Dahlawi, S. M., Damiani, G. n., Darwish, A. H., Daryani, A. n., das Neves, J. n., Demeke, F. M., Demis, A. B., Demissie, B. W., Demoz, G. T., Denova-Gutiérrez, E. n., Derakhshani, A. n., Deribe, K. S., Desai, R. n., Desalegn, B. B., Desta, M. n., Dey, S. n., Dharmaratne, S. D., Dhimal, M. n., Diaz, D. n., Dinberu, M. T., Djalalinia, S. n., Doku, D. T., Drake, T. M., Dubey, M. n., Dubljanin, E. n., Duken, E. E., Ebrahimi, H. n., Effiong, A. n., Eftekhari, A. n., El Sayed, I. n., Zaki, M. E., El-Jaafary, S. I., El-Khatib, Z. n., Elemineh, D. A., Elkout, H. n., Ellenbogen, R. G., Elsharkawy, A. n., Emamian, M. H., Endalew, D. A., Endries, A. Y., Eshrati, B. n., Fadhil, I. n., Fallah, V. n., Faramarzi, M. n., Farhangi, M. A., Farioli, A. n., Farzadfar, F. n., Fentahun, N. n., Fernandes, E. n., Feyissa, G. T., Filip, I. n., Fischer, F. n., Fisher, J. L., Force, L. M., Foroutan, M. n., Freitas, M. n., Fukumoto, T. n., Futran, N. D., Gallus, S. n., Gankpe, F. G., Gayesa, R. T., Gebrehiwot, T. T., Gebremeskel, G. G., Gedefaw, G. A., Gelaw, B. K., Geta, B. n., Getachew, S. n., Gezae, K. E., Ghafourifard, M. n., Ghajar, A. n., Ghashghaee, A. n., Gholamian, A. n., Gill, P. S., Ginindza, T. T., Girmay, A. n., Gizaw, M. n., Gomez, R. S., Gopalani, S. V., Gorini, G. n., Goulart, B. 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H., Monasta, L. n., Moodley, Y. n., Moosazadeh, M. n., Moossavi, M. n., Moradi, G. n., Moradi-Joo, M. n., Moradi-Lakeh, M. n., Moradpour, F. n., Morawska, L. n., Morgado-da-Costa, J. n., Morisaki, N. n., Morrison, S. D., Mosapour, A. n., Mousavi, S. M., Muche, A. A., Muhammed, O. S., Musa, J. n., Nabhan, A. R., Naderi, M. n., Nagarajan, A. J., Nagel, G. n., Nahvijou, A. n., Naik, G. n., Najafi, F. n., Naldi, L. n., Nam, H. S., Nasiri, N. n., Nazari, J. n., Negoi, I. n., Neupane, S. n., Newcomb, P. A., Nggada, H. A., Ngunjiri, J. W., Nguyen, C. T., Nikniaz, L. n., Ningrum, D. N., Nirayo, Y. L., Nixon, M. R., Nnaji, C. A., Nojomi, M. n., Nosratnejad, S. n., Shiadeh, M. N., Obsa, M. S., Ofori-Asenso, R. n., Ogbo, F. A., Oh, I. H., Olagunju, A. T., Olagunju, T. O., Oluwasanu, M. M., Omonisi, A. E., Onwujekwe, O. E., Oommen, A. M., Oren, E. n., Ortega-Altamirano, D. D., Ota, E. n., Otstavnov, S. S., Owolabi, M. O., P A, M. n., Padubidri, J. R., Pakhale, S. n., Pakpour, A. H., Pana, A. n., Park, E. K., Parsian, H. n., Pashaei, T. n., Patel, S. n., Patil, S. T., Pennini, A. n., Pereira, D. M., Piccinelli, C. n., Pillay, J. D., Pirestani, M. n., Pishgar, F. n., Postma, M. J., Pourjafar, H. n., Pourmalek, F. n., Pourshams, A. n., Prakash, S. n., Prasad, N. n., Qorbani, M. n., Rabiee, M. n., Rabiee, N. n., Radfar, A. n., Rafiei, A. n., Rahim, F. n., Rahimi, M. n., Rahman, M. A., Rajati, F. n., Rana, S. M., Raoofi, S. n., Rath, G. K., Rawaf, D. L., Rawaf, S. n., Reiner, R. C., Renzaho, A. M., Rezaei, N. n., Rezapour, A. n., Ribeiro, A. I., Ribeiro, D. n., Ronfani, L. n., Roro, E. M., Roshandel, G. n., Rostami, A. n., Saad, R. S., Sabbagh, P. n., Sabour, S. n., Saddik, B. n., Safiri, S. n., Sahebkar, A. n., Salahshoor, M. R., Salehi, F. n., Salem, H. n., Salem, M. R., Salimzadeh, H. n., Salomon, J. A., Samy, A. M., Sanabria, J. n., Santric Milicevic, M. 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R., Traini, E. n., Tran, B. X., Tran, K. B., Tsadik, A. G., Ullah, I. n., Uthman, O. A., Vacante, M. n., Vaezi, M. n., Varona Pérez, P. n., Veisani, Y. n., Vidale, S. n., Violante, F. S., Vlassov, V. n., Vollset, S. E., Vos, T. n., Vosoughi, K. n., Vu, G. T., Vujcic, I. S., Wabinga, H. n., Wachamo, T. M., Wagnew, F. S., Waheed, Y. n., Weldegebreal, F. n., Weldesamuel, G. T., Wijeratne, T. n., Wondafrash, D. Z., Wonde, T. E., Wondmieneh, A. B., Workie, H. M., Yadav, R. n., Yadegar, A. n., Yadollahpour, A. n., Yaseri, M. n., Yazdi-Feyzabadi, V. n., Yeshaneh, A. n., Yimam, M. A., Yimer, E. M., Yisma, E. n., Yonemoto, N. n., Younis, M. Z., Yousefi, B. n., Yousefifard, M. n., Yu, C. n., Zabeh, E. n., Zadnik, V. n., Moghadam, T. Z., Zaidi, Z. n., Zamani, M. n., Zandian, H. n., Zangeneh, A. n., Zaki, L. n., Zendehdel, K. n., Zenebe, Z. M., Zewale, T. A., Ziapour, A. n., Zodpey, S. n., Murray, C. J. 2019

    Abstract

    Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

    View details for DOI 10.1001/jamaoncol.2019.2996

    View details for PubMedID 31560378

  • The potential population-level impact of different gonorrhea screening strategies in Baltimore and San Francisco: an exploratory mathematical modeling analysis. Sexually transmitted diseases Rönn, M. M., Testa, C. n., Tuite, A. R., Chesson, H. W., Gift, T. L., Schumacher, C. n., Williford, S. L., Zhu, L. n., Bellerose, M. n., Earnest, R. n., Malyuta, Y. n., Hsu, K. K., Salomon, J. A., Menzies, N. A. 2019

    Abstract

    Baltimore and San Francisco represent high burden areas for gonorrhea in the United States. We explored different gonorrhea screening strategies and their comparative impact in the two cities.We used a compartmental transmission model of gonorrhea stratified by sex, sexual orientation, age, and race/ethnicity, calibrated to city-level surveillance data for 2010-2017. We analyzed the benefits of 5-year interventions which improved retention in care cascade or increased screening from current levels. We also examined a 1-year outreach screening intervention of high-activity populations.In Baltimore, annual screening of population aged 15-24 was the most efficient of the five-year interventions with 17.9 additional screening tests (95% Credible Interval [CrI] 11.8-31.4) needed per infection averted while twice annual screening of the same population averted the most infections (5.4%, 95%CrI 3.1-8.2%) overall with 25.3 (95%CrI 19.4-33.4) tests per infection averted. In San Francisco, quarter-annual screening of all men who have sex with men was the most efficient with 16.2 additional (95%CrI 12.5-44.5) tests needed per infection averted and it also averted the most infections (10.8%, 95%CrI 1.2-17.8%). Interventions that reduce loss to follow-up after diagnosis improved outcomes. Depending on the ability to of a short-term outreach screening to screen populations at higher acquisition risk, such interventions can offer efficient ways to expand screening coverage.Data on gonorrhea prevalence distribution and time trends locally would improve the analyses. More focused intervention strategies could increase the impact and efficiency of screening interventions.

    View details for DOI 10.1097/OLQ.0000000000001108

    View details for PubMedID 31842089

  • EPP-ASM and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa. AIDS (London, England) Eaton, J. W., Brown, T. n., Puckett, R. n., Glaubius, R. n., Mutai, K. n., Bao, L. n., Salomon, J. A., Stover, J. n., Mahy, M. n., Hallett, T. B. 2019

    Abstract

    Improve models for estimating HIV epidemic trends in sub-Saharan Africa (SSA).Mathematical epidemic model fit to national HIV survey and ANC sentinel surveillance (ANC-SS) data.We modified EPP to incorporate age and sex stratification (EPP-ASM) to more accurately capture the shifting demographics of maturing HIV epidemics. Secondly, we developed a new functional form, termed 'r-hybrid', for the HIV transmission rate which combines a four-parameter logistic function for the initial epidemic growth, peak, and decline followed by a first-order random walk for recent trends after epidemic stabilization. We fitted the r-hybrid model along with previously developed r-spline and r-trend models to HIV prevalence data from household surveys and ANC-SS in 177 regions in 34 SSA countries. We used leave-one-out cross validation with household survey HIV prevalence to compare model predictions.The r-hybrid and r-spline models typically provided similar HIV prevalence trends, but sometimes qualitatively different assessments of recent incidence trends due to different structural assumptions about the HIV transmission rate. The r-hybrid model had the lowest average continuous ranked probability score, indicating the best model predictions. Coverage of 95% posterior predictive intervals was 91.5% for the r-hybrid model, versus 87.2% and 85.5% for r-spline and r-trend, respectively.The EPP-ASM and r-hybrid models improve consistency of EPP and Spectrum, improve the epidemiological assumptions underpinning recent HIV incidence estimates, and improve estimates and short-term projections of HIV prevalence trends. Countries that use general population survey and ANC-SS data to estimate HIV epidemic trends should consider using these tools.

    View details for DOI 10.1097/QAD.0000000000002437

    View details for PubMedID 31725434

  • Multimorbidity and care for hypertension, diabetes and HIV among older adults in rural South Africa. Bulletin of the World Health Organization Chang, A. Y., Gomez-Olive, F. X., Manne-Goehler, J., Wade, A. N., Tollman, S., Gaziano, T. A., Salomon, J. A. 2019; 97 (1): 10–23

    Abstract

    Objective: To examine how multimorbidity might affect progression along the continuum of care among older adults with hypertension, diabetes and human immunodeficiency virus (HIV) infection in rural South Africa.Methods: We analysed data from 4447people aged 40years or older who were enrolled in a longitudinal study in Agincourt sub-district. Household-based interviews were completed between November2014 and November2015. For hypertension and diabetes (2813 and 512people, respectively), we defined concordant conditions as other cardiometabolic conditions, and discordant conditions as mental disorders or HIV infection. For HIV infection (1027people) we defined any other conditions as discordant. Regression models were fitted to assess the relationship between the type of multimorbidity and progression along the care continuum and the likelihood of patients being in each stage of care for the index condition (four stages from testing to treatment).Findings: People with hypertension or diabetes plus other cardiometabolic conditions were more like to progress through the care continuum for the index condition than those without cardiometabolic conditions (relative risk, RR: 1.14, 95% confidence interval, CI: 1.09-1.20, and RR: 2.18, 95% CI: 1.52-3.26, respectively). Having discordant comorbidity was associated with greater progression in care for those with hypertension but not diabetes. Those with HIV infection plus cardiometabolic conditions had less progress in the stages of care compared with those without such conditions (RR: 0.86, 95% CI: 0.80-0.92).Conclusion: Patients with concordant conditions were more likely to progress further along the care continuum, while those with discordant multimorbidity tended not to progress beyond diagnosis.

    View details for PubMedID 30618461

  • Cost-effectiveness and budgetary impact of HCV testing, treatment and linkage to care in U.S. prisons. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Assoumou, S. A., Tasillo, A. n., Vellozzi, C. n., Yazdi, G. E., Wang, J. n., Nolen, S. n., Hagan, L. n., Thompson, W. n., Randall, L. M., Strick, L. n., Salomon, J. A., Linas, B. P. 2019

    Abstract

    Hepatitis C virus (HCV) testing and treatment uptake in prisons remains low. We aimed to estimate clinical outcomes, cost-effectiveness (CE), and budgetary impact (BI) of HCV testing and treatment in United States (U.S.) prisons or linkage to care at release.We used individual-based simulation modeling with healthcare and Department of Corrections (DOC) perspectives for CE and BI analyses, respectively. We simulated a U.S. prison cohort at entry using published data and Washington State DOC individual-level data. We considered permutations of testing (risk factor-based, routine at entry or at release, no testing), treatment (if liver fibrosis ≥F3, for all HCV-infected or no treatment) and linkage to care (at release or no linkage). Outcomes included quality adjusted life years (QALY); cases identified, treated and cured; cirrhosis cases avoided; incremental cost-effectiveness ratios (ICER); DOC costs (2016 US $); and BI (healthcare cost/prison entrant) to generalize to other states.Compared to "no testing, no treatment and no linkage to care", "test all, treat all, and linkage to care at release" increased the lifetime sustained virologic response by 23%, reduced cirrhosis cases by 54% at a DOC annual additional cost of $1,440/ prison entrant, and would be cost-effective. At current drug prices, targeted testing and liver fibrosis-based treatment provided worse outcomes at higher cost or worse outcomes at higher cost/QALY gained. In sensitivity analysis, fibrosis-based treatment restrictions were cost-effective at previous higher drug costs.Although costly, widespread testing and treatment in prisons are considered of good value at current drug prices.

    View details for PubMedID 31095676

  • Multimorbidity and care for hypertension, diabetes and HIV among older adults in rural South Africa BULLETIN OF THE WORLD HEALTH ORGANIZATION Chang, A. Y., Gomez-Olive, X., Manne-Goehler, J., Wade, A. N., Tollman, S., Gaziano, T. A., Salomon, J. A. 2019; 97 (1): 10–23
  • Modelling hospital operations: insight from using data from paper registries in the obstetrics ward at a hospital in Addis Ababa, Ethiopia. BMJ global health Bigelow, B. n., Desalegn, D. N., Salomon, J. A., Verguet, S. n. 2019; 4 (3): e001281

    Abstract

    In the Ethiopian health system, operations management techniques have been underutilised. Although previous research has outlined limitations of paper-based patient records, few studies have examined their potential utility for improving management of hospital operations. In this paper, we used data collected from paper registries in an Ethiopian obstetrics ward at Addis Ababa's Tikur Anbessa Specialized Hospital, Ethiopia's largest university hospital, to model the ward's operations. First, we attempted to identify predictors of lengthy stays and readmissions among women giving birth: few predictors were deemed significant. Second, time series methods for demand forecasting were applied to the data and evaluated with several error metrics, and these forecasts were improvements over baseline methods. We conclude with recommendations on how the obstetrics ward could incorporate our modelling approaches into their daily operations.

    View details for DOI 10.1136/bmjgh-2018-001281

    View details for PubMedID 31179031

    View details for PubMedCentralID PMC6528765

  • Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. Nature Burstein, R. n., Henry, N. J., Collison, M. L., Marczak, L. B., Sligar, A. n., Watson, S. n., Marquez, N. n., Abbasalizad-Farhangi, M. n., Abbasi, M. n., Abd-Allah, F. n., Abdoli, A. n., Abdollahi, M. n., Abdollahpour, I. n., Abdulkader, R. S., Abrigo, M. R., Acharya, D. n., Adebayo, O. M., Adekanmbi, V. n., Adham, D. n., Afshari, M. n., Aghaali, M. n., Ahmadi, K. n., Ahmadi, M. n., Ahmadpour, E. n., Ahmed, R. n., Akal, C. G., Akinyemi, J. O., Alahdab, F. n., Alam, N. n., Alamene, G. M., Alene, K. A., Alijanzadeh, M. n., Alinia, C. n., Alipour, V. n., Aljunid, S. M., Almalki, M. J., Al-Mekhlafi, H. M., Altirkawi, K. n., Alvis-Guzman, N. n., Amegah, A. K., Amini, S. n., Amit, A. M., Anbari, Z. n., Androudi, S. n., Anjomshoa, M. n., Ansari, F. n., Antonio, C. A., Arabloo, J. n., Arefi, Z. n., Aremu, O. n., Armoon, B. n., Arora, A. n., Artaman, A. n., Asadi, A. n., Asadi-Aliabadi, M. n., Ashraf-Ganjouei, A. n., Assadi, R. n., Ataeinia, B. n., Atre, S. R., Quintanilla, B. P., Ayanore, M. A., Azari, S. n., Babaee, E. n., Babazadeh, A. n., Badawi, A. n., Bagheri, S. n., Bagherzadeh, M. n., Baheiraei, N. n., Balouchi, A. n., Barac, A. n., Bassat, Q. n., Baune, B. T., Bayati, M. n., Bedi, N. n., Beghi, E. n., Behzadifar, M. n., Behzadifar, M. n., Belay, Y. B., Bell, B. n., Bell, M. L., Berbada, D. A., Bernstein, R. S., Bhattacharjee, N. V., Bhattarai, S. n., Bhutta, Z. A., Bijani, A. n., Bohlouli, S. n., Breitborde, N. J., Britton, G. n., Browne, A. J., Nagaraja, S. B., Busse, R. n., Butt, Z. A., Car, J. n., Cárdenas, R. n., Castañeda-Orjuela, C. A., Cerin, E. n., Chanie, W. F., Chatterjee, P. n., Chu, D. T., Cooper, C. n., Costa, V. 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L., Nguyen, L. H., Nguyen, S. H., Nielsen, K. R., Ningrum, D. N., Nirayo, Y. L., Nixon, M. R., Nnaji, C. A., Nojomi, M. n., Noroozi, M. n., Nosratnejad, S. n., Noubiap, J. J., Motlagh, S. N., Ofori-Asenso, R. n., Ogbo, F. A., Oladimeji, K. E., Olagunju, A. T., Olfatifar, M. n., Olum, S. n., Olusanya, B. O., Oluwasanu, M. M., Onwujekwe, O. E., Oren, E. n., Ortega-Altamirano, D. D., Ortiz, A. n., Osarenotor, O. n., Osei, F. B., Osgood-Zimmerman, A. E., Otstavnov, S. S., Owolabi, M. O., P A, M. n., Pagheh, A. S., Pakhale, S. n., Panda-Jonas, S. n., Pandey, A. n., Park, E. K., Parsian, H. n., Pashaei, T. n., Patel, S. K., Pepito, V. C., Pereira, A. n., Perkins, S. n., Pickering, B. V., Pilgrim, T. n., Pirestani, M. n., Piroozi, B. n., Pirsaheb, M. n., Plana-Ripoll, O. n., Pourjafar, H. n., Puri, P. n., Qorbani, M. n., Quintana, H. n., Rabiee, M. n., Rabiee, N. n., Radfar, A. n., Rafiei, A. n., Rahim, F. n., Rahimi, Z. n., Rahimi-Movaghar, V. n., Rahimzadeh, S. n., Rajati, F. n., Raju, S. B., Ramezankhani, A. n., Ranabhat, C. L., Rasella, D. n., Rashedi, V. n., Rawal, L. n., Reiner, R. C., Renzaho, A. M., Rezaei, S. n., Rezapour, A. n., Riahi, S. M., Ribeiro, A. I., Roever, L. n., Roro, E. M., Roser, M. n., Roshandel, G. n., Roshani, D. n., Rostami, A. n., Rubagotti, E. n., Rubino, S. n., Sabour, S. n., Sadat, N. n., Sadeghi, E. n., Saeedi, R. n., Safari, Y. n., Safari-Faramani, R. n., Safdarian, M. n., Sahebkar, A. n., Salahshoor, M. R., Salam, N. n., Salamati, P. n., Salehi, F. n., Zahabi, S. S., Salimi, Y. n., Salimzadeh, H. n., Salomon, J. A., Sambala, E. Z., Samy, A. M., Santric Milicevic, M. M., Jose, B. P., Saraswathy, S. Y., Sarmiento-Suárez, R. n., Sartorius, B. n., Sathian, B. n., Saxena, S. n., Sbarra, A. N., Schaeffer, L. E., Schwebel, D. C., Sepanlou, S. G., Seyedmousavi, S. n., Shaahmadi, F. n., Shaikh, M. A., Shams-Beyranvand, M. n., Shamshirian, A. n., Shamsizadeh, M. n., Sharafi, K. n., Sharif, M. n., Sharif-Alhoseini, M. n., Sharifi, H. n., Sharma, J. n., Sharma, R. n., Sheikh, A. n., Shields, C. n., Shigematsu, M. n., Shiri, R. n., Shiue, I. n., Shuval, K. n., Siddiqi, T. J., Silva, J. P., Singh, J. A., Sinha, D. N., Sisay, M. M., Sisay, S. n., Sliwa, K. n., Smith, D. L., Somayaji, R. n., Soofi, M. n., Soriano, J. B., Sreeramareddy, C. T., Sudaryanto, A. n., Sufiyan, M. B., Sykes, B. L., Sylaja, P. N., Tabarés-Seisdedos, R. n., Tabb, K. M., Tabuchi, T. n., Taveira, N. n., Temsah, M. H., Terkawi, A. S., Tessema, Z. T., Thankappan, K. R., Thirunavukkarasu, S. n., To, Q. G., Tovani-Palone, M. R., Tran, B. X., Tran, K. B., Ullah, I. n., Usman, M. S., Uthman, O. A., Vahedian-Azimi, A. n., Valdez, P. R., van Boven, J. F., Vasankari, T. J., Vasseghian, Y. n., Veisani, Y. n., Venketasubramanian, N. n., Violante, F. S., Vladimirov, S. K., Vlassov, V. n., Vos, T. n., Vu, G. T., Vujcic, I. S., Waheed, Y. n., Wakefield, J. n., Wang, H. n., Wang, Y. n., Wang, Y. P., Ward, J. L., Weintraub, R. G., Weldegwergs, K. G., Weldesamuel, G. T., Westerman, R. n., Wiysonge, C. S., Wondafrash, D. Z., Woyczynski, L. n., Wu, A. M., Xu, G. n., Yadegar, A. n., Yamada, T. n., Yazdi-Feyzabadi, V. n., Yilgwan, C. S., Yip, P. n., Yonemoto, N. n., Lebni, J. Y., Younis, M. Z., Yousefifard, M. n., Yousof, H. S., Yu, C. n., Yusefzadeh, H. n., Zabeh, E. n., Moghadam, T. Z., Bin Zaman, S. n., Zamani, M. n., Zandian, H. n., Zangeneh, A. n., Zerfu, T. A., Zhang, Y. n., Ziapour, A. n., Zodpey, S. n., Murray, C. J., Hay, S. I. 2019; 574 (7778): 353–58

    Abstract

    Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

    View details for DOI 10.1038/s41586-019-1545-0

    View details for PubMedID 31619795

  • The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET PSYCHIATRY Degenhardt, L., Charlson, F., Ferrari, A., Santomauro, D., Erskine, H., Mantilla-Herrara, A., Whiteford, H., Leung, J., Naghavi, M., Griswold, M., Rehm, J., Hall, W., Sartorius, B., Scott, J., Vollset, S., Knudsen, A., Haro, J., Patton, G., Kopec, J., Malta, D., Topor-Madry, R., McGrath, J., Haagsma, J., Allebeck, P., Phillips, M., Salomon, J., Hay, S., Foreman, K., Lim, S., Mokdad, A., Smith, M., Gakidou, E., Murray, C., Vos, T., Gbd2016 Alcohol Drug Use Collabora 2018; 5 (12): 987–1012

    Abstract

    Alcohol and drug use can have negative consequences on the health, economy, productivity, and social aspects of communities. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to calculate global and regional estimates of the prevalence of alcohol, amphetamine, cannabis, cocaine, and opioid dependence, and to estimate global disease burden attributable to alcohol and drug use between 1990 and 2016, and for 195 countries and territories within 21 regions, and within seven super-regions. We also aimed to examine the association between disease burden and Socio-demographic Index (SDI) quintiles.We searched PubMed, EMBASE, and PsycINFO databases for original epidemiological studies on alcohol and drug use published between Jan 1, 1980, and Sept 7, 2016, with out language restrictions, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to estimate population-level prevalence of substance use disorders. We combined these estimates with disability weights to calculate years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 1990-2016. We also used a comparative assessment approach to estimate burden attributable to alcohol and drug use as risk factors for other health outcomes.Globally, alcohol use disorders were the most prevalent of all substance use disorders, with 100·4 million estimated cases in 2016 (age-standardised prevalence 1320·8 cases per 100 000 people, 95% uncertainty interval [95% UI] 1181·2-1468·0). The most common drug use disorders were cannabis dependence (22·1 million cases; age-standardised prevalence 289·7 cases per 100 000 people, 95% UI 248·9-339·1) and opioid dependence (26·8 million cases; age-standardised prevalence 353·0 cases per 100 000 people, 309·9-405·9). Globally, in 2016, 99·2 million DALYs (95% UI 88·3-111·2) and 4·2% of all DALYs (3·7-4·6) were attributable to alcohol use, and 31·8 million DALYs (27·4-36·6) and 1·3% of all DALYs (1·2-1·5) were attributable to drug use as a risk factor. The burden of disease attributable to alcohol and drug use varied substantially across geographical locations, and much of this burden was due to the effect of substance use on other health outcomes. Contrasting patterns were observed for the association between total alcohol and drug-attributable burden and SDI: alcohol-attributable burden was highest in countries with a low SDI and middle-high middle SDI, whereas the burden due to drugs increased with higher S DI level.Alcohol and drug use are important contributors to global disease burden. Effective interventions should be scaled up to prevent and reduce substance use disease burden.Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

    View details for DOI 10.1016/S2215-0366(18)30337-7

    View details for Web of Science ID 000451086800036

    View details for PubMedID 30392731

    View details for PubMedCentralID PMC6251968

  • Global, regional, and national burden of tuberculosis, 1990-2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study LANCET INFECTIOUS DISEASES Kyu, H., Maddison, E. R., Henry, N. J., Ledesma, J. R., Wiens, K. E., Reiner, R., Biehl, M. H., Shields, C., Osgood-Zimmerman, A., Ross, J. M., Carter, A., Frank, T. D., Wang, H., Srinivasan, V., Abebe, Z., Agarwal, S., Alahdab, F., Alene, K., Ali, B., Alvis-Guzman, N., Andrews, J. R., Antonio, C. T., Atique, S., Atre, S. R., Awasthi, A., Ayele, H., Badali, H., Badawi, A., Barac, A., Bedi, N., Behzadifar, M., Behzadifar, M., Bekele, B., Belay, S., Bensenor, I. M., Butt, Z. A., Carvalho, F., Cercy, K., Christopher, D. J., Daba, A., Dandona, L., Dandona, R., Daryani, A., Demeke, F., Deribe, K., Dharmaratne, S., Doku, D., Dubey, M., Edessa, D., El-Khatib, Z., Enany, S., Fernandes, E., Fischer, F., Garcia-Basteiro, A. L., Gebre, A., Gebregergs, G., Gebremichael, T., Gelano, T., Geremew, D., Gona, P. N., Goodridge, A., Gupta, R., Bidgoli, H., Hailu, G., Hassen, H., Hedayati, M., Henok, A., Hostiuc, S., Hussen, M., Ilesanmi, O., Irvani, S., Jacobsen, K. H., Johnson, S. C., Jonas, J. B., Kahsay, A., Kant, S., Kasaeian, A., Kassa, T., Khader, Y., Khafaie, M., Khalil, I., Khan, E., Khang, Y., Kim, Y., Kochhar, S., Koyanagi, A., Krohn, K. J., Kumar, G., Lakew, A., Leshargie, C., Lodha, R., Macarayan, E., Majdzadeh, R., Martins-Melo, F., Melese, A., Memish, Z. A., Mendoza, W., Mengistu, D., Mengistu, G., Mestrovic, T., Moazen, B., Mohammad, K., Mohammed, S., Mokdad, A. H., Moosazadeh, M., Mousavi, S., Mustafa, G., Nachega, J. B., Long Hoang Nguyen, Son Hoang Nguyen, Trang Huyen Nguyen, Ningrum, D., Nirayo, Y., Vuong Minh Nong, Ofori-Asenso, R., Ogbo, F., Oh, I., Oladimeji, O., Olagunju, A. T., Oren, E., Pereira, D. M., Prakash, S., Qorbani, M., Rafay, A., Rai, R., Ram, U., Rubino, S., Safiri, S., Salomon, J. A., Samy, A. M., Sartorius, B., Satpathy, M., Seyedmousavi, S., Sharif, M., Silva, J., Silveira, D., Singh, J. A., Sreeramareddy, C. T., Tran, B., Tsadik, A., Ukwaja, K., Ullah, I., Uthman, O. A., Vlassov, V., Vollset, S., Vu, G., Weldegebreal, F., Werdecker, A., Yimer, E. M., Yonemoto, N., Yotebieng, M., Naghavi, M., Theo Vos, Hay, S. I., Murray, C. L., GBD TB Collaborators 2018; 18 (12): 1329–49

    Abstract

    Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016.We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate.Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05-10·16) and the number of tuberculosis deaths was 1·21 million (1·16-1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01-1·89) and the number of tuberculosis deaths was 0·24 million (0·16-0·31). Globally, among HIV-negative individuals the age-standardised incidence of tuberculosis decreased annually at a slower rate (-1·3% [-1·5 to -1·2]) than mortality did (-4·5% [-5·0 to -4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was -4·0% (-4·5 to -3·7) and mortality was -8·9% (-9·5 to -8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality).If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S1473-3099(18)30625-X

    View details for Web of Science ID 000450899900030

    View details for PubMedID 30507459

  • Does incident circumcision lead to risk compensation? Evidence from a population cohort in KwaZulu-Natal, South Africa. Journal of acquired immune deficiency syndromes (1999) Ortblad, K. F., Harling, G., Chimbindi, N., Tanser, F., Salomon, J. A., Barnighausen, T. 2018

    Abstract

    BACKGROUND: Voluntary medical male circumcision reduces men's risk of HIV acquisition and may thus increase HIV risk-related sexual behaviors through risk compensation. We analyze longitudinal data from one of Africa's largest population cohorts using fixed effects panel estimation to measure the effect of incident circumcision on sexual behaviors.SETTING: KwaZulu-Natal, South Africa.METHODS: An open population cohort of men were followed from 2009 to 2015. Men self-reported their circumcision status and sexual behavior annually. We used linear regression models with individual-level fixed effects to measure the effect of incident circumcision on recent sex (past 12 months) and sexual behaviors that increase HIV risk (not using a condom at last sex, never using condoms with the most recent sexual partner, concurrent sexual partners at present, and multiple sexual partners in the past 12 months). We controlled for potential time-varying confounders: calendar year, age, education, and sexual debut.RESULTS: The 5,127 men in the cohort had a median age of 18 years (IQR 16 to 24) at cohort entry. Over the study period, almost one in five of these men (19.4%) became newly circumcised. Incident circumcision affected neither recent sex (percentage point change [PP] 0.0, 95%CI -1.2 to 1.3) nor sexual behaviors that increase HIV risk (PP -1.6, 95%CI -4.5 to 1.4).CONCLUSION: The data from this study strongly reject the hypothesis that circumcision affects sexual risk taking. Risk compensation should not serve as an argument against increased and accelerated scale-up of circumcision in this and similar communities in South Africa.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

    View details for PubMedID 30531298

  • Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries LANCET Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., Garcia-Saiso, S., Salomon, J. A. 2018; 392 (10160): 2203–12
  • Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries (vol 392, pg 2203, 2018) LANCET Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., Garcia-Saiso, S., Salomon, J. A. 2018; 392 (10160): 2170
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H., Banach, M., Banoub, J., Barac, A., Barker-Collo, S., Bamighausen, T., Barrero, L. H., Basu, S., Baune, B. T., Bazargan-Hejazi, S., Bedi, N., Beghi, E., Behzadifar, M., Behzadifar, M., Bejoy, Y., Bekele, B., Bekru, F., Belay, E., Belay, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Bergeron, G., Berhane, A., Bemabe, E., Bemstein, R. S., Beuran, M., Beyranvand, T., Bhala, N., Bhalla, A., Bhattarai, S., Bhutta, Z. A., Biadgo, B., Bijani, A., Bikbov, B., Bilano, V., Bililign, N., Bin Sayeed, M., Bisanzio, D., Biswas, T., Bjorge, T., Blacker, B. F., Bleyer, A., Borschmann, R., Bou-Orm, I. R., Boufous, S., Bourne, R., Brady, O. J., Brauer, M., Brazinova, A., Breitborde, N. K., Brenner, H., Briko, A., Britton, G., Brugha, T., Buchbindet, R., Burnett, R. T., Busse, R., Butt, Z. A., Cahill, L. E., Cahuana-Hurtado, L., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaneda-Orjuela, C. 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  • Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Murray, C. L., Callender, C. H., Kulikoff, X., Srinivasan, V., Abate, D., Abate, K., Abay, S. M., Abbasi, N., Abbastabar, H., Abdela, J., Abdelalim, A., Abdel-Rahman, O., Abdi, A., Abdoli, N., Abdollahpour, I., Abdulkader, R., Abebe, H., Abebe, M., Abebe, Z., Abebo, T., Abejie, A., Aboyans, V., Abraha, H., Abreu, D., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N. E., Accrombessi, M., Acharya, P., Adamu, A. A., Adebayo, O. M., Adedeji, I., Adekanmbi, V., Adetokunboh, O. O., Adhena, B., Adhikari, T., Adib, M. C., Adou, A., Adsuar, J. C., Afarideh, M., Afshin, A., Agarwal, G., Agesa, K. M., Aghayan, S., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmed, M., Ahmed, S., Aichour, A., Aichour, I., Aichour, M., Akanda, A. 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    Abstract

    How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2).With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(18)32335-3

    View details for Web of Science ID 000449710900006

    View details for PubMedID 30415748

    View details for PubMedCentralID PMC6252083

  • Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Lozano, R., Fullman, N., Abate, D., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdel-Rahman, O., Abdi, A., Abdollahpour, I., Abdulkader, R., Abebe, N., Abebe, Z., Abejie, A., Abera, S. P., Abil, O., Aboyans, V., Abraha, H., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N., Abyu, G. Y., Accrombessi, M., Acharya, D., Acharya, P., Adamu, A. A., Adebayo, O. M., Adedeji, I., Adedoyin, R., Adekanmbi, V., Adetokunboh, O., Adhena, B., Adhikari, T., Adib, M. G., Adou, A., Adsuar, J. C., Afarideh, M., Afshari, M., Afshin, A., Agarwal, G., Aghayan, S., Agius, D., Agrawal, A., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmadieh, F., Ahmed, M., Ahmed, S., Akalu, T., Akanda, A. 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  • Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016 LANCET INFECTIOUS DISEASES Troeger, C., Blacker, B. F., Khalil, I. A., Rao, P. C., Cao, S., Zimsen, S. M., Albertson, S., Stanaway, J. D., Deshpande, A., Brown, A., Abebe, Z., Alvis-Guzman, N., Amare, A. T., Asgedom, S., Alamrew Anteneh, Z., Antonio, C. T., Aremu, O., Asfaw, E., Atey, T., Atique, S., Avokpaho, E., Awasthi, A., Ayele, H., Barac, A., Barreto, M. L., Bassat, Q., Belay, S., Bensenor, I. M., Bhutta, Z. A., Bijani, A., Bizuneh, H., Castaneda-Orjuela, C. A., Dadi, A., Dandona, L., Dandona, R., Huyen Phuc Do, Dubey, M., Dubljanin, E., Edessa, D., Endries, A., Eshrati, B., Farag, T., Feyissa, G., Foreman, K. J., Forouzanfar, M. H., Fullman, N., Gething, P. W., Gishu, M., Godwin, W. W., Gugnani, H., Gupta, R., Hailu, G., Hassen, H., Hibstu, D., Ilesanmi, O. S., Jonas, J. B., Kahsay, A., Kang, G., Kasaeian, A., Khader, Y., Khan, E., Khan, M., Khang, Y., Kissoon, N., Kochhar, S., Kotloff, K. L., Koyanagi, A., Kumar, G., Abd El Razek, H., Malekzadeh, R., Malta, D., Mehata, S., Mendoza, W., Mengistu, D., Menota, B., Mezgebe, H., Mlashu, F., Murthy, S., Naik, G. A., Cuong Tat Nguyen, Trang Huyen Nguyen, Ningrum, D., Ogbo, F., Olagunju, A., Paudel, D., Platts-Mills, J. A., Qorbani, M., Rafay, A., Rai, R., Rana, S. M., Ranabhat, C., Rasella, D., Ray, S. E., Reis, C., Renzaho, A. N., Rezai, M., Ruhago, G., Safiri, S., Salomon, J. A., Sanabria, J., Sartorius, B., Sawhney, M., Sepanlou, S. G., Shigematsu, M., Sisay, M., Somayaji, R., Sreeramareddy, C. T., Sykes, B. L., Taffere, G., Topor-Madry, R., Bach Xuan Tran, Tuem, K., Ukwaja, K., Vollset, S., Walson, J. L., Weaver, M. R., Weldegwergs, K., Werdecker, A., Workicho, A., Yenesew, M., Yirsaw, B., Yonemoto, N., Zaki, M., Vos, T., Lim, S. S., Naghavi, M., Murray, C. L., Mokdad, A. H., Hay, S. I., Reiner, R. C., GBD 2016 Diarrhoeal Dis Collabora 2018; 18 (11): 1211–28

    Abstract

    The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990-2016 and assesses how the burden of diarrhoea has changed in people of all ages.We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty.In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655 944 deaths, 95% uncertainty interval [UI] 1 244 073-2 366 552) and the fifth leading cause of death among children younger than 5 years (446 000 deaths, 390 894-504 613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128 515 deaths, 105 138-155 133) and among all ages (228 047 deaths, 183 526-292 737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2-85·0), 72·1% (34·0-91·4), and 56·4% (49·3-62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521-2170) could avert one death from diarrhoea.Substantial progress has been made globally in reducing the burden of diarrhoeal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S1473-3099(18)30362-1

    View details for Web of Science ID 000448325300031

    View details for PubMedID 30243583

    View details for PubMedCentralID PMC6202444

  • Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET INFECTIOUS DISEASES Troeger, C., Blacker, B. F., Khalil, I. A., Rao, P. C., Cao, S., Zimsen, S. M., Albertson, S., Stanaway, J. D., Deshpande, A., Farag, T., Forouzanfar, M. H., Abebe, Z., Adetifa, I. O., Adhikari, T., Akibu, M., Al Lami, F., Al-Eyadhy, A., Alvis-Guzman, N., Amare, A. T., Amoako, Y., Antonio, C. T., Aremu, O., Asfaw, E., Asgedom, S., Atey, T., Attia, E., Avokpaho, E., Ayele, H., Ayuk, T., Balakrishnan, K., Barac, A., Bassat, Q., Behzadifar, M., Behzadifar, M., Bhaumik, S., Bhutta, Z. A., Bijani, A., Brauer, M., Brown, A., Camargos, P. M., Castaneda-Orjuela, C. A., Colombara, D., Conti, S., Dadi, A., Dandona, L., Dandona, R., Huyen Phuc Do, Dubljanin, E., Edessa, D., Elkout, H., Endries, A., Fijabi, D., Foreman, K. J., Fullman, N., Garcia-Basteiro, A. L., Gessner, B. D., Gething, P. W., Gupta, R., Gupta, T., Hailu, G., Hassen, H., Hedayati, M. T., Heidari, M., Hibstu, D., Horita, N., Ilesanmi, O. S., Jakovljevic, M. B., Jamal, A. A., Kahsay, A., Kasaeian, A., Kassa, D., Khader, Y., Khan, E., Khan, M., Khang, Y., Kim, Y., Kissoon, N., Knibbs, L. D., Kochhar, S., Koul, P. A., Kumar, G., Lodha, R., Abd El Razek, H., Malta, D., Mathew, J. L., Mengistu, D., Mezgebe, H., Mohammad, K., Mohammed, A., Momeniha, F., Murthy, S., Cuong Tat Nguyen, Nielsen, K. R., Ningrum, D., Nirayo, Y., Oren, E., Ortiz, J. R., Mahesh, P. A., Postma, M. J., Qorbani, M., Quansah, R., Rai, R., Rana, S. M., Ranabhat, C., Ray, S. E., Rezai, M., Ruhago, G., Safiri, S., Salomon, J. A., Sartorius, B., Savic, M., Sawhney, M., She, J., Sheikh, A., Shiferaw, M., Shigematsu, M., Singh, J. A., Somayaji, R., Sufiyan, M., Taffere, G., Temsah, M., Thompson, M. J., Tobe-Gai, R., Topor-Madry, R., Tran, B., Tung Thanh Tran, Tuem, K., Ukwaja, K., Vollset, S., Walson, J. L., Weldegebreal, F., Werdecker, A., West, T., Yonemoto, N., Zaki, M., Zhou, L., Zodpey, S., Vos, T., Lim, S. S., Naghavi, M., Murray, C. L., Mokdad, A. H., Hay, S. I., Reiner, R. C., GBD 2016 Lower Respiratory Infecti 2018; 18 (11): 1191–1210

    Abstract

    Lower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages.We used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and health-care data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatio-temporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000-16 using the risk factors associated with LRI in GBD 2016.In 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475-720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749-1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584-2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445-1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7-69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden.Our findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world's most susceptible populations.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S1473-3099(18)30310-4

    View details for Web of Science ID 000448325300030

    View details for PubMedID 30243584

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  • Future Directions for Cost-effectiveness Analyses in Health and Medicine MEDICAL DECISION MAKING Neumann, P. J., Kim, D. D., Trikalinos, T. A., Sculpher, M. J., Salomon, J. A., Prosser, L. A., Owens, D. K., Meltzer, D. O., Kuntz, K. M., Krahn, M., Feeny, D., Basu, A., Russell, L. B., Siegel, J. E., Ganiats, T. G., Sanders, G. D. 2018; 38 (7): 767–77

    Abstract

    In 2016, the Second Panel on Cost-effectiveness in Health and Medicine updated the seminal work of the original panel from 2 decades earlier. The Second Panel had an opportunity to reflect on the evolution of cost-effectiveness analysis (CEA) and to provide guidance for the next generation of practitioners and consumers. In this article, we present key topics for future research and policy.During the course of its deliberations, the Second Panel discussed numerous topics for advancing methods and for improving the use of CEA in decision making. We identify and consider 7 areas for which the panel believes that future research would be particularly fruitful. In each of these areas, we highlight outstanding research needs. The list is not intended as an exhaustive inventory but rather a set of key items that surfaced repeatedly in the panel's discussions. In the online Appendix , we also list and expound briefly on 8 other important topics.We highlight 7 key areas: CEA and perspectives (determining, valuing, and summarizing elements for the analysis), modeling (comparative modeling and model transparency), health outcomes (valuing temporary health and path states, as well as health effects on caregivers), costing (a cost catalogue, valuing household production, and productivity effects), evidence synthesis (developing theory on learning across studies and combining data from clinical trials and observational studies), estimating and using cost-effectiveness thresholds (empirically representing 2 broad concepts: opportunity costs and public willingness to pay), and reporting and communicating CEAs (written protocols and a quality scoring system).Cost-effectiveness analysis remains a flourishing and evolving field with many opportunities for research. More work is needed on many fronts to understand how best to incorporate CEA into policy and practice.

    View details for PubMedID 30248277

  • Improving the validity of mathematical models for HIV elimination by incorporating empirical estimates of progression through the HIV treatment cascade. Journal of acquired immune deficiency syndromes (1999) Chang, A. Y., Haber, N., Barnighausen, T., Herbst, K., Gareta, D., Pillay, D., Salomon, J. A. 2018

    Abstract

    BACKGROUND: Optimism regarding prospects for eliminating HIV by expanding antiretroviral treatment has been emboldened in part by projections from several mathematical modeling studies. Drawing from a detailed empirical assessment of rates of progression through the entire HIV care cascade, we quantify for the first time the extent to which models may overestimate health benefits from policy changes when they fail to incorporate a realistic understanding of the cascade.SETTING: Rural KwaZulu-Natal, South Africa METHODS:: We estimated rates of progression through stages of the HIV treatment cascade using data from a longitudinal population-based HIV surveillance system in rural KwaZulu-Natal. Incorporating empirical estimates in a mathematical model of HIV progression, infection transmission, and care, we estimated life expectancy and secondary infections averted under a range of treatment scale-up scenarios reflecting expanding treatment eligibility thresholds. We compared the results to those implied by the conventional assumptions that have been commonly adopted by existing models.RESULTS: Survival gains from expanding the treatment eligibility threshold from CD4 350 to 500 cells/muL and from 500 cells/muL to treating everyone irrespective of their CD4 count may be overestimated by 3.60 and 3.79 times in models that fail to capture realities of the care cascade. HIV infections averted from raising the threshold from CD4 200 to 350, 350 to 500, and 500 cells/muL to treating everyone may be overestimated by 1.10, 2.65, and 1.18 times.CONCLUSION: Models using conventional assumptions about cascade progression may substantially overestimate health benefits. As implementation of treatment scale-up proceeds, it is important to assess the effects of required scale-up efforts in a way that incorporates empirical realities of how people move through the HIV cascade.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

    View details for PubMedID 30272631

  • Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET Griswold, M. G., Fullman, N., Hawley, C., Arian, N., Zimsen, S. M., Tymeson, H. D., Venkateswaran, V., Tapp, A., Forouzanfar, M. H., Salama, J. S., Abate, K., Abate, D., Abay, S. M., Abbafati, C., Abdulkader, R., Abebe, Z., Aboyans, V., Abrar, M., Acharya, P., Adetokunboh, O. O., Adhikari, T., Adsuar, J. C., Afarideh, M., Agardh, E., Agarwal, G., Aghayan, S., Agrawal, S., Ahmed, M., Akibu, M., Akinyemiju, T., Akseer, N., Al Asfoor, D. H., Al-Aly, Z., Alahdab, F., Alam, K., Albujeer, A., Alene, K., Ali, R., Ali, S., Alijanzadeh, M., Aljunid, S., Alkerwi, A., Allebeck, P., Alvis-Guzman, N., Amare, A. T., Aminde, L. N., Ammar, W., Amoako, Y., Amul, G., Andrei, C., Angus, C., Ansha, M., Antonio, C. T., Aremu, O., Arnlov, J., Artaman, A., Aryal, K. K., Assadi, R., Ausloos, M., Avila-Burgos, L., Avokpaho, E. A., Awasthi, A., Ayele, H., Ayer, R., Ayuk, T. B., Azzopardi, P. S., Badali, H., Badawi, A., Banach, M., Barker-Collo, S., Barrero, L. H., Basaleem, H., Baye, E., Bazargan-Hejazi, S., Bedi, N., Bejot, Y., Belachew, A., Belay, S., Bennett, D. A., Bensenor, I. M., Bernabe, E., Bernstein, R. S., Beyene, A., Beyranvand, T., Bhaumik, S., Bhutta, Z. A., Biadgo, B., Bijani, A., Bililign, N., Birlik, S., Birungi, C., Bizuneh, H., Bjerregaard, P., Bjorge, T., Borges, G., Bosetti, C., Boufous, S., Bragazzi, N., Brenner, H., Butt, Z. A., Cahuana-Hurtado, L., Calabria, B., Campos-Nonato, I. R., Campuzano Rincon, J., Carreras, G., Carrero, J. J., Carvalho, F., Castaneda-Orjuela, C. A., Castillo Rivas, J., Catala-Lopez, F., Chang, J., Charlson, F. J., Chattopadhyay, A., Chaturvedi, P., Chowdhury, R., Christopher, D. J., Chung, S., Ciobanu, L. G., Claro, R. M., Conti, S., Cousin, E., Criqui, M. H., Dachew, B., Dargan, P., Daryani, A., Das Neves, J., Davletov, K., De Castro, F., De Courten, B., De Neve, J., Degenhardt, L., Demoz, G., Des Jarlais, D. C., Dey, S., Dhaliwal, R., Dharmaratne, S., Dhimal, M., Doku, D., Doyle, K. E., Dubey, M., Dubljanin, E., Duncan, B. B., Ebrahimi, H., Edessa, D., Zaki, M., Ermakov, S., Erskine, H. E., Esteghamati, A., Faramarzi, M., Farioli, A., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Felisbino-Mendes, M., Fernandes, E., Ferrari, A. J., Ferri, C. P., Fijabi, D., Filip, I., Finger, J., Fischer, F., Flaxman, A. D., Franklin, R., Futran, N. D., Gallus, S., Ganji, M., Gankpe, F., Gebregergs, G., Gebrehiwot, T., Geleijnse, J. M., Ghadimi, R., Ghandour, L. A., Ghimire, M., Gill, P., Ginawi, I., Giref, A. Z., Gona, P. N., Gopalani, S., Gotay, C. C., Goulart, A. C., Greaves, F., Grosso, G., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Alma Gutierrez, R., Gvs, M., Hafezi-Nejad, N., Hagos, T., Hailu, G., Hamadeh, R. R., Hamidi, S., Hankey, G. J., Harb, H. L., Harikrishnan, S., Maria Haro, J., Hassen, H., Havmoeller, R., Hay, S., Heibati, B., Henok, A., Heredia-Pi, I., Francisco Hernandez-Llanes, N., Herteliu, C., Hibstu, D., Hoogar, P., Horita, N., Hosgood, H., Hosseini, M., Hostiuc, M., Hu, G., Huang, H., Husseini, A., Idrisov, B., Ileanu, B., Ilesanmi, O., Irvani, S., Islam, S., Jackson, M. D., Jakovljevic, M., Jayatilleke, A., Jha, R., Jonas, J. B., Jozwiak, J., Kabir, Z., Kadel, R., Kahsay, A., Kapil, U., Kasaeian, A., Kassa, T., Katikireddi, S., Kawakami, N., Kebede, S., Kefale, A., Keiyoro, P., Kengne, A., Khader, Y., Khafaie, M., Khalil, I. A., Khan, M., Khang, Y., Khater, M. M., Khubchandani, J., Kim, C., Kim, D., Kim, Y., Kimokoti, R. W., Kisa, A., Kivimaki, M., Kochhar, S., Kosen, S., Koul, P. A., Koyanagi, A., Krishan, K., Defo, B., Bicer, B., Kulkarni, V. S., Kumar, P., Lafranconi, A., Balaji, A., Lalloo, R., Lallukka, T., Lam, H., Lami, F., Lan, Q., Lang, J. J., Lansky, S., Larsson, A. O., Latifi, A., Leasher, J. L., Lee, P. H., Leigh, J., Leinsalu, M., Leung, J., Levi, M., Li, Y., Lim, L., Linn, S., Liu, S., Lobato-Cordero, A., Lotufo, P. A., King Macarayan, E., Machado, I., Madotto, F., Abd El Razek, H., Abd El Razek, M., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malta, D., Mapoma, C., Martinez-Raga, J., Maulik, P. K., Mazidi, M., Mckee, M., Mehta, V., Meier, T., Mekonen, T., Meles, K., Melese, A., Memiah, P. N., Mendoza, W., Mengistu, D., Mensah, G. A., Meretoja, T. J., Mezgebe, H., Miazgowski, T., Miller, T. R., Mini, G. K., Mirica, A., Mirrakhimov, E. M., Moazen, B., Mohammad, K., Mohammadifard, N., Mohammed, S., Monasta, L., Moraga, P., Morawska, L., Jalu, M., Mousavi, S., Mukhopadhyay, S., Musa, K., Naheed, A., Naik, G., Najafi, F., Nangia, V., Nansseu, J., Nayak, M., Nejjari, C., Neupane, S., Neupane, S., Ngunjiri, J. W., Cuong Tat Nguyen, Long Hoang Nguyen, Trang Huyen Nguyen, Ningrum, D., Nirayo, Y., Noubiap, J., Ofori-Asenso, R., Ogbo, F., Oh, I., Oladimeji, O., Olagunju, A. T., Olivares, P. R., Olusanya, B., Olusanya, J., Oommen, A., Oren, E., Orpana, H. M., Ortega-Altamirano, D. D., Ortiz, J. R., Ota, E., Owolabi, M., Oyekale, A., Mahesh, P. A., Pana, A., Park, E., Parry, C. H., Parsian, H., Patle, A., Patton, G. C., Paudel, D., Petzold, M., Phillips, M. R., Pillay, J., Postma, M. J., Pourmalek, F., Prabhakaran, D., Qorbani, M., Radfar, A., Rafay, A., Rafiei, A., Rahim, F., Rahimi-Movaghar, A., Rahman, M., Rahman, M., Rai, R., Rajsic, S., Raju, S., Ram, U., Rana, S. M., Ranabhat, C., Rawaf, D., Rawaf, S., Reiner, R. C., Reis, C., Renzaho, A. N., Rezai, M., Roever, L., Ronfani, L., Room, R., Roshandel, G., Rostami, A., Roth, G. A., Roy, A., Sabde, Y., Saddik, B., Safiri, S., Sahebkar, A., Saleem, Z., Salomon, J. A., Salvi, S., Sanabria, J., Dolores Sanchez-Nino, M., Santomauro, D., Santos, I. S., Milicevic, M., Sarker, A., Sarmiento-Suarez, R., Sarrafzadegan, N., Sartorius, B., Satpathy, M., Sawhney, M., Saxena, S., Saylan, M., Schaub, M. P., Schmidt, M., Schneider, I. C., Schoettker, B., Schutte, A., Schwendicke, F., Sepanlou, S. G., Shaikh, M., Sharif, M., She, J., Sheikh, A., Shen, J., Shiferaw, M., Shigematsu, M., Shiri, R., Shishani, K., Shiue, I., Shukla, S., Sigfusdottir, I., Santos Silva, D., Da Silva, N., Alves Silveira, D., Sinha, D., Sitas, F., Soares Filho, A., Soofi, M., Sorensen, R. D., Soriano, J. B., Sreeramareddy, C. T., Steckling, N., Stein, D. J., Sufiyan, M., Sur, P. J., Sykes, B. L., Tabares-Seisdedos, R., Tabuchi, T., Tavakkoli, M., Tehrani-Banihashemi, A., Tekle, M., Thapa, S., Thomas, N., Topor-Madry, R., Topouzis, F., Tran, B., Troeger, C. E., Truelsen, T., Tsilimparis, N., Tyrovolas, S., Ukwaja, K., Ullah, I., Uthman, O. A., Valdez, P. R., Van Boven, J. M., Vasankari, T., Venketasubramanian, N., Violante, F. S., Vladimirov, S., Vlassov, V., Vollset, S., Vos, T., Wagnew, F., Waheed, Y., Wang, Y., Weiderpass, E., Weldegebreal, F., Weldegwergs, K., Werdecker, A., Westerman, R., Whiteford, H. A., Widecka, J., Wijeratne, T., Wyper, G. A., Xu, G., Yamada, T., Yano, Y., Ye, P., Yimer, E. M., Yip, P., Yirsaw, B., Yisma, E., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Zachariah, G., Zaidi, Z., Zamani, M., Zhang, X., Zodpey, S., Mokdad, A. H., Naghavi, M., Murray, C. L., Gakidou, E., GBD 2016 Alcohol Collaborators 2018; 392 (10152): 1015–35

    Abstract

    Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5-3·0) of age-standardised female deaths and 6·8% (5·8-8·0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2-4·3) of female deaths and 12·2% (10·8-13·6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2·3% (95% UI 2·0-2·6) and male attributable DALYs were 8·9% (7·8-9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0-1·7] of total deaths), road injuries (1·2% [0·7-1·9]), and self-harm (1·1% [0·6-1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2-33·3) of total alcohol-attributable female deaths and 18·9% (15·3-22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0-0·8) standard drinks per week.Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(18)31310-2

    View details for Web of Science ID 000445098800025

    View details for PubMedID 30146330

    View details for PubMedCentralID PMC6148333

  • High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet. Global health Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., Adeyi, O., Barker, P., Daelmans, B., Doubova, S. V., English, M., Elorrio, E. G., Guanais, F., Gureje, O., Hirschhorn, L. R., Jiang, L., Kelley, E., Lemango, E. T., Liljestrand, J., Malata, A., Marchant, T., Matsoso, M. P., Meara, J. G., Mohanan, M., Ndiaye, Y., Norheim, O. F., Reddy, K. S., Rowe, A. K., Salomon, J. A., Thapa, G., Twum-Danso, N. A., Pate, M. 2018

    View details for PubMedID 30196093

  • Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet (London, England) Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., Garcia-Saiso, S., Salomon, J. A. 2018

    Abstract

    BACKGROUND: Universal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems.METHODS: Using data from the 2016 Global Burden of Disease study, we calculated mortality amenable to personal health care for 61 SDG conditions by comparing case fatality between each LMIC with corresponding numbers from 23 high-income reference countries with strong health systems. We used data on health-care utilisation from population surveys to separately estimate the portion of amenable mortality attributable to non-utilisation of health care versus that attributable to receipt of poor-quality care.FINDINGS: 15·6 million excess deaths from 61 conditions occurred in LMICs in 2016. After excluding deaths that could be prevented through public health measures, 8·6 million excess deaths were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care. Poor quality of health care was a major driver of excess mortality across conditions, from cardiovascular disease and injuries to neonatal and communicable disorders.INTERPRETATION: Universal health coverage for SDG conditions could avert 8·6 million deaths per year but only if expansion of service coverage is accompanied by investments into high-quality health systems.FUNDING: Bill & Melinda Gates Foundation.

    View details for PubMedID 30195398

  • Prospects for Tuberculosis Elimination in the United States: Results of a Transmission Dynamic Model AMERICAN JOURNAL OF EPIDEMIOLOGY Menzies, N. A., Cohen, T., Hill, A. N., Yaesoubi, R., Galer, K., Wolf, E., Marks, S. M., Salomon, J. A. 2018; 187 (9): 2011–20

    Abstract

    We estimated long-term tuberculosis (TB) trends in the US population and assessed prospects for TB elimination. We used a detailed simulation model allowing for changes in TB transmission, immigration, and other TB risk determinants. Five hypothetical scenarios were evaluated from 2017 to 2100: 1) maintain current TB prevention and treatment activities (base case); 2) provision of latent TB infection testing and treatment for new legal immigrants; 3) increased uptake of latent TB infection screening and treatment among high-risk populations, including a 3-month isoniazid-rifapentine regimen; 4) improved TB case detection; and 5) improved TB treatment quality. Under the base case, we estimate that by 2050, TB incidence will decline to 14 cases per million, a 52% (95% posterior interval (PI): 35, 67) reduction from 2016, and 82% (95% posterior interval: 78, 86) of incident TB will be among persons born outside of the United States. Intensified TB control could reduce incidence by 77% (95% posterior interval: 66, 85) by 2050. We predict TB may be eliminated in US-born but not non-US-born persons by 2100. Results were sensitive to numbers of people entering the United States with latent or active TB, and were robust to alternative interpretations of epidemiologic evidence. TB elimination in the United States remains a distant goal; however, strengthening TB prevention and treatment could produce important health benefits.

    View details for PubMedID 29762657

    View details for PubMedCentralID PMC6119121

  • Female Sex Workers Often Incorrectly Interpret HIV Self-Test Results in Uganda. Journal of acquired immune deficiency syndromes (1999) Ortblad, K. F., Musoke, D. K., Ngabirano, T., Nakitende, A., Haberer, J. E., McConnell, M., Salomon, J. A., Barnighausen, T., Oldenburg, C. E. 2018; 79 (1): e42–e45

    View details for PubMedID 29847478

  • Population-level Outcomes and Cost-Effectiveness of Expanding the Recommendation for Age-based Hepatitis C Testing in the United States CLINICAL INFECTIOUS DISEASES Barocas, J. A., Tasillo, A., Yazdi, G., Wang, J., Vellozzi, C., Hariri, S., Isenhour, C., Randall, L., Ward, J. W., Mermin, J., Salomon, J. A., Linas, B. P. 2018; 67 (4): 549–56

    Abstract

    The U.S. Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend one-time hepatitis C virus (HCV) testing for persons born 1945-1965 and targeted testing for high-risk persons. This strategy targets HCV testing to a prevalent population at high risk for HCV morbidity and mortality, but does not include younger populations with high incidence. To address this gap and improve access to HCV testing, age-based strategies should be considered.We used a simulation of HCV to estimate the effectiveness and cost-effectiveness of HCV testing strategies: 1) standard of care (SOC) - recommendation for one-time testing for all persons born 1945-1965, 2) recommendation for one-time testing for adults ≥40 years (≥40 strategy), 3) ≥30 years (≥30 strategy), and 4) ≥18 years (≥18 strategy). All strategies assumed targeted testing of high-risk persons. Inputs were derived from national databases, observational cohorts and clinical trials. Outcomes included quality-adjusted life expectancy, costs, and cost-effectiveness.Expanded age-based testing strategies increased U.S. population lifetime case identification and cure rates. Greatest increases were observed in the ≥18 strategy. Compared to the SOC, this strategy resulted in an estimated 256,000 additional infected persons identified and 280,000 additional cures at the lowest cost per QALY gained (ICER = $28,000/QALY).In addition to risk-based testing, one-time HCV testing of persons 18 and older appears to be cost-effective, leads to improved clinical outcomes and identifies more persons with HCV than the current birth cohort recommendations. These findings could be considered for future recommendation revisions.

    View details for PubMedID 29420742

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  • Measuring health and economic wellbeing in the Sustainable Development Goals era: development of a poverty-free life expectancy metric and estimates for 90 countries LANCET GLOBAL HEALTH Riumallo-Herl, C., Canning, D., Salomon, J. A. 2018; 6 (8): E843–E858

    Abstract

    The Sustainable Development Goals (SDGs), adopted in September, 2015, emphasise the link between health and economic development policies. Despite this link, and the multitude of targets and indicators in the SDGs and other initiatives, few monitoring tools explicitly incorporate measures of both health and economic status. Here we propose poverty-free life expectancy (PFLE) as a new metric that uses widely available data to provide a composite measure of population health and economic wellbeing.We developed a population-level measure of PFLE and computed this summary measure for 90 countries with available data. Specifically, we used Sullivan's method, as in many health expectancy measures, to incorporate the prevalence of poverty by age and sex from household economic surveys into demographic life tables based on mortality rates from the 2015 Global Burden of Disease Study (GBD). For comparison, we also recalculated all PFLE measures using life tables from WHO and the UN. PFLE estimates for each country, stratified by sex, are the average number of poverty-free years a person could expect to live if exposed to current mortality rates and poverty prevalence in that country.The average PFLE in the 90 countries included in this study was 66·0 years (95% uncertainty interval [UI] 64·5-67·3) for females and 61·6 years (60·1-62·9) for males, whereas life expectancy estimates were 76·3 years (95% UI 74·0-78·2) for females and 71·0 years (68·7-73·0) for males. PFLE varied widely between countries, ranging from 9·9 years (95% UI 9·1-10·5) for both sexes combined in Malawi, to 83·2 years (83·0-83·5) in Iceland, the latter differing only marginally from life expectancy in that country. In 67 of 90 countries, the difference between life expectancy and PFLE was greater for females than for males, indicating that women generally live more years of life in poverty than men do. Results were consistent when using GBD, WHO, or UN life tables.Differences in PFLE between countries are substantially greater than differences in life expectancy. Despite general improvements in survival in most regions of the world in the past decades, the focus in the SDG era on ending poverty brings into sharp relief the importance of ensuring that years of added life are lived with at least a minimum standard of economic wellbeing. Although summary measures of population health provide overall measures of survivorship and functional health, our new measure of PFLE provides complementary information that can inform and benchmark policies seeking to improve both health and economic wellbeing.None.

    View details for PubMedID 30012266

  • Evidence sources on the natural history of latent tuberculosis infection LANCET INFECTIOUS DISEASES Menzies, N. A., Cohen, T., Salomon, J. A. 2018; 18 (8): 834–35

    View details for PubMedID 30064672

  • Progression from latent infection to active disease in dynamic tuberculosis transmission models: a systematic review of the validity of modelling assumptions LANCET INFECTIOUS DISEASES Menzies, N. A., Wolf, E., Connors, D., Bellerose, M., Sbarra, A. N., Cohen, T., Hill, A. N., Yaesoubi, R., Galer, K., White, P. J., Abubakar, I., Salomon, J. A. 2018; 18 (8): E228–E238

    Abstract

    Mathematical modelling is commonly used to evaluate infectious disease control policy and is influential in shaping policy and budgets. Mathematical models necessarily make assumptions about disease natural history and, if these assumptions are not valid, the results of these studies can be biased. We did a systematic review of published tuberculosis transmission models to assess the validity of assumptions about progression to active disease after initial infection (PROSPERO ID CRD42016030009). We searched PubMed, Web of Science, Embase, Biosis, and Cochrane Library, and included studies from the earliest available date (Jan 1, 1962) to Aug 31, 2017. We identified 312 studies that met inclusion criteria. Predicted tuberculosis incidence varied widely across studies for each risk factor investigated. For population groups with no individual risk factors, annual incidence varied by several orders of magnitude, and 20-year cumulative incidence ranged from close to 0% to 100%. A substantial proportion of modelled results were inconsistent with empirical evidence: for 10-year cumulative incidence, 40% of modelled results were more than double or less than half the empirical estimates. These results demonstrate substantial disagreement between modelling studies on a central feature of tuberculosis natural history. Greater attention to reproducing known features of epidemiology would strengthen future tuberculosis modelling studies, and readers of modelling studies are recommended to assess how well those studies demonstrate their validity.

    View details for PubMedID 29653698

    View details for PubMedCentralID PMC6070419

  • Estimating the distribution of morbidity and mortality of childhood diarrhea, measles, and pneumonia by wealth group in low- and middle-income countries BMC MEDICINE Chang, A. Y., Riumallo-Herl, C., Salomon, J. A., Resch, S. C., Brenzel, L., Verguet, S. 2018; 16: 102

    Abstract

    Equitable access to vaccines has been suggested as a priority for low- and middle-income countries (LMICs). However, it is unclear whether providing equitable access is enough to ensure health equity. Furthermore, disaggregated data on health outcomes and benefits gained across population subgroups are often unavailable. This paper develops a model to estimate the distribution of childhood disease cases and deaths across socioeconomic groups, and the potential benefits of three vaccine programs in LMICs.For each country and for three diseases (diarrhea, measles, pneumonia), we estimated the distributions of cases and deaths that would occur across wealth quintiles in the absence of any immunization or treatment programs, using both the prevalence and relative risk of a set of risk and prognostic factors. Building on these baseline estimates, we examined what might be the impact of three vaccines (first dose of measles, pneumococcal conjugate, and rotavirus vaccines), under five scenarios based on different sets of quintile-specific immunization coverage and disease treatment utilization rates.Due to higher prevalence of risk factors among the poor, disproportionately more disease cases and deaths would occur among the two lowest wealth quintiles for all three diseases when vaccines or treatment are unavailable. Country-specific context, including how the baseline risks, immunization coverage, and treatment utilization are currently distributed across quintiles, affects how different policies translate into changes in cases and deaths distribution.Our study highlights several factors that would substantially contribute to the unequal distribution of childhood diseases, and finds that merely ensuring equal access to vaccines will not reduce the health outcomes gap across wealth quintiles. Such information can inform policies and planning of programs that aim to improve equitable delivery of healthcare services.

    View details for PubMedID 29970074

  • Depressive Symptoms and their Relation to Age and Chronic diseases among middle-aged and Older Adults in rural South Africa. The journals of gerontology. Series A, Biological sciences and medical sciences Geldsetzer, P., Vaikath, M., Wagner, R., Rohr, J. K., Montana, L., Gomez-Olive, F. X., Rosenberg, M. S., Manne-Goehler, J., Mateen, F. J., Payne, C. F., Kahn, K., Tollman, S. M., Salomon, J. A., Gaziano, T. A., Barnighausen, T., Berkman, L. F. 2018

    Abstract

    Background: Understanding how depression is associated with chronic conditions and socio-demographic characteristics can inform the design and effective targeting of depression screening and care interventions. In this study, we present some of the first evidence from sub-Saharan Africa on the association between depressive symptoms and a range of chronic conditions (diabetes, HIV, hypertension, and obesity) as well as socio-demographic characteristics.Methods: A questionnaire was administered to a population-based simple random sample of 5,059 adults aged 40 years in Agincourt, South Africa. Depressive symptoms were measured using a modified version of the eight-item Center for Epidemiological Studies Depression screening tool. Diabetes was assessed using a capillary blood glucose measurement and HIV using a dried blood spot.Results: 17.0% (95% CI: 15.9% - 18.1%) of participants had at least three depressive symptoms. None of the chronic conditions were significantly associated with depressive symptoms in multivariable regressions. Older age was the strongest correlate of depressive symptoms with those aged 80 years and older having on average 0.63 (95% CI: 0.40 - 0.86; p<0.001) more depressive symptoms than those aged 40-49 years. Household wealth quintile and education were not significant correlates.Conclusions: This study provides some evidence that the positive associations of depression with diabetes, HIV, hypertension, and obesity that are commonly reported in high-income settings might not exist in rural South Africa. Our finding that increasing age is strongly associated with depressive symptoms suggests that there is a particularly high need for depression screening and treatment among the elderly in rural South Africa.

    View details for PubMedID 29939214

  • Estimated impact of screening on gonorrhea epidemiology in the United States: insights from a mathematical model. Sexually transmitted diseases Tuite, A. R., Ronn, M. M., Wolf, E. E., Gift, T. L., Chesson, H. W., Berruti, A., Galer, K., Menzies, N. A., Hsu, K., Salomon, J. A. 2018

    Abstract

    BACKGROUND: The burden of gonorrhea infections in the United States is high. There are marked disparities by race/ethnicity and sexual orientation. We quantified the impact of screening and treatment on gonorrhea rates in the US population aged 15-39 years for the time period 2000 to 2015 and estimated the impact that alternative screening strategies might have had over the same time period.METHODS: We developed a national-level transmission model that divides the population by race/ethnicity, preferred sex of sex partners, age, sex, and sexual activity level. We compared our fitted model ('base case') to four alternative strategies: (i) no screening; (ii) full adherence to current screening guidelines; (iii) annual universal screening; or (iv) enhanced screening in groups with the highest infection burden. Main outcomes were incidence, infections averted, and incidence rate ratios by race/ethnicity. Mean values and 95% credible intervals (CrI) were calculated from 1000 draws from parameter posterior distributions.RESULTS: The calibrated model reproduced observed trends in gonorrhea, including disparities in infection burden by race/ethnicity. We estimated that screening for gonorrhea from 2000-2015 averted 30% (95% CrI: 18-44%) of total infections that would otherwise have occurred. All alternative active screening strategies were estimated to further reduce, but not eliminate, gonorrhea infections relative to the base case, with differential impacts on the subpopulations of interest.CONCLUSIONS: Our model results suggest that screening has reduced gonorrhea incidence in the US population. Additional reductions in infection burden may have been possible over this time period with increased screening, but elimination was unlikely.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

    View details for DOI 10.1097/OLQ.0000000000000876

    View details for PubMedID 29894368

  • The impact of measurement differences on cross-country depression prevalence estimates: A latent transition analysis PLOS ONE Scorza, P., Masyn, K., Salomon, J. A., Betancourt, T. S. 2018; 13 (6): e0198429

    Abstract

    Depression is currently the second largest contributor to non-fatal disease burden globally. For that reason, economic evaluations are increasingly being conducted using data from depression prevalence estimates to analyze return on investments for services that target mental health. Psychiatric epidemiology studies have reported large cross-national differences in the prevalence of depression. These differences may impact the cost-effectiveness assessments of mental health interventions, thereby affecting decisions regarding government and multi-lateral investment in mental health services. Some portion of the differences in prevalence estimates across countries may be due to true discrepancies in depression prevalence, resulting from differential levels of risk in environmental and demographic factors. However, some portion of those differences may reflect non-invariance in the way standard tools measure depression across countries. This paper attempts to discern the extent to which measurement differences are responsible for reported differences in the prevalence of depression across countries.This analysis uses data from the World Mental Health Surveys, a coordinated series of psychiatric epidemiology studies in 27 countries using multistage household probability samples to assess prevalence and correlates of mental disorders. Data in the current study include responses to the depression module of the World Mental Health Composite International Diagnostic Interview (CIDI) in four countries: Two high-income, western countries-the United States (n = 20, 015) and New Zealand (n = 12,992)-an upper-middle income sub-Saharan African country, South Africa (n = 4,351), and a lower-middle income sub-Saharan African country, Nigeria (n = 6,752). Latent class analysis, a type of finite mixture modeling, was used to categorize respondents into underlying categories based on the variation in their responses to questions in each of three sequential parts of the CIDI depression module: 1) The initial screening items, 2) Additional duration and severity exclusion criteria, and 3) The core symptom questions. After each of these parts, exclusion criteria expel respondents from the remainder of the diagnostic interview, rendering a diagnosis of "not depressed". Latent class models were fit to each of the three parts in each of the four countries, and model fit was assessed using overall chi-square values and Pearson standardized residuals. Latent transition analysis was then applied in order to model participants' progression through the CIDI depression module. Proportion of individuals falling into each latent class and probabilities of transitioning into subsequent classes were used to estimate the percentage in each country that ultimately fell into the more symptomatic class, i.e. classified as "depressed". This latent variable design allows for a non-zero probability that individuals were incorrectly excluded from or retained in the diagnostic interview at any of the three exclusion points and therefore incorrectly diagnosed. Prevalence estimates based on the latent transition model reversed the order of depression prevalence across countries. Based on the latent transition model in this analysis, Nigeria has the highest prevalence (21.6%), followed by New Zealand (17.4%), then South Africa (15.0%), and finally the US (12.5%). That is compared to the estimates in the World Mental Health Surveys that do not allow for measurement differences, in which Nigeria had by far the lowest prevalence (3.1%), followed by South Africa (9.8%), then the United States (13.5%) and finally New Zealand (17.8%). Individuals endorsing the screening questions in Nigeria and South Africa were more likely to endorse more severe depression symptomology later in the module (i.e. they had higher transition probabilities), suggesting that individuals in the two Western countries may be more likely to endorse screening questions even when they don't have as severe symptoms. These differences narrow the range of depression prevalence between countries 14 percentage points in the original estimates to 6 percentage points in the estimate taking account of measurement differences.These data suggest fewer differences in cross-national prevalence of depression than previous estimates. Given that prevalence data are used to support key decisions regarding resource-allocation for mental health services, more critical attention should be paid to differences in the functioning of measurement across contexts and the impact these differences have on prevalence estimates. Future research should include qualitative methods as well as external measures of disease severity, such as impairment, to assess how the latent classes predict these external variables, to better understand the way that standard tools estimate depression prevalence across contexts. Adjustments could then be made to prevalence estimates used in cost-effectiveness analyses.

    View details for PubMedID 29879167

  • Feasibility of a Health-Utility Approach to Quantifying Noneconomic Losses from Personal Injury JOURNAL OF EMPIRICAL LEGAL STUDIES Carvalho, N., Fish, D., Grant, G. M., Salomon, J. A., Studdert, D. M. 2018; 15 (2): 278–319
  • Cohort Profile: Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Gomez-Olive, F., Montana, L., Wagner, R. G., Kabudula, C. W., Rohr, J. K., Kahn, K., Barnighausen, T., Collinson, M., Canning, D., Gaziano, T., Salomon, J. A., Payne, C. F., Wade, A., Tollman, S. M., Berkman, L. 2018; 47 (3): 689-+

    View details for PubMedID 29325152

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  • The State of US Health, 1990-2016 Burden of Diseases, Injuries, and Risk Factors Among US States JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Mokdad, A. H., Ballestros, K., Echko, M., Glenn, S., Olsen, H. E., Mullany, E., Lee, A., Khan, A., Ahmadi, A., Ferrari, A. J., Kasaeian, A., Werdecker, A., Carter, A., Zipkin, B., Sartorius, B., Serdar, B., Sykes, B. L., Troeger, C., Fitzmaurice, C., Rehm, C. D., Santomauro, D., Kim, D., Colombara, D., Schwebel, D. C., Tsoi, D., Kolte, D., Nsoesie, E., Nichols, E., Oren, E., Charlson, F. J., Patton, G. C., Roth, G. A., Hosgood, H., Whiteford, H. A., Kyu, H., Erskine, H. E., Huang, H., Martopullo, I., Singh, J. A., Nachega, J. B., Sanabria, J. R., Abbas, K., Ong, K., Tabb, K., Krohn, K., Cornaby, L., Degenhardt, L., Moses, M., Farvid, M., Griswold, M., Criqui, M., Bell, M., Nguyen, M., Wallin, M., Mirarefin, M., Qorbani, M., Younis, M., Fullman, N., Liu, P., Briant, P., Gona, P., Havmoller, R., Leung, R., Kimokoti, R., Bazargan-Hejazi, S., Hay, S. I., Yadgir, S., Biryukov, S., Vollset, S., Alam, T., Frank, T., Farid, T., Miller, T., Vos, T., Barnighausen, T., Gebrehiwot, T., Yano, Y., Al-Aly, Z., Mehari, A., Handal, A., Kandel, A., Anderson, B., Biroscak, B., Mozaffarian, D., Dorsey, E., Ding, E. L., Park, E., Wagner, G., Hu, G., Chen, H., Sunshine, J. E., Khubchandani, J., Leasher, J., Leung, J., Salomon, J., Unutzer, J., Cahill, L., Cooper, L., Horino, M., Brauer, M., Breitborde, N., Hotez, P., Topor-Madry, R., Soneji, S., Stranges, S., James, S., Amrock, S., Jayaraman, S., Patel, T., Akinyemiju, T., Skirbekk, V., Kinfu, Y., Bhutta, Z., Jonas, J. B., Murray, C. L., US Burden Dis Collaborators 2018; 319 (14): 1444–72

    Abstract

    Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state.To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed.Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

    View details for PubMedID 29634829

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  • Tuberculosis control interventions targeted to previously treated people in a high-incidence setting: a modelling study LANCET GLOBAL HEALTH Marx, F. M., Yaesoubi, R., Menzies, N. A., Salomon, J. A., Bilinski, A., Beyers, N., Cohen, T. 2018; 6 (4): E426–E435

    Abstract

    In high-incidence settings, recurrent disease among previously treated individuals contributes substantially to the burden of incident and prevalent tuberculosis. The extent to which interventions targeted to this high-risk group can improve tuberculosis control has not been established. We aimed to project the population-level effect of control interventions targeted to individuals with a history of previous tuberculosis treatment in a high-incidence setting.We developed a transmission-dynamic model of tuberculosis and HIV in a high-incidence setting with a population of roughly 40 000 people in suburban Cape Town, South Africa. The model was calibrated to data describing local demography, TB and HIV prevalence, TB case notifications and treatment outcomes using a Bayesian calibration approach. We projected the effect of annual targeted active case finding in all individuals who had previously completed tuberculosis treatment and targeted active case finding combined with lifelong secondary isoniazid preventive therapy. We estimated the effect of these targeted interventions on local tuberculosis incidence, prevalence, and mortality over a 10 year period (2016-25).We projected that, under current control efforts in this setting, the tuberculosis epidemic will remain in slow decline for at least the next decade. Additional interventions targeted to previously treated people could greatly accelerate these declines. We projected that annual targeted active case finding combined with secondary isoniazid preventive therapy in those who previously completed tuberculosis treatment would avert 40% (95% uncertainty interval [UI] 21-56) of incident tuberculosis cases and 41% (16-55) of tuberculosis deaths occurring between 2016 and 2025.In this high-incidence setting, the use of targeted active case finding in combination with secondary isoniazid preventive therapy in previously treated individuals could accelerate decreases in tuberculosis morbidity and mortality. Studies to measure cost and resource implications are needed to establish the feasibility of this type of targeted approach for improving tuberculosis control in settings with high tuberculosis and HIV prevalence.National Institutes of Health, German Research Foundation.

    View details for PubMedID 29472018

  • Treatment gaps and potential cardiovascular risk reduction from expanded statin use in the US and England PLOS ONE Ueda, P., Lung, T., Lu, Y., Salomon, J. A., Rahimi, K., Clarke, P., Danaei, G. 2018; 13 (3): e0190688

    Abstract

    The updated national guidelines for cardiovascular risk assessment and lipid modification in the UK and US expand the indications for statin therapy in primary prevention to adults with moderate risk of cardiovascular disease (CVD) but many adults at high CVD risk remain untreated in both countries. We set out to identify treatment gaps in English and American adults at moderate and high risk of cardiovascular disease (CVD), and to estimate the number of CVD events that would be prevented from expanding statin therapy to those who are currently untreated.We used nationally representative samples of 10,375 English adults and 7,687 US adults aged 40-75 years and free of existing CVD from the Health Survey for England 2009-2013, and the National Health and Nutrition Examination Survey 2007-2012 in the US. We used the risk algorithms and the risk thresholds for statin therapy recommended by each country's national guideline to categorize the survey participants into moderate-risk (≥10% to <20% 10-year risk of CVD in England and ≥7.5% to <20% risk in the US) or high-risk (≥20%risk) and simulated the number of events that would be prevented from expansion of statin therapy to those currently untreated.Close to half of adults at high CVD risk in England (46.0%) and the US (49.7%) were not receiving statins. Expanding statin use to 1.45 million high-risk adults in England would save 101,000 (95% CI = 81,000-120,000) CVD events in the next 10 years compared with 128,000 (103,000-154,000) CVD events that would be prevented from expanding treatment to 3.64 million untreated moderate-risk adults. In the US, expanding statin use to 5.27 million untreated high-risk adults would save 384,000 (305,000-461,000) CVD events over 10 years compared with 616,000 (493,000-738,000) CVD events that would be prevented from treating 20.29 million untreated moderate-risk adults.In both England and the US, expanding statin therapy to untreated moderate-risk adults would prevent a comparable number of events as expanding statin use to a much smaller number of currently untreated high-risk adults. A large potential for CVD prevention remains from improving coverage of statin therapy among high-risk adults.

    View details for PubMedID 29561843

  • Disability weights for infectious diseases in four European countries: comparison between countries and across respondent characteristics EUROPEAN JOURNAL OF PUBLIC HEALTH de Noordhout, C., Devleesschauwer, B., Salomon, J. A., Turner, H., Cassini, A., Colzani, E., Speybroeck, N., Polinder, S., Kretzschmar, M. E., Havelaar, A. H., Haagsma, J. A. 2018; 28 (1): 124–33

    Abstract

    In 2015, new disability weights (DWs) for infectious diseases were constructed based on data from four European countries. In this paper, we evaluated if country, age, sex, disease experience status, income and educational levels have an impact on these DWs.We analyzed paired comparison responses of the European DW study by participants' characteristics with separate probit regression models. To evaluate the effect of participants' characteristics, we performed correlation analyses between countries and within country by respondent characteristics and constructed seven probit regression models, including a null model and six models containing participants' characteristics. We compared these seven models using Akaike Information Criterion (AIC).According to AIC, the probit model including country as covariate was the best model. We found a lower correlation of the probit coefficients between countries and income levels (range rs: 0.97-0.99, P < 0.01) than between age groups (range rs: 0.98-0.99, P < 0.01), educational level (range rs: 0.98-0.99, P < 0.01), sex (rs = 0.99, P < 0.01) and disease status (rs = 0.99, P < 0.01). Within country the lowest correlations of the probit coefficients were between low and high income level (range rs = 0.89-0.94, P < 0.01).We observed variations in health valuation across countries and within country between income levels. These observations should be further explored in a systematic way, also in non-European countries. We recommend future researches studying the effect of other characteristics of respondents on health assessment.

    View details for PubMedID 29020343

    View details for PubMedCentralID PMC5881674

  • Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet (London, England) 2018; 391 (10136): 2236–71

    Abstract

    A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(18)30994-2

    View details for PubMedID 29893224

  • The Burden of Cardiovascular Diseases Among US States, 1990-2016. JAMA cardiology Roth, G. A., Johnson, C. O., Abate, K. H., Abd-Allah, F. n., Ahmed, M. n., Alam, K. n., Alam, T. n., Alvis-Guzman, N. n., Ansari, H. n., Ärnlöv, J. n., Atey, T. M., Awasthi, A. n., Awoke, T. n., Barac, A. n., Bärnighausen, T. n., Bedi, N. n., Bennett, D. n., Bensenor, I. n., Biadgilign, S. n., Castañeda-Orjuela, C. n., Catalá-López, F. n., Davletov, K. n., Dharmaratne, S. n., Ding, E. L., Dubey, M. n., Faraon, E. J., Farid, T. n., Farvid, M. S., Feigin, V. n., Fernandes, J. n., Frostad, J. n., Gebru, A. n., Geleijnse, J. M., Gona, P. N., Griswold, M. n., Hailu, G. B., Hankey, G. J., Hassen, H. Y., Havmoeller, R. n., Hay, S. n., Heckbert, S. R., Irvine, C. M., James, S. L., Jara, D. n., Kasaeian, A. n., Khan, A. R., Khera, S. n., Khoja, A. T., Khubchandani, J. n., Kim, D. n., Kolte, D. n., Lal, D. n., Larsson, A. n., Linn, S. n., Lotufo, P. A., Magdy Abd El Razek, H. n., Mazidi, M. n., Meier, T. n., Mendoza, W. n., Mensah, G. A., Meretoja, A. n., Mezgebe, H. B., Mirrakhimov, E. n., Mohammed, S. n., Moran, A. E., Nguyen, G. n., Nguyen, M. n., Ong, K. L., Owolabi, M. n., Pletcher, M. n., Pourmalek, F. n., Purcell, C. A., Qorbani, M. n., Rahman, M. n., Rai, R. K., Ram, U. n., Reitsma, M. B., Renzaho, A. M., Rios-Blancas, M. J., Safiri, S. n., Salomon, J. A., Sartorius, B. n., Sepanlou, S. G., Shaikh, M. A., Silva, D. n., Stranges, S. n., Tabarés-Seisdedos, R. n., Tadele Atnafu, N. n., Thakur, J. S., Topor-Madry, R. n., Truelsen, T. n., Tuzcu, E. M., Tyrovolas, S. n., Ukwaja, K. N., Vasankari, T. n., Vlassov, V. n., Vollset, S. E., Wakayo, T. n., Weintraub, R. n., Wolfe, C. n., Workicho, A. n., Xu, G. n., Yadgir, S. n., Yano, Y. n., Yip, P. n., Yonemoto, N. n., Younis, M. n., Yu, C. n., Zaidi, Z. n., Zaki, M. E., Zipkin, B. n., Afshin, A. n., Gakidou, E. n., Lim, S. S., Mokdad, A. H., Naghavi, M. n., Vos, T. n., Murray, C. J. 2018; 3 (5): 375–89

    Abstract

    Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously.To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes.Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017.Residing in the United States.Cardiovascular disease disability-adjusted life-years (DALYs).Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors.Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.

    View details for PubMedID 29641820

    View details for PubMedCentralID PMC6145754

  • Predictors of male circumcision incidence in a traditionally non-circumcising South African population-based cohort. PloS one Ortblad, K. F., Barnighausen, T., Chimbindi, N., Masters, S. H., Salomon, J. A., Harling, G. 2018; 13 (12): e0209172

    Abstract

    BACKGROUND: Voluntary medical male circumcision has been promoted in high HIV prevalence settings to prevent HIV acquisition in males. However, the uptake of circumcision in many sub-Saharan African settings remains low. While many studies have measured circumcision prevalence, understanding circumcision incidence and its predictors is vital to achieving ambitious circumcision prevalence targets.SETTING: Rural KwaZulu-Natal, South Africa.METHODS: We measured circumcision incidence over the period 2009-2014 in a longitudinal population-based cohort with high HIV prevalence and low circumcision prevalence. Multivariable survival models with Weibull distributions were used to assess socio-demographic, behavioral and biological predictors of circumcision incidence.RESULTS: Between 2009 and 2014, circumcision prevalence among males 15-49 years in the cohort increased from 3% to 24%. Among 6,203 males 15-49 years, 873 new circumcisions occurred over 13,678 person-years (incidence rate: 6.4/100 person-years, 95% CI 6.0-6.8). Circumcision incidence was substantially higher amongst young males: 15-19 year olds were twice as likely to circumcise as older males. In the survival model, shorter household distance to the nearest healthcare facility, knowledge of HIV status and biological HIV-negative status were associated with an increased likelihood of circumcision incidence.CONCLUSIONS: Circumcision prevalence among males in rural KwaZulu-Natal remains well below South Africa's national 80% coverage target across age groups. In this population, distance to the nearest healthcare facility and knowledge of HIV status were important independent predictors of circumcision incidence. Mobile circumcision clinics and innovative HIV testing services may be important tools to help achieve circumcision targets.

    View details for PubMedID 30566506

  • Spatially targeted screening to reduce tuberculosis transmission in high-incidence settings. The Lancet. Infectious diseases Cudahy, P. G., Andrews, J. R., Bilinski, A. n., Dowdy, D. W., Mathema, B. n., Menzies, N. A., Salomon, J. A., Shrestha, S. n., Cohen, T. n. 2018

    Abstract

    As the leading infectious cause of death worldwide and the primary proximal cause of death in individuals living with HIV, tuberculosis remains a global concern. Existing tuberculosis control strategies that rely on passive case-finding appear insufficient to achieve targets for reductions in tuberculosis incidence and mortality. Active case-finding strategies aim to detect infectious individuals earlier in their infectious period to reduce onward transmission and improve treatment outcomes. Empirical studies of active case-finding have produced mixed results and determining how to direct active screening to those most at risk remains a topic of intense research. Our systematic review of literature evaluating the effects of geographically targeted tuberculosis screening interventions found three studies in low tuberculosis incidence settings, but none conducted in high tuberculosis incidence countries. We discuss open questions related to the use of spatially targeted approaches for active screening in countries where tuberculosis incidence is highest.

    View details for PubMedID 30554997

  • Inference With Difference-in-Differences With a Small Number of Groups A Review, Simulation Study, and Empirical Application Using SHARE Data MEDICAL CARE Rokicki, S., Cohen, J., Fink, G., Salomon, J. A., Landrum, M. 2018; 56 (1): 97–105
  • The Optimal Age for Screening Adolescents and Young Adults Without Identified Risk Factors for HIV JOURNAL OF ADOLESCENT HEALTH Neilan, A. M., Dunville, R., Ocfemia, M., Salomon, J. A., Francke, J. A., Bulteel, A. B., Wang, L., Hsu, K. K., DiNenno, E. A., Walensky, R. P., Parker, R. A., Freedberg, K. A., Ciaranello, A. L. 2018; 62 (1): 22–28

    Abstract

    To assess the optimal age at which a one-time HIV screen should begin for adolescents and young adults (AYA) in the U.S. without identified HIV risk factors, incorporating clinical impact, costs, and cost-effectiveness.We simulated HIV-uninfected 12-year-olds in the U.S. without identified risk factors who faced age-specific risks of HIV infection (.6-71.3/100,000PY). We modeled a one-time screen ($36) at age 15, 18, 21, 25, or 30, each in addition to current U.S. screening practices (30% screened by age 24). Outcomes included retention in care, virologic suppression, life expectancy, lifetime costs, and incremental cost-effectiveness ratios in $/year-of-life saved (YLS) from the health-care system perspective. In sensitivity analyses, we varied HIV incidence, screening and linkage rates, and costs.All one-time screens detected a small proportion of lifetime infections (.1%-10.3%). Compared with current U.S. screening practices, a screen at age 25 led to the most favorable care continuum outcomes at age 25: proportion diagnosed (77% vs. 51%), linked to care (71% vs. 51%), retained in care (68% vs. 44%), and virologically suppressed (49% vs. 32%). Compared with the next most effective screen, a screen at age 25 provided the greatest clinical benefit, and was cost-effective ($96,000/YLS) by U.S. standards (<$100,000/YLS).For U.S. AYA without identified risk factors, a one-time routine HIV screen at age 25, after the peak of incidence, would optimize clinical outcomes and be cost-effective compared with current U.S. screening practices. Focusing screening on AYA ages 18 or younger is a less efficient use of a one-time screen among AYA than screening at a later age.

    View details for PubMedID 29273141

    View details for PubMedCentralID PMC5745059

  • Trading Bankruptcy for Health: A Discrete-Choice Experiment VALUE IN HEALTH Shrime, M. G., Weinstein, M. C., Hammitt, J. K., Cohen, J. L., Salomon, J. A. 2018; 21 (1): 95–104

    Abstract

    Although nearly two-third of bankruptcy in the United States is medical in origin, a common assumption is that individuals facing a potentially lethal disease opt for cure at any cost. This assumption has never been tested, and knowledge of how the American population values a trade-off between cure and bankruptcy is unknown.To determine the relative importance among the general American population of improved health versus improved financial risk protection, and to determine the impact of demographics on these preferences.A discrete-choice experiment was performed with 2359 members of the US population. Respondents were asked to value treatments with varying chances of cure and bankruptcy in the presence of a lethal disease. Latent class analysis with concomitant variables was performed, weighted for national representativeness. Sensitivity analyses were undertaken to test the robustness of the results.It was found that 31.3% of the American population values cure at all costs. Nevertheless, for 8.5% of the US population, financial solvency dominates concerns for health in medical decision making. Individuals who value cure at all costs are more likely to have had experience with serious disease and to be women. No demographic characteristics significantly predicted individuals who value solvency over cure.Although the average American values cure more than financial solvency, a cure-at-all-costs rubric describes the preferences of a minority of the population, and 1 in 12 value financial protection over any chances of cure. This study provides empirical evidence for how the US population values a trade-off between avoiding adverse health outcomes and facing bankruptcy. These findings bring to the fore the decision making that individuals face in balancing the acute financial burden of health care access.

    View details for PubMedID 29304947

  • Prevalence and correlates of frailty in an older rural African population: findings from the HAALSI cohort study BMC GERIATRICS Payne, C. F., Wade, A., Kabudula, C. W., Davies, J. I., Chang, A. Y., Gomez-Olive, F., Kahn, K., Berkman, L. F., Tollman, S. M., Salomon, J. A., Witham, M. D. 2017; 17: 293

    Abstract

    Frailty is a key predictor of death and dependency, yet little is known about frailty in sub-Saharan Africa despite rapid population ageing. We describe the prevalence and correlates of phenotypic frailty using data from the Health and Aging in Africa: Longitudinal Studies of an INDEPTH Community cohort.We analysed data from rural South Africans aged 40 and over. We used low grip strength, slow gait speed, low body mass index, and combinations of self-reported exhaustion, decline in health, low physical activity and high self-reported sedentariness to derive nine variants of a phenotypic frailty score. Each frailty category was compared with self-reported health, subjective wellbeing, impairment in activities of daily living and the presence of multimorbidity. Cox regression analyses were used to compare subsequent all-cause mortality for non-frail (score 0), pre-frail (score 1-2) and frail participants (score 3+).Five thousand fifty nine individuals (mean age 61.7 years, 2714 female) were included in the analyses. The nine frailty score variants yielded a range of frailty prevalences (5.4% to 13.2%). For all variants, rates were higher in women than in men, and rose steeply with age. Frailty was associated with worse subjective wellbeing, and worse self-reported health. Both prefrailty and frailty were associated with a higher risk of death during a mean 17 month follow up for all score variants (hazard ratios 1.29 to 2.41 for pre-frail vs non-frail; hazard ratios 2.65 to 8.91 for frail vs non-frail).Phenotypic frailty could be measured in this older South African population, and was associated with worse health, wellbeing and earlier death.

    View details for PubMedID 29281995

  • Hepatitis C Testing Increased Among Baby Boomers Following The 2012 Change To CDC Testing Recommendations HEALTH AFFAIRS Barocas, J. A., Wang, J., White, L. F., Tasillo, A., Salomon, J. A., Freedberg, K. A., Linas, B. P. 2017; 36 (12): 2142–50

    Abstract

    In 2012 the Centers for Disease Control and Prevention recommended routine testing for hepatitis C for people born in the period 1945-65. Until now, the recommendation's impact on hepatitis C screening rates in the United States has not been fully understood. We used an interrupted time series with comparison group design to analyze hepatitis C screening rates in the period 2010-14 among 2.8 million commercially insured adults in the MarketScan database. Hepatitis C screening rates increased yearly between 2010 and 2014, from 1.65 to 2.59 per 100 person-years. A 49 percent increase in screening rates among people born during 1945-65 followed the release of the recommendation, but no such increase was observed among adults born after 1965. The effect among the target population was sustained, and by twenty-four months after the recommendation's release, screening rates had increased 106 percent. We conclude that the hepatitis C testing policy change resulted in significantly increased testing among the target population and may have decreased the magnitude of the hepatitis C epidemic.

    View details for PubMedID 29200354

  • The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level Results From the Global Burden of Disease Study 2015 JAMA ONCOLOGY Akinyemiju, T., Abera, S., Ahmed, M., Alam, N., Alemayohu, M., Allen, C., Al-Raddadi, R., Alvis-Guzman, N., Amoako, Y., Artaman, A., Ayele, T., Barac, A., Bensenor, I., Berhane, A., Bhutta, Z., Castillo-Rivas, J., Chitheer, A., Choi, J., Cowie, B., Dandona, L., Dandona, R., Dey, S., Dicker, D., Phuc, H., Ekwueme, D. U., Zaki, M., Fischer, F., Furst, T., Hancock, J., Hay, S. I., Hotez, P., Jee, S., Kasaeian, A., Khader, Y., Khang, Y., Kumar, G., Kutz, M., Larson, H., Lopez, A., Lunevicius, R., Malekzadeh, R., McAlinden, C., Meier, T., Mendoza, W., Mokdad, A., Moradi-Lakeh, M., Nagel, G., Nguyen, Q., Nguyen, G., Ogbo, F., Patton, G., Pereira, D. M., Pourmalek, F., Qorbani, M., Radfar, A., Roshandel, G., Salomon, J. A., Sanabria, J., Sartorius, B., Satpathy, M., Sawhney, M., Sepanlou, S., Shackelford, K., Shore, H., Sun, J., Mengistu, D., Topor-Madry, R., Tran, B., Ukwaja, K., Vlassov, V., Vollset, S., Vos, T., Wakayo, T., Weiderpass, E., Werdecker, A., Yonemoto, N., Younis, M., Yu, C., Zaidi, Z., Zhu, L., Murray, C. L., Naghavi, M., Fitzmaurice, C., Global Burden Dis Liver Canc Colla 2017; 3 (12): 1683–91

    View details for PubMedID 28983565

  • Cost-effectiveness of Testing and Treatment for Latent Tuberculosis Infection in Residents Born Outside the United States With and Without Medical Comorbidities in a Simulation Model JAMA INTERNAL MEDICINE Tasillo, A., Salomon, J. A., Trikalinos, T. A., Horsburgh, C., Marks, S. M., Linas, B. P. 2017; 177 (12): 1755–64

    Abstract

    Testing for and treating latent tuberculosis infection (LTBI) is among the main strategies to achieve TB elimination in the United States. The best approach to testing among non-US born residents, particularly those with comorbid conditions, is uncertain.To estimate health outcomes, costs, and cost-effectiveness of LTBI testing and treatment among non-US born residents with and without medical comorbidities.Decision analytic tree and Markov cohort simulation model among non-US born residents with no comorbidities, with diabetes, with HIV infection, or with end-stage renal disease (ESRD) using a health care sector perspective with 3% annual discounting. Strategies compared included no testing, tuberculin skin test (TST), interferon gamma release assay (IGRA), confirm positive (initial TST, IGRA only for TST-positive results; both tests positive indicates LTBI), and confirm negative (initial IGRA, then TST for IGRA-negative; any test positive indicates LTBI). All strategies were coupled to treatment with 3 months of self-administered rifapentine and isoniazid.Number needed to test and treat to prevent 1 case of TB reactivation, discounted quality-adjusted life-years (QALYs), discounted lifetime medical costs, and incremental cost-effectiveness ratios (ICERs).Improving health outcomes increased costs, with choice of test dependent on willingness to pay. Strategies ranked by ascending costs and benefits: no testing, confirm positive, TST, IGRA, and confirm negative. The ICERs varied by non-US born patient risk group: patients with no comorbidities, IGRA was likely cost-effective at $83 000/QALY; patients with diabetes, both confirm positive ($53 000/QALY) and IGRA ($120 000/QALY) were likely cost-effective; patients with HIV, confirm negative was clearly preferred ($63 000/QALY); and patients with ESRD, no testing was cost-effective. Increased LTBI prevalence and reduced return for TST reading improved IGRA's relative performance. In 10 000 probabilistic simulations among non-US born patients with no comorbidities, with diabetes, and with HIV, some form of testing was virtually always cost-effective. These simulations highlight the uncertainty of test choice for non-US born patients with no comorbidities and non-US born patients with diabetes, but strategies including IGRA were preferred in over 60% of simulations for all non-US born populations except those with ESRD.Testing for and treating LTBI among non-US born residents with and without selected comorbidities is likely cost-effective except among those with ESRD in whom competing risks of death limit benefits. Strategies including IGRA fell below a $100 000/QALY willingness-to-pay threshold for non-US born patients with no comorbidities, patients with diabetes, and patients with HIV.

    View details for PubMedID 29049814

    View details for PubMedCentralID PMC5808933

  • Inference With Difference-in-Differences With a Small Number of Groups: A Review, Simulation Study, and Empirical Application Using SHARE Data. Medical care Rokicki, S., Cohen, J., Fink, G., Salomon, J. A., Landrum, M. B. 2017

    Abstract

    BACKGROUND: Difference-in-differences (DID) estimation has become increasingly popular as an approach to evaluate the effect of a group-level policy on individual-level outcomes. Several statistical methodologies have been proposed to correct for the within-group correlation of model errors resulting from the clustering of data. Little is known about how well these corrections perform with the often small number of groups observed in health research using longitudinal data.METHODS: First, we review the most commonly used modeling solutions in DID estimation for panel data, including generalized estimating equations (GEE), permutation tests, clustered standard errors (CSE), wild cluster bootstrapping, and aggregation. Second, we compare the empirical coverage rates and power of these methods using a Monte Carlo simulation study in scenarios in which we vary the degree of error correlation, the group size balance, and the proportion of treated groups. Third, we provide an empirical example using the Survey of Health, Ageing, and Retirement in Europe.RESULTS: When the number of groups is small, CSE are systematically biased downwards in scenarios when data are unbalanced or when there is a low proportion of treated groups. This can result in over-rejection of the null even when data are composed of up to 50 groups. Aggregation, permutation tests, bias-adjusted GEE, and wild cluster bootstrap produce coverage rates close to the nominal rate for almost all scenarios, though GEE may suffer from low power.CONCLUSIONS: In DID estimation with a small number of groups, analysis using aggregation, permutation tests, wild cluster bootstrap, or bias-adjusted GEE is recommended.

    View details for PubMedID 29112050

  • Impact of Rapid Susceptibility Testing and Antibiotic Selection Strategy on the Emergence and Spread of Antibiotic Resistance in Gonorrhea JOURNAL OF INFECTIOUS DISEASES Tuite, A. R., Gift, T. L., Chesson, H. W., Hsu, K., Salomon, J. A., Grad, Y. H. 2017; 216 (9): 1141–49

    Abstract

    Increasing antibiotic resistance limits treatment options for gonorrhea. We examined the impact of a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles on slowing resistance spread.A mathematical model describing gonorrhea transmission incorporated resistance emergence probabilities and fitness costs associated with resistance based on characteristics of ciprofloxacin (A), azithromycin (B), and ceftriaxone (C). We evaluated time to 1% and 5% prevalence of resistant strains among all isolates with the following: (1) empiric treatment (B and C), and treatment guided by POC tests determining susceptibility to (2) A only and (3) all 3 antibiotics.Continued empiric treatment without POC testing was projected to result in >5% of isolates being resistant to both B and C within 15 years. Use of either POC test in 10% of identified cases delayed this by 5 years. The 3 antibiotic POC test delayed the time to reach 1% prevalence of triply-resistant strains by 6 years, whereas the A-only test resulted in no delay. Results were less sensitive to assumptions about fitness costs and test characteristics with increasing test uptake.Rapid diagnostics reporting antibiotic susceptibility may extend the usefulness of existing antibiotics for gonorrhea treatment, but ongoing monitoring of resistance patterns will be critical.

    View details for PubMedID 28968710

    View details for PubMedCentralID PMC5853443

  • Catastrophic costs potentially averted by tuberculosis control in India and South Africa: a modelling study LANCET GLOBAL HEALTH Verguet, S., Riumallo-Herl, C., Gomez, G. B., Menzies, N. A., Houben, R. J., Sumner, T., Lalli, M., White, R. G., Salomon, J. A., Cohen, T., Foster, N., Chatterjee, S., Sweeney, S., Baena, I., Lonnroth, K., Weil, D. E., Vassall, A. 2017; 5 (11): E1123–E1132

    Abstract

    The economic burden on households affected by tuberculosis through costs to patients can be catastrophic. WHO's End TB Strategy recognises and aims to eliminate these potentially devastating economic effects. We assessed whether aggressive expansion of tuberculosis services might reduce catastrophic costs.We estimated the reduction in tuberculosis-related catastrophic costs with an aggressive expansion of tuberculosis services in India and South Africa from 2016 to 2035, in line with the End TB Strategy. Using modelled incidence and mortality for tuberculosis and patient-incurred cost estimates, we investigated three intervention scenarios: improved treatment of drug-sensitive tuberculosis; improved treatment of multidrug-resistant tuberculosis; and expansion of access to tuberculosis care through intensified case finding (South Africa only). We defined tuberculosis-related catastrophic costs as the sum of direct medical, direct non-medical, and indirect costs to patients exceeding 20% of total annual household income. Intervention effects were quantified as changes in the number of households incurring catastrophic costs and were assessed by quintiles of household income.In India and South Africa, improvements in treatment for drug-sensitive and multidrug-resistant tuberculosis could reduce the number of households incurring tuberculosis-related catastrophic costs by 6-19%. The benefits would be greatest for the poorest households. In South Africa, expanded access to care could decrease household tuberculosis-related catastrophic costs by 5-20%, but gains would be seen largely after 5-10 years.Aggressive expansion of tuberculosis services in India and South Africa could lessen, although not eliminate, the catastrophic financial burden on affected households.Bill & Melinda Gates Foundation.

    View details for PubMedID 29025634

  • Disparities in Management of Cardiovascular Disease in Rural South Africa: Data From the HAALSI Study (Health and Aging in Africa: Longitudinal Studies of International Network for the Demographic Evaluation of Populations and Their Health Communities) CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES Jardim, T., Reiger, S., Abrahams-Gessel, S., Crowther, N. J., Wade, A., Gomez-Olive, F., Salomon, J., Tollman, S., Gaziano, T. A. 2017; 10 (11)

    Abstract

    Optimal secondary prevention is critical for the reduction of repeated cardiovascular events, and the control of cardiovascular risk factors in this context is essential. Data on secondary prevention of cardiovascular disease (CVD) in sub-Saharan Africa are needed to inform intervention strategies with a particular focus on local disparities. The aim of this study was to assess CVD management in a rural community in northeast South Africa.We recruited adults aged ≥40 years residing in the Agincourt subdistrict of Mpumalanga province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure, human immunodeficiency virus status, and point-of-care glucose and lipid levels. CVD was defined as self-report of myocardial infarction and stroke or angina diagnosed by Rose Criteria. A linear regression model was built to identify variables independently associated with the number of cardiovascular risk factors controlled. Of 5059 subjects, 592 (11.7%) met CVD diagnostic criteria. Angina was reported in 77.0% of these subjects, stroke in 25.2%, and myocardial infarction in 3.7%. Percent controlled of the 5 individual risk factors assessed were as follows: tobacco 92.9%; blood pressure 51.2%; body mass index 33.8%; low-density lipoprotein 31.4%; and waist-to-hip ratio 29.7%. Only 4.4% had all 5 risk factors controlled and 42.4% had ≥3 risk factors controlled. Male sex (β coefficient=0.44; 95% confidence interval, 0.25-0.63; P<0.001), absence of physical disability (β coefficient=0.40; 95% confidence interval, 0.16-0.65; P=0.001), and socioeconomic status (β coefficient=0.10; 95% confidence interval, 0.01-0.19; P=0.035) were directly associated with the number of risk factors controlled.Currently, CVD is not being optimally managed in this rural area of South Africa. There are significant disparities in control of CVD risk factors by sex, socioeconomic status, and level of disability. Efforts to improve secondary prevention in this population should be focused on females, subjects from lower socioeconomic status, and those with physical disabilities.

    View details for PubMedID 29150535

    View details for PubMedCentralID PMC5777525

  • Awareness, treatment, and control of dyslipidemia in rural South Africa: The HAALSI (Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa) study PLOS ONE Reiger, S., Jardim, T., Abrahams-Gessel, S., Crowther, N. J., Wade, A., Gomez-Olive, F., Salomon, J., Tollman, S., Gaziano, T. A. 2017; 12 (10): e0187347

    Abstract

    Dyslipidemia is a primary driver for chronic cardiovascular conditions and there is no comprehensive literature about its management in South Africa. The objective of this study was to assess the prevalence, awareness, treatment, and control of dyslipidemia in rural South Africa and how they are impacted by different behaviors and non-modifiable factors. To fulfill this objective we recruited for this cohort study adults aged ≥40 years residing in the Agincourt sub-district of Mpumalanga Province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure (BP), HIV-status, point-of-care glucose and lipid levels. Framingham CVD Risk Score was ascribed to patients based upon categories for 10 year cardiovascular risk of low (<3%), moderate (≥3% and <15%), high (≥15% and <30%), and very high (≥30%).LDL cholesterol control by risk category was defined according to South African Guidelines. Multivariable logistic regression models were built to identify factors that were significantly associated with dyslipidemia and awareness of dyslipidemia From 5,059 respondents a total of 4247 subjects (83.9%) had their cholesterol levels measured and were included in our analysis. Overall, 67.3% (2860) of these met criteria for dyslipidemia, only 30 (1.05%) were aware of their condition, and only 21 subjects (0.73%) were on treatment. The majority have abnormalities in triglycerides (59.3%). As cardiovascular risk increased the rates of lipid control according to LDL level dropped. Multivariate logistic regression analyses showed that being overweight was predictive of dyslipidemia (OR 1.76; 95%CI 1.51-2.05, p<0.001) and dyslipidemia awareness (OR 2.58; 95%CI 1.19-5.58; p = 0.017). In conclusion, the very low awareness and treatment of dyslipidemia in this cohort indicate a greater need for systematic screening and education within the population and demonstrate that there are multiple opportunities to allay this burden.

    View details for PubMedID 29077762

  • When cost-effective interventions are unaffordable: Integrating cost-effectiveness and budget impact in priority setting for global health programs PLOS MEDICINE Bilinski, A., Neumann, P., Cohen, J., Thorat, T., McDaniel, K., Salomon, J. A. 2017; 14 (10): e1002397

    Abstract

    Potential cost-effective barriers in cost-effectiveness studies mean that budgetary impact analyses should also be included in post-2015 Sustainable Development Goal projects says Joshua Salomon and colleagues.

    View details for PubMedID 28968399

  • Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET Wang, H., Abajobir, A., Abate, K., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S., Abraha, H., Abu-Raddad, L. J., Abu-Rmeileh, N. E., Adedeji, I., Adedoyin, R., Adetifa, I. O., Adetokunboh, O., Afshin, A., Aggarwal, R., Agrawal, A., Agrawal, S., Kiadaliri, A., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Aiyar, S., Akanda, S., Akinyemiju, T. F., Akseer, N., Al-Eyadhy, A., Al Lami, F., Alabed, S., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alasfoor, D., Aldridge, R., Alene, K., Alhabib, S., Ali, R., Alizadeh-Navaei, R., Aljunid, S. M., Alkaabi, J. M., Alkerwi, A., Alla, F., Allam, S. D., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Martin, E., Alvis-Guzman, N., Amare, A. T., Ameh, E. A., Amini, E., Ammar, W., Amoako, Y., Anber, N., Andrei, C., Androudi, S., Ansari, H., Ansha, M., Antonio, C. T., Anwari, P., Arnlov, J., Arora, M., Al Artaman, Aryal, K., Asayesh, H., Asgedom, S., Asghar, R., Assadi, R., Atey, T., Atre, S. R., Avila-Burgos, L., Avokpaho, E., Awasthi, A., Quintanilla, B., Babalola, T., Bacha, U., Badawi, A., Balakrishnan, K., Balalla, S., Barac, A., Barber, R. M., Barboza, M. A., Barker-Collo, S. L., Barnighausen, T., Barquera, S., Barregard, L., Barrero, L. H., Baune, B. T., Bazargan-Hejazi, S., Bedi, N., Beghi, E., Bejot, Y., Bekele, B., Bell, M. L., Bello, A. K., Bennett, D. A., Bennett, J. R., Bensenor, I. M., Benson, J., Berhane, A., Berhe, D., Bernabe, E., Beuran, M., Beyene, A., Bhala, N., Bhansali, A., Bhaumik, S., Bhutta, Z. A., Bikbov, B., Birungi, C., Biryukov, S., Bisanzio, D., Bizuayehu, H., Bjerregaard, P., Blosser, C. D., Boneya, D., Boufous, S., Bourne, R. A., Brazinova, A., Breitborde, N. K., Brenner, H., Brugha, T. S., Bukhman, G., Negesa, L., Bulto, B., Bumgarner, B., Burch, M., Butt, Z. A., Cahill, L. E., Cahuana-Hurtado, L., Campos-Nonato, I., Car, J., Car, M., Crdenas, R., Carpenter, D. O., Carrero, J., Carter, A., Castaneda-Orjuela, C. A., Rivas, J., Castro, F. F., Castro, R., Catala-Lopez, F., Chen, H., Chiang, P., Chibalabala, M., Chisumpa, V., Chitheer, A. A., Choi, J., Christensen, H., Christopher, D., Ciobanu, L. G., Cirillo, M., Cohen, A. J., Colquhoun, S. M., Coresh, J., Criqui, M. H., Cromwell, E. A., Crump, J. A., Dandona, L., Dandona, R., Dargan, P. I., das Neves, J., Davey, G., Davitoiu, D. V., Davletov, K., de Courten, B., De Leo, D., Degenhardt, L., Deiparine, S., Dellavalle, R. P., Deribe, K., Deribew, A., Des Jarlais, D. C., Dey, S., Dharmaratne, S. D., Dherani, M. K., Diaz-Torne, C., Ding, E. L., Dixit, P., Djalalinia, S., Huyen Phuc Do, Doku, D., Donnelly, C., Priscila, K., dos Santos, B., Douwes-Schultz, D., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B., Dwivedi, L., Ebrahimi, H., El Bcheraoui, C., Ellingsen, C., Enayati, A., Endries, A., Ermakov, S., Eshetie, S., Eshrati, B., Eskandarieh, S., Esteghamati, A., Estep, K., Fanuel, B., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Feyissa, T., Filip, I., Fischer, F., Foigt, N., Foreman, K. J., Frank, T., Franklin, R. C., Fraser, M., Friedman, J., Frostad, J. J., Fullman, N., Furst, T., Furtado, J. M., Futran, N. D., Gakidou, E., Gambashidze, K., Gamkrelidze, A., Gankpe, F., Garcia-Basteiro, A. L., Gebregergs, G., Gebrehiwot, T., Gebrekidan, K., Gebremichael, M., Gelaye, A., Geleijnse, J. M., Gemechu, B., Gemechu, K., Genova-Maleras, R., Gesesew, H., Gething, P. W., Gibney, K. B., Gill, P., Gillum, R. F., Giref, A., Girma, B., Giussani, G., Goenka, S., Gomez, B., Gona, P. N., Gopalani, S., Goulart, A., Graetz, N., Gugnani, H., Gupta, P. C., Gupta, R., Gupta, R., Gupta, T., Gupta, V., Haagsma, J. A., Hafezi-Nejad, N., Bidgoli, H., Hakuzimana, A., Halasa, Y. A., Hamadeh, R., Hambisa, M., Hamidi, S., Hammami, M., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Hareri, H., Harikrishnan, S., Haro, J., Hassanvand, M., Havmoeller, R., Hay, R. J., Hay, S. I., He, F., Heredia-Pi, I., Herteliu, C., Hilawe, E., Hoek, H. W., Horita, N., Hosgood, H., Hostiuc, S., Hotez, P. J., Hoy, D. G., Hsairi, M., Htet, A., Hu, G., Huang, H., Huang, J. J., Iburg, K., Igumbor, E., Ileanu, B., Inoue, M., Irenso, A., Irvine, C. S., Islam, N., Jacobsen, K. H., Jaenisch, T., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A., Jeemon, P., Jensen, P. N., Jha, V., Jin, Y., John, D., John, O., Johnson, S., Jonas, J. B., Jurisson, M., Kabir, Z., Kadel, R., Kahsay, A., Kalkonde, Y., Kamal, R., Kan, H., Karch, A., Karema, C., Karimi, S. M., Karthikeyan, G., Kasaeian, A., Kassaw, N., Kassebaum, N. J., Kastor, A., Katikireddi, S., Kaul, A., Kawakami, N., Kazanjan, K., Keiyoro, P., Kelbore, S., Kemp, A., Kengne, A., Keren, A., Kereselidze, M., Kesavachandran, C., Ketema, E., Khader, Y., Khalil, I. A., Khan, E., Khan, G., Khang, Y., Khera, S., Khoja, A., Khosravi, M., Kibret, G., Kieling, C., Kim, C., Kim, D., Kim, P., Kim, S., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kishawi, S., Kissimova-Skarbek, K. A., Kissoon, N., Kivimaki, M., Knudsen, A., Kokubo, Y., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Kravchenko, M., Krohn, K. J., Defo, B., Bicer, B., Kuipers, E. J., Kulikoff, X., Kulkarni, V. S., Kumar, G., Kumar, P., Kumsa, F., Kutz, M., Lachat, C., Lagat, A. K., Lager, A., Lal, D., Lalloo, R., Lambert, N., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Laryea, D., Lavados, P. M., Laxmaiah, A., Lee, P. H., Leigh, J., Leung, J., Leung, R., Levi, M., Li, Y., Liao, Y., Liben, M., Lim, S. S., Linn, S., Lipshultz, S. E., Liu, S., Lodha, R., Logroscino, G., Lorch, S. A., Lorkowski, S., Lotufo, P. A., Lozano, R., Lunevicius, R., Lyons, R. A., Ma, S., Macarayan, E., Machado, I., Mackay, M. T., Abd el Razek, M., Magis-Rodriguez, C., Mahdavi, M., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malhotra, R., Malta, D., Mantovani, L. G., Manyazewal, T., Mapoma, C. C., Marczak, L. B., Marks, G. B., Martinez-Raga, J., Martins-Melo, F., Massano, J., Maulik, P. K., Mayosi, B. M., Mazidi, M., McAlinden, C., McGarvey, S., McGrath, J. J., Mckee, M., Mehata, S., Mehndiratta, M., Mehta, K. M., Meier, T., Mekonnen, T., Meles, K., Memiah, P., Memish, Z. A., Mendoza, W., Mengesha, M., Mengistie, M., Tadese, D., Menon, M. R., Menota, B., Mensah, G. A., Meretoja, A., Meretoja, T. J., Mezgebe, H., Micha, R., Mikesell, J., Miller, T. R., Mills, E. J., Minnig, S., Mirarefin, M., Mirrakhimov, E. M., Misganaw, A., Mishra, S., Mohammad, K., Mohammadi, A., Mohammed, K., Mohan, M. V., Mohanty, S. K., Mokdad, A. H., Assaye, A., Mollenkopf, S. K., Molokhia, M., Monasta, L., Hernandez, J., Montico, M., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Moraga, P., Morawska, L., Velasquez, I., Mori, R., Morrison, S. D., Mruts, K., Mueller, U. O., Mullany, E., Muller, K., Venkata, G., Murthy, S., Murthy, S., Musa, K., Nachega, J. B., Nagata, C., Nagel, G., Naghavi, M., Naidoo, K. S., Nanda, L., Nangia, V., Nascimento, B., Natarajan, G., Negoi, I., Cuong Tat Nguyen, Ningrum, D., Nisar, M., Nomura, M., Vuong Minh Nong, Norheim, O. F., Norrving, B., Noubiap, J. N., Nyakarahuka, L., Obermeyer, C., O'Donnell, M. J., Ogbo, F., Oh, I., Okoro, A., Oladimeji, O., Olagunju, A., Olusanya, B., Olusanya, J., Oren, E., Ortiz, A., Osgood-Zimmerman, A., Ota, E., Owolabi, M. O., Oyekale, A., Pa, M., Pacella, R. E., Pakhale, S., Pana, A., Panda, B., Panda-Jonas, S., Park, E., Parsaeian, M., Patel, T., Patten, S. B., Patton, G. C., Paudel, D., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C., Petri, W., Petzold, M., Phillips, M., Piel, F. B., Pigott, D. M., Pishgar, F., Plass, D., Polinder, S., Popova, S., Postma, M. J., Poulton, R. G., Pourmalek, F., Prasad, N., Purwar, M., Qorbani, M., Rabiee, R. S., Radfar, A., Rafay, A., Rahimi-Movaghar, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, S., Rai, R., Rajsic, S., Ram, U., Rana, S. M., Ranabhat, C., Rao, P., Rawaf, S., Ray, S. E., Rego, M., Rehm, J., Reiner, R. C., Remuzzi, G., Renzaho, A. N., Resnikoff, S., Rezaei, S., Rezai, M., Ribeiro, A. L., Rokni, M., Ronfani, L., Roshandel, G., Roth, G. A., Rothenbacher, D., Roy, A., Rubagotti, E., Ruhago, G., Saadat, S., Sabde, Y., Sachdev, P. S., Sadat, N., Safdarian, M., Safiri, S., Sagar, R., Sahathevan, R., Sahebkar, A., Sahraian, M., Salama, J., Salamati, P., Salomon, J. A., Salvi, S., Samy, A. M., Sanabria, J., Sanchez-Nino, M., Santos, I. S., Milicevic, M., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Sawhney, M., Saxena, S., Saylan, M. I., Schmidt, M., Schneider, I. C., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Seedat, S., Seid, A., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K., Shaheen, A., Shahraz, S., Shaikh, M., Shamsipour, M., Shamsizadeh, M., Islam, S., Sharma, J., Sharma, R., She, J., Shen, J., Shetty, B. P., Shi, P., Shibuya, K., Shigematsu, M., Shiri, R., Shiue, I., Shrime, M. G., Sigfusdottir, I., Silberberg, D. H., Silpakit, N., Silva, D., Silva, J., Silveira, D., Sindi, S., Singh, A., Singh, J. A., Singh, P., Singh, V., Sinha, D., Skiadaresi, E., Sligar, A., Smith, D. L., Sobaih, B. A., Sobngwi, E., Soneji, S., Soriano, J. B., Sreeramareddy, C. T., Srinivasan, V., Stathopoulou, V., Steel, N., Stein, D. J., Steiner, C., Stockl, H., Stokes, M., Strong, M., Sufiyan, M., Suliankatchi, R., Sunguya, B. F., Sur, P. J., Swaminathan, S., Sykes, B. L., Szoeke, C. I., Tabares-Seisdedos, R., Tadakamadla, S., Tadese, F., Tandon, N., Tanne, D., Tarajia, M., Tavakkoli, M., Taveira, N., Tehrani-Banihashemi, A., Tekelab, T., Tekle, D., Shifa, G., Temsah, M., Terkawi, A., Tesema, C., Tesssema, B., Theis, A., Thomas, N., Thompson, A. H., Thomson, A. J., Thrift, A. G., Tiruye, T., Tobe-Gai, R., Tonelli, M., Topor-Madry, R., Topouzis, F., Tortajada, M., Tran, B., Trujillo, T., Tsilimparis, N., Tuem, K., Tuzcu, E., Tyrovolas, S., Ukwaja, K., Undurraga, E. A., Uthman, O. A., Uzochukwu, B., van Boven, J. M., Varakin, Y. Y., Varughese, S., Vasankari, T., Vasconcelos, A., Venketasubramanian, N., Vidavalur, R., Violante, F. S., Vishnu, A., Vladimirov, S. K., Vlassov, V., Vollset, S., Vos, T., Waid, J. L., Wakayo, T., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wesana, J., Wijeratne, T., Wilkinson, J. D., Wiysonge, C., Woldeyes, B., Wolfe, C. A., Workicho, A., Workie, S., Xavier, D., Xu, G., Yaghoubi, M., Yakob, B., Yalew, A., Yan, L. L., Yano, Y., Yaseri, M., Ye, P., Yimam, H., Yip, P., Yirsaw, B., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Zaidi, Z., Zaki, M., Zeeb, H., Zenebe, Z., Zerfu, T., Zhang, A., Zhang, X., Zodpey, S., Zuhlke, L., Lopez, A. D., Murray, C. L., GBD 2016 Mortality Collaborators 2017; 390 (10100): 1084–1150

    Abstract

    Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone.Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016.Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled.Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

    View details for DOI 10.1016/S0140-6736(17)31833-0

    View details for Web of Science ID 000410630000002

    View details for PubMedID 28919115

    View details for PubMedCentralID PMC5605514

  • Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET Gakidou, E., Afshin, A., Abajobir, A., Abate, K., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abera, S., Aboyans, V., Abu-Raddad, L. J., Abu-Rmeileh, N. E., Abyu, G., Adedeji, I., Adetokunboh, O., Afarideh, M., Agrawal, A., Agrawal, S., Kiadaliri, A., Ahmadieh, H., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Akinyemi, R., Akseer, N., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alam, T., Alasfoor, D., Alene, K., Ali, K., Alizadeh-Navaei, R., Alkerwi, A., Alla, F., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Alvis-Guzman, N., Amare, A. T., Amini, E., Ammar, W., Amoako, Y., Ansari, H., Anto, J. M., Antonio, C. T., Anwari, P., Arian, N., Arnlov, J., Artaman, A., Aryal, K., Asayesh, H., Asgedom, S., Atey, T., Avila-Burgos, L., Avokpaho, E., Awasthi, A., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Ballew, S. H., Barac, A., Barber, R. M., Barker-Collo, S. L., Barnighausen, T., Barquera, S., Barregard, L., Barrero, L. H., Batis, C., Battle, K. E., Baune, B. T., Beardsley, J., Bedi, N., Beghi, E., Bell, M. L., Bennett, D. A., Bennett, J. R., Bensenor, I. M., Berhane, A., Berhe, D., Bernabe, E., Betsu, B., Beuran, M., Beyene, A., Bhansali, A., Bhutta, Z. A., Bikbov, B., Birungi, C., Biryukov, S., Blosser, C. D., Boneya, D., Bou-Orm, I. R., Brauer, M., Breitborde, N. K., Brenner, H., Brugha, T. S., Bulto, L., Baumgarner, B. R., Butt, Z. A., Cahuana-Hurtado, L., Cardenas, R., Carrero, J., Castaneda-Orjuela, C. A., Catala-Lopez, F., Cercy, K., Chang, H., Charlson, F. J., Chimed-Ochir, O., Chisumpa, V., Chitheer, A. A., Christensen, H., Christopher, D., Cirillo, M., Cohen, A. J., Comfort, H., Cooper, C., Coresh, J., Cornaby, L., Cortesi, P., Criqui, M. H., Crump, J. A., Dandona, L., Dandona, R., das Neves, J., Davey, G., Davitoiu, D. V., Davletov, K., de Courten, B., Degenhardt, L., Deiparine, S., Dellavalle, R. P., Deribe, K., Deshpande, A., Dharmaratne, S. D., Ding, E. L., Djalalinia, S., Huyen Phuc Do, Dokova, K., Doku, D., Dorsey, E., Driscoll, T. R., Dubey, M., Duncan, B., Duncan, S., Ebert, N., Ebrahimi, H., El-Khatib, Z., Enayati, A., Endries, A., Ermakov, S., Erskine, H. E., Eshrati, B., Eskandarieh, S., Esteghamati, A., Estep, K., Faraon, E., E Sa Farinha, C., Faro, A., Farzadfar, F., Fay, K., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. C., Ferrari, A. J., Feyissa, T., Filip, I., Fischer, F., Fitzmaurice, C., Flaxman, A. D., Foigt, N., Foreman, K. J., Frostad, J. J., Fullman, N., Furst, T., Furtado, J. M., Ganji, M., Garcia-Basteiro, A. L., Gebrehiwot, T., Geleijnse, J. M., Geleto, A., Gemechu, B., Gesesew, H., Gething, P. 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    Abstract

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.

    View details for DOI 10.1016/S0140-6736(17)32366-8

    View details for Web of Science ID 000410630000006

    View details for PubMedID 28919119

    View details for PubMedCentralID PMC5614451

  • Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016 LANCET Naghavi, M., Abajobir, A., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S., Aboyans, V., Adetokunboh, O., Arnlov, J., Afshin, A., Agrawal, A., Kiadaliri, A., Ahmadi, A., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Aiyar, S., Al-Eyadhy, A., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alam, T., Alene, K., Ali, S., Alizadeh-Navaei, R., Alkaabi, J. M., Alkerwi, A., Alla, F., Allebeck, P., Allen, C., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Alvis-Guzman, N., Amare, A. T., Amini, E., Ammar, W., Amoako, Y., Anber, N., Andersen, H. H., Andrei, C., Androudi, S., Ansari, H., Antonio, C. T., Anwari, P., Arora, M., Artaman, A., Aryal, K., Asayesh, H., Asgedom, S. 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E., Olusanya, B., Olusanya, J., Ong, K., Opio, J., Oren, E., Ortiz, A., Osman, M., Ota, E., Pa, M., Pacella, R. E., Pakhale, S., Pana, A., Panda, B., Panda-Jonas, S., Papachristou, C., Park, E., Patten, S. B., Patton, G. C., Paudel, D., Paulson, K., Pereira, D. M., Perez-Ruiz, F., Perico, N., Pervaiz, A., Petzold, M., Phillips, M., Pigott, D. M., Pinho, C., Plass, D., Pletcher, M. A., Polinder, S., Postma, M. J., Pourmalek, F., Purcell, C., Qorbani, M., Radfar, A., Rafay, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rai, R., Ranabhat, C., Rankin, Z., Rao, P. C., Rath, G., Rawaf, S., Ray, S. E., Rehm, J., Reiner, R. C., Reitsma, M. B., Remuzzi, G., Rezaei, S., Rezai, M., Rokni, M., Ronfani, L., Roshandel, G., Roth, G. A., Rothenbacher, D., Ruhago, G., Saadat, R., Sachdev, P. S., Sadat, N., Safdarian, M., Safi, S., Safiri, S., Sagar, R., Sahathevan, R., Salama, J., Salamati, P., Salomon, J. A., Samy, A. M., Sanabria, J., Dolores Sanchez-Nino, M., Santomauro, D., Santos, I. S., Milicevic, M., Sartorius, B., Satpathy, M., Shahraz, S., Schmidt, M., Schneider, I. C., Schulhofer-Wohl, S., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K., Shaikh, M., Shamsipour, M., Shamsizadeh, M., Islam, S., Sharma, J., Sharma, R., She, J., Sheikhbahaei, S., Shey, M., Shi, P., Shields, C., Shields, C., Shigematsu, M., Shiri, R., Shirude, S., Shiue, I., Shoman, H., Shrime, M. G., Sigfusdottir, I., Silpakit, N., Silva, J., Singh, A., Singh, J. A., Skiadaresi, E., Sligar, A., Smith, A., Smith, D. L., Smith, M., Sobaih, B. A., Soneji, S., Sorensen, R. D., Soriano, J. B., Sreeramareddy, C. T., Srinivasan, V., Stanaway, J. D., Stathopoulou, V., Steel, N., Stein, D. J., Steiner, C., Steinke, S., Stokes, M., Strong, M., Strub, B., Subart, M., Sufiyan, M., Sunguya, B. F., Sur, P. J., Swaminathan, S., Sykes, B. L., Tabares-Seisdedos, R., Tadakamadla, S., Takahashi, K., Takala, J. S., Talongwa, R., Tarawneh, M., Tavakkoli, M., Taveira, N., Tegegne, T., Tehrani-Banihashemi, A., Temsah, M., Terkawi, A., Thakur, J. S., Thamsuwan, O., Thankappan, K., Thomas, K. E., Thompson, A. H., Thomson, A. J., Thrift, A. G., Tobe-Gai, R., Topor-Madry, R., Torre, A., Tortajada, M., Towbin, J., Bach Xuan Tran, Troeger, C., Truelsen, T., Tsoi, D., Tuzcu, E., Tyrovolas, S., Ukwaja, K. N., Undurraga, E. A., Updike, R., Uthman, O. A., Uzochukwu, B., van Boven, J. M., Vasankari, T., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S., Vos, T., Wakayo, T., Wallin, M. T., Wang, Y., Weiderpass, E., Weintraub, R. G., Weiss, D. J., Werdecker, A., Westerman, R., Whetter, B., Whiteford, H. A., Wijeratne, T., Wiysonge, C., Woldeyes, B., Wolfe, C. A., Woodbrook, R., Workicho, A., Xavier, D., Xiao, Q., Xu, G., Yaghoubi, M., Yakob, B., Yano, Y., Yaseri, M., Yimam, H., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Zaidi, Z., Zaki, M., Zegeye, E., Zenebe, Z., Zerfu, T., Zhang, A., Zhang, X., Zipkin, B., Zodpey, S., Lopez, A. D., Murray, C. L., GBD 2016 Causes Death Collaborato 2017; 390 (10100): 1151–1210

    Abstract

    Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends.We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016.The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe.The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(17)32152-9

    View details for Web of Science ID 000410630000003

    View details for PubMedID 28919116

    View details for PubMedCentralID PMC5605883

  • Improving Vignette Descriptions and Question Formats to Measure Distance Vision: Evidence from Cognitive Interviews among Students in China FIELD METHODS Su, Y., Willis, G., Salomon, J. A. 2017; 29 (3): 175–93
  • Performance of self-reported HIV status in determining true HIV status among older adults in rural South Africa: a validation study JOURNAL OF THE INTERNATIONAL AIDS SOCIETY Rohr, J. K., Gomez-Olive, F., Rosenberg, M., Manne-Goehler, J., Geldsetzer, P., Wagner, R. G., Houle, B., Salomon, J. A., Kahn, K., Tollman, S., Berkman, L., Baernighausen, T. 2017; 20: 21691

    Abstract

    In South Africa, older adults make up a growing proportion of people living with HIV. HIV programmes are likely to reach older South Africans in home-based interventions where testing is not always feasible. We evaluate the accuracy of self-reported HIV status, which may provide useful information for targeting interventions or offer an alternative to biomarker testing.Data were taken from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) baseline survey, which was conducted in rural Mpumalanga province, South Africa. A total of 5059 participants aged ≥40 years were interviewed from 2014 to 2015. Self-reported HIV status and dried bloodspots for HIV biomarker testing were obtained during at-home interviews. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for self-reported status compared to "gold standard" biomarker results. Log-binomial regression explored associations between demographic characteristics, antiretroviral therapy (ART) status and sensitivity of self-report.Most participants (93%) consented to biomarker testing. Of those with biomarker results, 50.9% reported knowing their HIV status and accurately reported it. PPV of self-report was 94.1% (95% confidence interval (CI): 92.0-96.0), NPV was 87.2% (95% CI: 86.2-88.2), sensitivity was 51.2% (95% CI: 48.2-54.3) and specificity was 99.0% (95% CI: 98.7-99.4). Participants on ART were more likely to report their HIV-positive status, and participants reporting false-negatives were more likely to have older HIV tests.The majority of participants were willing to share their HIV status. False-negative reports were largely explained by lack of testing, suggesting HIV stigma is retreating in this setting, and that expansion of HIV testing and retesting is still needed in this population. In HIV interventions where testing is not possible, self-reported status should be considered as a routine first step to establish HIV status.

    View details for PubMedID 28782333

  • Health Effects of Overweight and Obesity in 195 Countries over 25 Years NEW ENGLAND JOURNAL OF MEDICINE Afshin, A., Forouzanfar, M. H., Reitsma, M. B., Sur, P., Estep, K., Lee, A., Marczak, L., Mokdad, A. H., Moradi-Lakeh, M., Naghavi, M., Salama, J. S., Vos, T., Abate, K. H., Abbafati, C., Ahmed, M. B., Al-Aly, Z., Alkerwi, A., Al-Raddadi, R., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, E., Amrock, S. M., Anjana, R. M., Arnlov, J., Asayesh, H., Banerjee, A., Barac, A., Baye, E., Bennett, D. A., Beyene, A. S., Biadgilign, S., Biryukov, S., Bjertness, E., Boneya, D. J., Campos-Nonato, I., Carrero, J. J., Cecilio, P., Cercy, K., Ciobanu, L. G., Cornaby, L., Damtew, S. A., Dandona, L., Dandona, R., Dharmaratne, S. D., Duncan, B. B., Eshrati, B., Esteghamati, A., Feigin, V. L., Fernandes, J. C., Furst, T., Gebrehiwot, T. T., Gold, A., Gona, P. N., Goto, A., Habtewold, T. D., Hadush, K. T., Hafezi-Nejad, N., Hay, S. I., Horino, M., Islami, F., Kamal, R., Kasaeian, A., Katikireddi, S. V., Kengne, A. P., Kesavachandran, C. N., Khader, Y. S., Khang, Y., Khubchandani, J., Kim, D., Kim, Y. J., Kinfu, Y., Kosen, S., Ku, T., Defo, B., Kumar, G., Larson, H. J., Leinsalu, M., Liang, X., Lim, S. S., Liu, P., Lopez, A. D., Lozano, R., Majeed, A., Malekzadeh, R., Malta, D. C., Mazidi, M., McAlinden, C., McGarvey, S. T., Mengistu, D. T., Mensah, G. A., Mensink, G. M., Mezgebe, H. B., Mirrakhimov, E. M., Mueller, U. O., Noubiap, J. J., Obermeyer, C. M., Ogbo, F. A., Owolabi, M. O., Patton, G. C., Pourmalek, F., Qorbani, M., Rafay, A., Rai, R. K., Ranabhat, C. L., Reinig, N., Safiri, S., Salomon, J. A., Sanabria, J. R., Santos, I. S., Sartorius, B., Sawhney, M., Schmidhuber, J., Schutte, A. E., Schmidt, M. I., Sepanlou, S. G., Shamsizadeh, M., Sheikhbahaei, S., Shin, M., Shiri, R., Shiue, I., Roba, H. S., Silva, D. S., Silverberg, J. I., Singh, J. A., Stranges, S., Swaminathan, S., Tabares-Seisdedos, R., Tadese, F., Tedla, B. A., Tegegne, B. S., Terkawi, A. S., Thakur, J. S., Tonelli, M., Topor-Madry, R., Tyrovolas, S., Ukwaja, K. N., Uthman, O. A., Vaezghasemi, M., Vasankari, T., Vlassov, V. V., Vollset, S. E., Weiderpass, E., Werdecker, A., Wesana, J., Westerman, R., Yano, Y., Yonemoto, N., Yonga, G., Zaidi, Z., Zenebe, Z. M., Zipkin, B., Murray, C. L., GBD 2015 Obesity Collaborators 2017; 377 (1): 13–27

    Abstract

    Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain.We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015.In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease.The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. (Funded by the Bill and Melinda Gates Foundation.).

    View details for DOI 10.1056/NEJMoa1614362

    View details for Web of Science ID 000404730000005

    View details for PubMedID 28604169

    View details for PubMedCentralID PMC5477817

  • Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Roth, G. A., Johnson, C., Abajobir, A., Abd-Allah, F., Abera, S., Abyu, G., Ahmed, M., Aksut, B., Alam, T., Alam, K., Alla, F., Alvis-Guzman, N., Amrock, S., Ansari, H., Arnlov, J., Asayesh, H., Atey, T., Avila-Burgos, L., Awasthi, A., Banerjee, A., Barac, A., Barnighausen, T., Barregard, L., Bedi, N., Ketema, E., Bennett, D., Berhe, G., Bhutta, Z., Bitew, S., Carapetis, J., Carrero, J., Malta, D., Andres Castaneda-Orjuela, C., Castillo-Rivas, J., Catala-Lopez, F., Choi, J., Christensen, H., Cirillo, M., Cooper, L., Criqui, M., Cundiff, D., Damasceno, A., Dandona, L., Dandona, R., Davletov, K., Dharmaratne, S., Dorairaj, P., Dubey, M., Ehrenkranz, R., Zaki, M., Faraon, E. A., Esteghamati, A., Farid, T., Farvid, M., Feigin, V., Ding, E. L., Fowkes, G., Gebrehiwot, T., Gillum, R., Gold, A., Gona, P., Gupta, R., Habtewold, T., Hafezi-Nejad, N., Hailu, T., Hailu, G., Hankey, G., Hassen, H., Abate, K., Havmoeller, R., Hay, S. I., Horino, M., Hotez, P. J., Jacobsen, K., James, S., Javanbakht, M., Jeemon, P., John, D., Jonas, J., Kalkonde, Y., Karimkhani, C., Kasaeian, A., Khader, Y., Khan, A., Khang, Y., Khera, S., Khoja, A. T., Khubchandani, J., Kim, D., Kolte, D., Kosen, S., Krohn, K. J., Kumar, G., Kwan, G. F., Lal, D., Larsson, A., Linn, S., Lopez, A., Lotufo, P. A., Abd El Razek, H., Malekzadeh, R., Mazidi, M., Meier, T., Meles, K., Mensah, G., Meretoja, A., Mezgebe, H., Miller, T., Mirrakhimov, E., Mohammed, S., Moran, A. E., Musa, K., Narula, J., Neal, B., Ngalesoni, F., Grant Nguyen, Obermeyer, C., Owolabi, M., Patton, G., Pedro, J., Qato, D., Qorbani, M., Rahimi, K., Rai, R., Rawaf, S., Ribeiro, A., Safiri, S., Salomon, J. A., Santos, I., Milicevic, M., Sartorius, B., Schutte, A., Sepanlou, S., Shaikh, M., Shin, M., Shishehbor, M., Shore, H., Santos Silva, D., Sobngwi, E., Stranges, S., Swaminathan, S., Tabares-Seisdedos, R., Atnafu, N., Tesfay, F., Thakur, J. S., Thrift, A., Topor-Madry, R., Truelsen, T., Tyrovolas, S., Ukwaja, K., Uthman, O., Vasankari, T., Vlassov, V., Vollset, S., Wakayo, T., Watkins, D., Weintraub, R., Werdecker, A., Westerman, R., Wiysonge, C., Wolfe, C., Workicho, A., Xu, G., Yano, Y., Yip, P., Yonemoto, N., Younis, M., Yu, C., Vos, T., Naghavi, M., Murray, C. 2017; 70 (1): 1–25

    Abstract

    The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

    View details for PubMedID 28527533

    View details for PubMedCentralID PMC5491406

  • EVALUATING CHLAMYDIA TRENDS IN THE UNITED STATES 2000-2015 USING A PAIR FORMATION TRANSMISSION MODEL Ronn, M. M., Tuite, A., Menzies, N. A., Gift, T., Chesson, H., Torrone, E., Wolf, E. E., Galer, K., Hsu, K., Salomon, J. A. BMJ PUBLISHING GROUP. 2017: A2–A3
  • Child and Adolescent Health From 1990 to 2015 Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study JAMA PEDIATRICS Kassebaum, N., Hmwe Kyu, H., Zoeckler, L., Elizabeth Olsen, H., Thomas, K., Pinho, C., Bhutta, Z. A., Dandona, L., Ferrari, A., Ghiwot, T., Hay, S. I., Kinfu, Y., Liang, X., Lopez, A., Carvalho Malta, D., Mokdad, A. H., Naghavi, M., Patton, G. C., Salomon, J., Sartorius, B., Topor-Madry, R., Vollset, S., Werdecker, A., Whiteford, H. A., Abate, K., Abbas, K., Damtew, S., Ahmed, M., Akseer, N., Al-Raddadi, R., Alemayohu, M., Altirkawi, K., Abajobir, A., Amare, A. T., Antonio, C. T., Amlov, J., Al Artaman, Asayesh, H., Avokpaho, E., Awasthi, A., Quintanilla, B., Bacha, U., Betsu, B., Barac, A., Bamighausen, T., Baye, E., Bedi, N., Bensenor, I. M., Berhane, A., Bernabe, E., Alberto Bernal, O., Beyene, A., Biadgilign, S., Bikbov, B., Anne Boyce, C., Brazinova, A., Hailu, G., Carter, A., Castaneda-Orjuela, C. A., Catala-Lopez, F., Charlson, F. J., Chitheer, A. A., Choi, J., Ciobanu, L. G., Crump, J., Dandona, R., Dellavalle, R. P., Deribew, A., deveber, G., Dicker, D., Ding, E. L., Dubey, M., Endries, A., Erskine, H. E., Faraon, E., Faro, A., Farzadfar, F., Fernandes, J. C., Obadare Fijabi, D., Fitzmaurice, C., Fleming, T. D., Sorio Flor, L., Foreman, K. J., Franklin, R. C., Fraser, M. S., Frostad, J. J., Fullman, N., Gebregergs, G., Gebru, A., Geleijnse, J. M., Gibney, K. B., Yihdego, M., Ginawi, I., Gishu, M., Gizachew, T., Glaser, E., Gold, A. L., Goldberg, E., Gona, P., Goto, A., Gugnani, H., Jiang, G., Gupta, R., Tesfay, F., Hankey, G. J., Havmoeller, R., Hijar, M., Horino, M., Hosgood, H., Hu, G., Jacobsen, K. H., Jakovljevic, M. B., Jayaraman, S. P., Jha, V., Jibat, T., Johnson, C. O., Jonas, J., Kasaeian, A., Kawakami, N., Keiyoro, P. N., Khalil, I., Khang, Y., Khubchandani, J., Ahmad Kiadaliri, A. A., Kieling, C., Kim, D., Kissoon, N., Knibbs, L. D., Koyanagi, A., Krohn, K. J., Defo, B., Bicer, B., Kulikoff, R., Kumar, A., Lal, D., Lam, H. Y., Larson, H. J., Larsson, A., Laryea, D., Leung, J., Lim, S. S., Lo, L., Lo, W. D., Looker, K. J., Lotufo, P. A., El Razek, H., Malekzadeh, R., Shifti, D., Mazidi, M., Meaney, P. A., Meles, K., Memiah, P., Mendoza, W., Mengistie, M., Mengistu, G., Mensah, G. A., Miller, T. R., Mock, C., Mohammadi, A., Mohammed, S., Monasta, L., Mueller, U., Nagata, C., Naheed, A., Nguyen, G., Le Nguyen, Q., Nsoesie, E., Oh, I., Okoro, A., Olusanya, J., Olusanya, B. O., Ortiz, A., Paudel, D., Pereira, D. M., Perico, N., Petzold, M., Phillips, M., Polanczyk, G. V., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi-Movaghar, V., Rahman, M., Rai, R., Ram, U., Rankin, Z., Remuzzi, G., Renzaho, A. N., Roba, H., Rojas-Rueda, D., Ronfani, L., Sagar, R., Sanabria, J., Mohammed, M., Santos, I. S., Satpathy, M., Sawhney, M., Ben Schottker, Schwebel, D. C., Scott, J. G., Sepanlou, S. G., Shaheen, A., Shaikh, M., She, J., Shiri, R., Shiue, I., Sigfusdottir, I., Singh, J., Silpakit, N., Smith, A., Sreeramareddy, C., Stanaway, J. D., Stein, D. J., Steiner, C., Sufiyan, M., Swaminathan, S., Tabares-Seisdedos, R., Tabb, K. M., Tadese, F., Tavakkoli, M., Taye, B., Teeple, S., Tegegne, T., Shifa, G., Terkawi, A., Thomas, B., Thomson, A. J., Tobe-Gai, R., Tonelli, M., Tran, B., Troeger, C., Ukwaja, K. N., Uthman, O., Vasankari, T., Venketasubramanian, N., Vlassov, V., Weiderpass, E., Weintraub, R., Gebrehiwot, S., Westerman, R., Williams, H. C., Wolfe, C. A., Woodbrook, R., Yano, Y., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaki, M., Zegeye, E., Zuhlke, L., Murray, C. L., Vos, T. 2017; 171 (6): 573–92

    Abstract

    Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

    View details for PubMedID 28384795

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  • Hypertension management in a population of older adults in rural South Africa JOURNAL OF HYPERTENSION Jardim, T., Reiger, S., Abrahams-Gessel, S., Gomez-Olive, F., Wagner, R. G., Wade, A., Baernighausen, T. W., Salomon, J., Tollman, S., Gaziano, T. A. 2017; 35 (6): 1283–89

    Abstract

    Assess awareness, treatment, and control of hypertension, as an indication of its management, in rural South Africa, especially regarding modifiers of these variables.A population-representative sample of adults aged at least 40 years residing in the rural Agincourt subdistrict (Mpumalanga Province) covered by a long-term health and sociodemographic surveillance system was recruited. In-person interviews, physical exams, and dried blood spots were collected. Hypertension awareness, treatment, and control rates were assessed. A regression model was built to identify predictors of those outcomes.The mean age of the 2884 hypertensive participants was 64.1 ± 12.7 years. Hypertension awareness rate was 64.4%, treatment among those aware was 89.3 and 45.8% of those treated were controlled. Considering aware and unaware hypertensives, treatment rate was 49.7% and control 22.8%. In the multivariable regression model, awareness was predicted by female sex, age at least 60 years, higher social economic status, prior cardiovascular disease (CVD), nonimmigrant status, literacy, and physical limitation. Improved control among those treated was predicted by age at least 60 years. Blood pressure control among all hypertensive study participants was predicted by female sex, being HIV-negative, age at least 60 years, nonimmigrant status, and prior CVD.High rates of awareness and treatment of hypertension as well as good levels of control were found in this population, probably explained by the long-term surveillance program conducted in the area. Considering the predictors of hypertension management, particular attention should be given to men, residents younger than 60 years, immigrants, and study participants without CVD as these characteristics were predictors of poor outcome.

    View details for PubMedID 28441697

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  • Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet (London, England) 2017

    Abstract

    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.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.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.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-system characteristics 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.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(17)30818-8

    View details for PubMedID 28528753

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  • Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015 LANCET Reitsma, M. B., Fullman, N., Ng, M., Salama, J. S., Abajobir, A., Abate, K., Abbafati, C., Abera, S., Abraham, B., Abyu, G., Adebiyi, A., Al-Aly, Z., Aleman, A. V., Ali, R., Al Alkerwi, A., Allebeck, P., Al-Raddadi, R., Amare, A. T., Amberbir, A., Ammar, W., Amrock, S., Antonio, C. T., Asayesh, H., Atnafu, N., Azzopardi, P., Banerjee, A., Barac, A., Barrientos-Gutierrez, T., Basto-Abreu, A., Bazargan-Hejazi, S., Bedi, N., Bell, B., Bello, A. K., Bensenor, I. M., Beyene, A., Bhala, N., Biryukov, S., Bolt, K., Brenner, H., Butt, Z., Cavalleri, F., Cercy, K., Chen, H., Christopher, D., Ciobanu, L. G., Colistro, V., Colomar, M., Cornaby, L., Dai, X., Damtew, S., Dandona, L., Dandona, R., Dansereau, E., Davletov, K., Dayama, A., Degfie, T., Deribew, A., Dharmaratne, S. D., Dimtsu, B., Doyle, K. E., Endries, A., Ermakov, S., Estep, K., Faraon, E., Farzadfar, F., Feigin, V. L., Feigl, A. B., Fischer, F., Friedman, J., Ghiwot, T., Gall, S. L., Gao, W., Gillum, R. F., Gold, A. L., Gopalani, S., Gotay, C. C., Gupta, R., Gupta, R., Gupta, V., Hamadeh, R., Hankey, G., Harb, H. L., Hay, S. I., Horino, M., Horita, N., Hosgood, H., Husseini, A., Ileanu, B., Islami, F., Jiang, G., Jiang, Y., Jonas, J. B., Kabir, Z., Kamal, R., Kasaeian, A., Kesavachandran, C., Khader, Y. S., Khalil, I., Khang, Y., Khera, S., Khubchandani, J., Kim, D., Kim, Y., Kimokoti, R. W., Kinfu, Y., Knibbs, L. D., Kokubo, Y., Kolte, D., Kopec, J., Kosen, S., Kotsakis, G. A., Koul, P. A., Koyanagi, A., Krohn, K. J., Krueger, H., Defo, B., Bicer, B., Kulkarni, C., Kumar, G., Leasher, J. L., Lee, A., Leinsalu, M., Li, T., Linn, S., Liu, P., Liu, S., Lo, L., Lopez, A. D., Ma, S., Abd El Razek, H., Majeed, A., Malekzadeh, R., Malta, D., Manamo, W., Martinez-Raga, J., Mekonnen, A., Mendoza, W., Miller, T. R., Mohammad, K., Morawska, L., Musa, K., Nagel, G., Neupane, S., Quyen Nguyen, Nguyen, G., Oh, I., Oyekale, A., Mahesh, P. A., Pana, A., Park, E., Patil, S. T., Patton, G. C., Pedro, J., Qorbani, M., Rafay, A., Rahman, M., Rai, R., Ram, U., Ranabhat, C., Refaat, A. H., Reinig, N., Roba, H., Rodriguez, A., Roman, Y., Roth, G., Roy, A., Sagar, R., Salomon, J., Sanabria, J., Santos, I., Sartorius, B., Satpathy, M., Sawhney, M., Sawyer, S., Saylan, M., Schaub, M. P., Schluger, N., Schutte, A., Sepanlou, S. G., Serdar, B., Shaikh, M., She, J., Shin, M., Shiri, R., Shishani, K., Shiue, I., Sigfusdottir, I., Silverberg, J. I., Singh, J., Singh, V., Slepak, E., Soneji, S., Soriano, J. B., Soshnikov, S., Sreeramareddy, C. T., Stein, D. J., Stranges, S., Subart, M. L., Swaminathan, S., Szoeke, C. I., Tefera, W., Topor-Madry, R., Tran, B., Tsilimparis, N., Tymeson, H., Ukwaja, K., Updike, R., Uthman, O. A., Violante, F., Vladimirov, S. K., Vlassov, V., Vollset, S., Vos, T., Weiderpass, E., Wen, C., Werdecker, A., Wilson, S., Wubshet, M., Xiao, L., Yakob, B., Yano, Y., Ye, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M., Zhang, A., Zipkin, B., Murray, C. L., Forouzanfar, M. H., Gakidou, E., GBD 2015 Tobacco Collaborators 2017; 389 (10082): 1885–1906

    Abstract

    The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed.We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI).Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2-25·7) for men and 5·4% (5·1-5·7) for women, representing 28·4% (25·8-31·1) and 34·4% (29·4-38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7-7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015.The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.Bill & Melinda Gates Foundation and Bloomberg Philanthropies.

    View details for DOI 10.1016/S0140-6736(17)30819-X

    View details for Web of Science ID 000400973500025

    View details for PubMedID 28390697

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  • The Use of Mathematical Models of Chlamydia Transmission to Address Public Health Policy Questions: A Systematic Review SEXUALLY TRANSMITTED DISEASES Ronn, M. M., Wolf, E. E., Chesson, H., Menzies, N. A., Galer, K., Gorwitz, R., Gift, T., Hsu, K., Salomon, J. A. 2017; 44 (5): 278–83

    Abstract

    Mathematical models of chlamydia transmission can help inform disease control policy decisions when direct empirical evaluation of alternatives is impractical. We reviewed published chlamydia models to understand the range of approaches used for policy analyses and how the studies have responded to developments in the field.We performed a literature review by searching Medline and Google Scholar (up to October 2015) to identify publications describing dynamic chlamydia transmission models used to address public health policy questions. We extracted information on modeling methodology, interventions, and key findings.We identified 47 publications (including two model comparison studies), which reported collectively on 29 distinct mathematical models. Nine models were individual-based, and 20 were deterministic compartmental models. The earliest studies evaluated the benefits of national-level screening programs and predicted potentially large benefits from increased screening. Subsequent trials and further modeling analyses suggested the impact might have been overestimated. Partner notification has been increasingly evaluated in mathematical modeling, whereas behavioral interventions have received relatively limited attention.Our review provides an overview of chlamydia transmission models and gives a perspective on how mathematical modeling has responded to increasing empirical evidence and addressed policy questions related to prevention of chlamydia infection and sequelae.

    View details for PubMedID 28407643

  • Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015 A Systematic Analysis for the Global Burden of Disease Study JAMA ONCOLOGY Fitzmaurice, C., Collaboration, G. B., Allen, C., Barber, R. M., Barregard, L., Bhutta, Z. A., Brenner, H., Dicker, D. J., Chimed-Orchir, O., Dandona, R., Dandona, L., Fleming, T., Forouzanfar, M. H., Hancock, J., Hay, R. J., Hunter-Merrill, R., Huynh, C., Hosgood, H. D., Johnson, C. O., Jonas, J. B., Khubchandani, J., Kumar, G. A., Kutz, M., Lan, Q., Larson, H. J., Liang, X., Lim, S. S., Lopez, A. D., MacIntyre, M. F., Marczak, L., Marquez, N., Mokdad, A. H., Pinho, C., Pourmalek, F., Salomon, J. A., Sanabria, J. R., Sandar, L., Sartorius, B., Schwartz, S. M., Shackelford, K. A., Shibuya, K., Stanaway, J., Steiner, C., Sun, J., Takahashi, K., Vollset, S. E., Vos, T., Wagner, J. A., Wang, H., Westerman, R., Zeeb, H., Zoeckler, L., Abd-Allah, F., Ahmed, M. B., Alabed, S., Alam, N. K., Aldhahri, S. F., Alem, G., Alemayohu, M. A., Ali, R., Al-Raddadi, R., Amare, A., Amoako, Y., Artaman, A., Asayesh, H., Atnafu, N., Awasthi, A., Saleem, H. B., Barac, A., Bedi, N., Bensenor, I., Berhane, A., Bemabe, E., Betsu, B., Binagwaho, A., Boneya, D., Campos-Nonato, I., Castaneda-Orjuela, C., Catala-Lopez, F., Chiang, P., Chibueze, C., Chitheer, A., Choi, J., Cowie, B., Damtew, S., das Neves, J., Dey, S., Dharmaratne, S., Dhillon, P., Ding, E., Driscoll, T., Ekwueme, D., Endries, A. Y., Farvid, M., Farzadfar, F., Fernandes, J., Fischer, F., Ghiwot, T. T., Gebru, A., Gopalani, S., Hailu, A., Horino, M., Horita, N., Husseini, A., Huybrechts, I., Inoue, M., Islami, F., Jakovljevic, M., James, S., Javanbakht, M., Jee, S. H., Kasaeian, A., Kedir, M. S., Khader, Y. S., Khang, Y., Kim, D., Leigh, J., Linn, S., Lunevicius, R., Abd El Razek, H. M., Malekzadeh, R., Malta, D. C., Marcenes, W., Markos, D., Melaku, Y. A., Meles, K. G., Mendoza, W., Mengiste, D. T., Meretoja, T. J., Miller, T. R., Mohammad, K. A., Mohammadi, A., Mohammed, S., Moradi-Lakeh, M., Nagel, G., Nand, D., Quyen Le Nguyen, Q., Nolte, S., Ogbo, F. A., Oladimeji, K. E., Oren, E., Pa, M., Park, E., Pereira, D. M., Plass, D., Qorbani, M., Radfar, A., Rafay, A., Rahman, M., Rana, S. M., Soreide, K., Satpathy, M., Sawhney, M., Sepanlou, S. G., Shaikh, M. A., She, J., Shiue, I., Shore, H. R., Shrime, M. G., So, S., Soneji, S., Stathopoulou, V., Stroumpoulis, K., Sufiyan, M. B., Sykes, B. L., Tabares-Seisdedos, R., Tadese, F., Tedla, B. A., Tessema, G. A., Thakur, J. S., Tran, B. X., Ukwaja, K. N., Uzochukwu, B. S., Vlassov, V. V., Weiderpass, E., Terefe, M. W., Yebyo, H. G., Yimam, H. H., Yonemoto, N., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zenebe, Z. M., Murray, C. J., Naghavi, M. 2017; 3 (4): 524-548

    Abstract

    Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning.To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015.Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results.In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globally was prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancer was the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancer was breast cancer (2.4 million cases). Breast cancer was also the leading cause of cancer deaths and DALYs for women (523 000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in 174 of 195 countries or territories. Age-standardized death rates (ASDRs) for all cancers combined decreased within that timeframe in 140 of 195 countries or territories. Countries with an increase in the ASDR due to all cancers were largely located on the African continent. Of all cancers, deaths between 2005 and 2015 decreased significantly for Hodgkin lymphoma (-6.1% [95% uncertainty interval (UI), -10.6% to -1.3%]). The number of deaths also decreased for esophageal cancer, stomach cancer, and chronic myeloid leukemia, although these results were not statistically significant.As part of the epidemiological transition, cancer incidence is expected to increase in the future, further straining limited health care resources. Appropriate allocation of resources for cancer prevention, early diagnosis, and curative and palliative care requires detailed knowledge of the local burden of cancer. The GBD 2015 study results demonstrate that progress is possible in the war against cancer. However, the major findings also highlight an unmet need for cancer prevention efforts, including tobacco control, vaccination, and the promotion of physical activity and a healthy diet.

    View details for DOI 10.1001/jamaoncol.2016.5688

    View details for Web of Science ID 000399425800017

  • Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys LANCET DIABETES & ENDOCRINOLOGY Ueda, P., Woodward, M., Lu, Y., Hajifathalian, K., Al-Wotayan, R., Aguilar-Salinas, C. A., Ahmadvand, A., Azizi, F., Bentham, J., Cifkova, R., Di Cesare, M., Eriksen, L., Farzadfar, F., Ferguson, T. S., Ikeda, N., Khalili, D., Khang, Y., Lanska, V., Leon-Munoz, L., Magliano, D. J., Margozzini, P., Msyamboza, K. P., Mutungi, G., Oh, K., Oum, S., Rodriguez-Artalejo, F., Rojas-Martinez, R., Valdivia, G., Wilks, R., Shaw, J. E., Stevens, G. A., Tolstrup, J. S., Zhou, B., Salomon, J. A., Ezzati, M., Danaei, G. 2017; 5 (3): 196–213

    Abstract

    Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years.Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores.Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13% in Iranian men (using a ≥20% risk threshold). More than 80% of adults were similarly classified as low or high risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among patients with diabetes.Our risk charts provide risk assessment tools that are recalibrated for each country and make the estimation of CVD risk possible without using laboratory-based measurements.National Institutes of Health.

    View details for PubMedID 28126460

  • SCREENING ADOLESCENTS AND YOUNG ADULTS FOR HIV IN THE UNITED STATES: A COST-EFFECTIVENESS ANALYSIS Neilan, A., Dunville, R., Ocfemia, M., Salomon, J., Francke, J., Wang, L., Bulteel, A., Hsu, K., DiNenno, E., Parker, R., Walensky, R., Freedberg, K., Ciaranello, A. ELSEVIER SCIENCE INC. 2017: S18
  • Impact of a Text-Messaging Programon Adolescent Reproductive Health: A Cluster-Randomized Trial in Ghana AMERICAN JOURNAL OF PUBLIC HEALTH Rokicki, S., Cohen, J., Salomon, J. A., Fink, G. 2017; 107 (2): 298–305

    Abstract

    To evaluate whether text-messaging programs can improve reproductive health among adolescent girls in low- and middle-income countries.We conducted a cluster-randomized controlled trial among 756 female students aged 14 to 24 years in Accra, Ghana, in 2014. We randomized 38 schools to unidirectional intervention (n = 12), interactive intervention (n = 12), and control (n = 14). The unidirectional intervention sent participants text messages with reproductive health information. The interactive intervention engaged adolescents in text-messaging reproductive health quizzes. The primary study outcome was reproductive health knowledge at 3 and 15 months. Additional outcomes included self-reported pregnancy and sexual behavior. Analysis was by intent-to-treat.From baseline to 3 months, the unidirectional intervention increased knowledge by 11 percentage points (95% confidence interval [CI] = 7, 15) and the interactive intervention by 24 percentage points (95% CI = 19, 28), from a control baseline of 26%. Although we found no changes in reproductive health outcomes overall, both unidirectional (odds ratio [OR] = 0.14; 95% CI = 0.03, 0.71) and interactive interventions (OR = 0.15; 95% CI = 0.03, 0.86) lowered odds of self-reported pregnancy for sexually active participants.Text-messaging programs can lead to large improvements in reproductive health knowledge and have the potential to lower pregnancy risk for sexually active adolescent girls.

    View details for PubMedID 27997236

  • SCREENING ADOLESCENTS AND YOUNG ADULTS FOR HIV IN THE UNITED STATES: A COST-EFFECTIVENESS ANALYSIS Neilan, A., Dunville, R., Ocfemia, M., Salomon, J., Francke, J., Wang, L., Bulteel, A., Hsu, K., DiNenno, E., Parker, R., Walensky, R., Freedberg, K., Ciaranello, A. ELSEVIER SCIENCE INC. 2017: S18
  • The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. The Lancet. Infectious diseases 2017

    Abstract

    An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories.We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes.Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (-4·1% [-5·0 to -3·4]) than in incidence (-1·6% [-1·9 to -1·2]) and prevalence (-0·7% [-1·0 to -0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3-13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8-14·8), and smoking accounted for 7·8% (3·8-12·0).Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S1473-3099(17)30703-X

    View details for PubMedID 29223583

  • Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 2017; 390 (10100): 1260–1344

    Abstract

    Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(17)32130-X

    View details for PubMedID 28919118

    View details for PubMedCentralID PMC5605707

  • Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 2017; 390 (10100): 1211–59

    Abstract

    As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228).The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

    View details for DOI 10.1016/S0140-6736(17)32154-2

    View details for PubMedID 28919117

    View details for PubMedCentralID PMC5605509

  • Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet (London, England) 2017; 390 (10100): 1423–59

    Abstract

    The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030.We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment.Globally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past.GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(17)32336-X

    View details for PubMedID 28916366

    View details for PubMedCentralID PMC5603800

  • Sexual Behaviors and HIV Status: A Population-Based Study Among Older Adults in Rural South Africa JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES Rosenberg, M. S., Gomez-Olive, F. X., Rohr, J. K., Houle, B. C., Kabudula, C. W., Wagner, R. G., Salomon, J. A., Kahn, K., Berkman, L. F., Tollman, S. M., Baernighausen, T. 2017; 74 (1): E9–E17

    Abstract

    To identify the unmet needs for HIV prevention among older adults in rural South Africa.We analyzed data from a population-based sample of 5059 men and women aged 40 years and older from the study Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI), which was carried out in the Agincourt health and sociodemographic surveillance system in the Mpumalanga province of South Africa. We estimated the prevalence of HIV (laboratory-confirmed and self-reported) and key sexual behaviors by age and sex. We compared sexual behavior profiles across HIV status categories with and without age-sex standardization.HIV prevalence was very high among HAALSI participants (23%, 95% confidence interval [CI]: 21 to 24), with no sex differences. Recent sexual activity was common (56%, 95% CI: 55 to 58) across all HIV status categories. Condom use was low among HIV-negative adults (15%, 95% CI: 14 to 17), higher among HIV-positive adults who were unaware of their HIV status (27%, 95% CI: 22 to 33), and dramatically higher among HIV-positive adults who were aware of their status (75%, 95% CI: 70 to 80). Casual sex and multiple partnerships were reported at moderate levels, with slightly higher estimates among HIV-positive compared to HIV-negative adults. Differences by HIV status remained after age-sex standardization.Older HIV-positive adults in an HIV hyperendemic community of rural South Africa report sexual behaviors consistent with high HIV transmission risk. Older HIV-negative adults report sexual behaviors consistent with high HIV acquisition risk. Prevention initiatives tailored to the particular prevention needs of older adults are urgently needed to reduce HIV risk in this and similar communities in sub-Saharan Africa.

    View details for PubMedID 27926667

    View details for PubMedCentralID PMC5147032

  • Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER Statement EPIDEMIOLOGIA E SERVICOS DE SAUDE Stevens, G. A., Alkema, L., Black, R. E., Boerma, J., Collins, G. S., Ezzati, M., Grove, J. T., Hogan, D. R., Hogan, M. C., Horton, R., Lawn, J. E., Marusic, A., Mathers, C. D., Murray, C. L., Rudan, I., Salomon, J. A., Simpson, P. J., Vos, T., Welch, V., Grp Trabalho GATHER 2017; 26 (1): 215–22

    Abstract

    Measurements of health indicators are rarely available for every population and period of interest, and available data may not be comparable. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) define best reporting practices for studies that calculate health estimates for multiple populations (in time or space) using multiple information sources. Health estimates that fall within the scope of GATHER include all quantitative population-level estimates (including global, regional, national, or subnational estimates) of health indicators, including indicators of health status, incidence and prevalence of diseases, injuries, and disability and functioning; and indicators of health determinants, including health behaviours and health exposures. GATHER comprises a checklist of 18 items that are essential for best reporting practice. A more detailed explanation and elaboration document, describing the interpretation and rationale of each reporting item along with examples of good reporting, is available on the GATHER website (http://gather-statement.org).

    View details for PubMedID 28226024

  • Cost Effectiveness and Cost Containment in the Era of Interferon-Free Therapies to Treat Hepatitis C Virus Genotype 1 OPEN FORUM INFECTIOUS DISEASES Linas, B. P., Morgan, J. R., Pho, M. T., Leff, J. A., Schackman, B. R., Horsburgh, C., Assoumou, S. A., Salomon, J. A., Weinstein, M. C., Freedberg, K. A., Kim, A. Y. 2017; 4 (1): ofw266

    Abstract

    Interferon-free regimens to treat hepatitis C virus (HCV) genotype 1 are effective but costly. At this time, payers in the United States use strategies to control costs including (1) limiting treatment to those with advanced disease and (2) negotiating price discounts in exchange for exclusivity.We used Monte Carlo simulation to investigate budgetary impact and cost effectiveness of these treatment policies and to identify strategies that balance access with cost control. Outcomes included nondiscounted 5-year payer cost per 10000 HCV-infected patients and incremental cost-effectiveness ratios.We found that the budgetary impact of HCV treatment is high, with 5-year undiscounted costs of $1.0 billion to 2.3 billion per 10000 HCV-infected patients depending on regimen choices. Among noncirrhotic patients, using the least costly interferon-free regimen leads to the lowest payer costs with negligible difference in clinical outcomes, even when the lower cost regimen is less convenient and/or effective. Among cirrhotic patients, more effective but costly regimens remain cost effective. Controlling costs by restricting treatment to those with fibrosis stage 2 or greater disease was cost ineffective for any patient type compared with treating all patients.Treatment strategies using interferon-free therapies to treat all HCV-infected persons are cost effective, but short-term cost is high. Among noncirrhotic patients, using the least costly interferon-free regimen, even if it is not single tablet or once daily, is the cost-control strategy that results in best outcomes. Restricting treatment to patients with more advanced disease often results in worse outcomes than treating all patients, and it is not preferred.

    View details for PubMedID 28480259

  • ESTIMATING HEALTH IMPACT OF RAPID DIAGNOSTIC TESTS FOR MALARIA Pradhan, E., Cohen, J., Salomon, J. AMER SOC TROP MED & HYGIENE. 2017: 404
  • Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda PLOS ONE Shrime, M. G., Sekidde, S., Linden, A., Cohen, J. L., Weinstein, M. C., Salomon, J. A. 2016; 11 (12): e0168867

    Abstract

    The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting.Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum.Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term "surgical mission trip". These results are robust to scenario and sensitivity analyses.The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems.

    View details for PubMedID 28036357

  • Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement LANCET Stevens, G. A., Alkema, L., Black, R. E., Boerma, J., Collins, G. S., Ezzati, M., Grove, J. T., Hogan, D. R., Hogan, M. C., Horton, R., Lawn, J. E., Marusic, A., Mathers, C. D., Murray, C. L., Rudan, I., Salomon, J. A., Simpson, P. J., Vos, T., Welch, V., Gather Working Grp 2016; 388 (10062): E19–E23

    Abstract

    Measurements of health indicators are rarely available for every population and period of interest, and available data may not be comparable. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) define best reporting practices for studies that calculate health estimates for multiple populations (in time or space) using multiple information sources. Health estimates that fall within the scope of GATHER include all quantitative population-level estimates (including global, regional, national, or subnational estimates) of health indicators, including indicators of health status, incidence and prevalence of diseases, injuries, and disability and functioning; and indicators of health determinants, including health behaviours and health exposures. GATHER comprises a checklist of 18 items that are essential for best reporting practice. A more detailed explanation and elaboration document, describing the interpretation and rationale of each reporting item along with examples of good reporting, is available on the GATHER website.

    View details for PubMedID 27371184

  • Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA oncology Fitzmaurice, C., Allen, C., Barber, R. M., Barregard, L., Bhutta, Z. A., Brenner, H., Dicker, D. J., Chimed-Orchir, O., Dandona, R., Dandona, L., Fleming, T., Forouzanfar, M. H., Hancock, J., Hay, R. J., Hunter-Merrill, R., Huynh, C., Hosgood, H. D., Johnson, C. O., Jonas, J. B., Khubchandani, J., Kumar, G. A., Kutz, M., Lan, Q., Larson, H. J., Liang, X., Lim, S. S., Lopez, A. D., MacIntyre, M. F., Marczak, L., Marquez, N., Mokdad, A. H., Pinho, C., Pourmalek, F., Salomon, J. A., Sanabria, J. R., Sandar, L., Sartorius, B., Schwartz, S. M., Shackelford, K. A., Shibuya, K., Stanaway, J., Steiner, C., Sun, J., Takahashi, K., Vollset, S. E., Vos, T., Wagner, J. A., Wang, H., Westerman, R., Zeeb, H., Zoeckler, L., Abd-Allah, F., Ahmed, M. B., Alabed, S., Alam, N. K., Aldhahri, S. F., Alem, G., Alemayohu, M. A., Ali, R., Al-Raddadi, R., Amare, A., Amoako, Y., Artaman, A., Asayesh, H., Atnafu, N., Awasthi, A., Saleem, H. B., Barac, A., Bedi, N., Bensenor, I., Berhane, A., Bernabé, E., Betsu, B., Binagwaho, A., Boneya, D., Campos-Nonato, I., Castañeda-Orjuela, C., Catalá-López, F., Chiang, P., Chibueze, C., Chitheer, A., Choi, J., Cowie, B., Damtew, S., das Neves, J., Dey, S., Dharmaratne, S., Dhillon, P., Ding, E., Driscoll, T., Ekwueme, D., Endries, A. Y., Farvid, M., Farzadfar, F., Fernandes, J., Fischer, F., G/Hiwot, T. T., Gebru, A., Gopalani, S., Hailu, A., Horino, M., Horita, N., Husseini, A., Huybrechts, I., Inoue, M., Islami, F., Jakovljevic, M., James, S., Javanbakht, M., Jee, S. H., Kasaeian, A., Kedir, M. S., Khader, Y. S., Khang, Y., Kim, D., Leigh, J., Linn, S., Lunevicius, R., El Razek, H. M., Malekzadeh, R., Malta, D. C., Marcenes, W., Markos, D., Melaku, Y. A., Meles, K. G., Mendoza, W., Mengiste, D. T., Meretoja, T. J., Miller, T. R., Mohammad, K. A., Mohammadi, A., Mohammed, S., Moradi-Lakeh, M., Nagel, G., Nand, D., Le Nguyen, Q., Nolte, S., Ogbo, F. A., Oladimeji, K. E., Oren, E., Pa, M., Park, E., Pereira, D. M., Plass, D., Qorbani, M., Radfar, A., Rafay, A., Rahman, M., Rana, S. M., Søreide, K., Satpathy, M., Sawhney, M., Sepanlou, S. G., Shaikh, M. A., She, J., Shiue, I., Shore, H. R., Shrime, M. G., So, S., Soneji, S., Stathopoulou, V., Stroumpoulis, K., Sufiyan, M. B., Sykes, B. L., Tabarés-Seisdedos, R., Tadese, F., Tedla, B. A., Tessema, G. A., Thakur, J. S., Tran, B. X., Ukwaja, K. N., Uzochukwu, B. S., Vlassov, V. V., Weiderpass, E., Wubshet Terefe, M., Yebyo, H. G., Yimam, H. H., Yonemoto, N., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zenebe, Z. M., Murray, C. J., Naghavi, M. 2016

    Abstract

    Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning.To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015.Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results.In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globally was prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancer was the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancer was breast cancer (2.4 million cases). Breast cancer was also the leading cause of cancer deaths and DALYs for women (523 000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in 174 of 195 countries or territories. Age-standardized death rates (ASDRs) for all cancers combined decreased within that timeframe in 140 of 195 countries or territories. Countries with an increase in the ASDR due to all cancers were largely located on the African continent. Of all cancers, deaths between 2005 and 2015 decreased significantly for Hodgkin lymphoma (-6.1% [95% uncertainty interval (UI), -10.6% to -1.3%]). The number of deaths also decreased for esophageal cancer, stomach cancer, and chronic myeloid leukemia, although these results were not statistically significant.As part of the epidemiological transition, cancer incidence is expected to increase in the future, further straining limited health care resources. Appropriate allocation of resources for cancer prevention, early diagnosis, and curative and palliative care requires detailed knowledge of the local burden of cancer. The GBD 2015 study results demonstrate that progress is possible in the war against cancer. However, the major findings also highlight an unmet need for cancer prevention efforts, including tobacco control, vaccination, and the promotion of physical activity and a healthy diet.

    View details for DOI 10.1001/jamaoncol.2016.5688

    View details for PubMedID 27918777

  • Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models. The Lancet. Global health Menzies, N. A., Gomez, G. B., Bozzani, F., Chatterjee, S., Foster, N., Baena, I. G., Laurence, Y. V., Qiang, S., Siroka, A., Sweeney, S., Verguet, S., Arinaminpathy, N., Azman, A. S., Bendavid, E., Chang, S. T., Cohen, T., Denholm, J. T., Dowdy, D. W., Eckhoff, P. A., Goldhaber-Fiebert, J. D., Handel, A., Huynh, G. H., Lalli, M., Lin, H., Mandal, S., McBryde, E. S., Pandey, S., Salomon, J. A., Suen, S., Sumner, T., Trauer, J. M., Wagner, B. G., Whalen, C. C., Wu, C., Boccia, D., Chadha, V. K., Charalambous, S., Chin, D. P., Churchyard, G., Daniels, C., Dewan, P., Ditiu, L., Eaton, J. W., Grant, A. D., Hippner, P., Hosseini, M., Mametja, D., Pretorius, C., Pillay, Y., Rade, K., Sahu, S., Wang, L., Houben, R. M., Kimerling, M. E., White, R. G., Vassall, A. 2016; 4 (11): e816-e826

    Abstract

    The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa.We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice.Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective.Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S2214-109X(16)30265-0

    View details for PubMedID 27720689

  • Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models LANCET GLOBAL HEALTH Menzies, N. A., Gomez, G. B., Bozzani, F., Chatterjee, S., Foster, N., Garcia Baena, I., Laurence, Y. V., Qiang, S., Siroka, A., Sweeney, S., Verguet, S., Arinaminpathy, N., Azman, A. S., Bendavid, E., Chang, S. T., Cohen, T., Denholm, J. T., Dowdy, D. W., Eckhoff, P. A., Goldhaber-Fiebert, J. D., Handel, A., Huynh, G. H., Lalli, M., Lin, H., Mandal, S., McBryde, E. S., Pandey, S., Salomon, J. A., Suen, S., Sumner, T., Trauer, J. M., Wagner, B. G., Whalen, C. C., Wu, C., Boccia, D., Chadha, V. K., Charalambous, S., Chin, D. P., Churchyard, G., Daniels, C., Dewan, P., Ditiu, L., Eaton, J. W., Grant, A. D., Hippner, P., Hosseini, M., Mametja, D., Pretorius, C., Pillay, Y., Rade, K., Sahu, S., Wang, L., Houben, R. M., Kimerling, M. E., White, R. G., Vassall, A. 2016; 4 (11): E816-E826

    Abstract

    The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa.We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice.Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective.Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S2214-109X(16)30265-0

    View details for Web of Science ID 000386811200023

  • Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models. The Lancet. Global health Houben, R. M., Menzies, N. A., Sumner, T., Huynh, G. H., Arinaminpathy, N., Goldhaber-Fiebert, J. D., Lin, H., Wu, C., Mandal, S., Pandey, S., Suen, S., Bendavid, E., Azman, A. S., Dowdy, D. W., Bacaër, N., Rhines, A. S., Feldman, M. W., Handel, A., Whalen, C. C., Chang, S. T., Wagner, B. G., Eckhoff, P. A., Trauer, J. M., Denholm, J. T., McBryde, E. S., Cohen, T., Salomon, J. A., Pretorius, C., Lalli, M., Eaton, J. W., Boccia, D., Hosseini, M., Gomez, G. B., Sahu, S., Daniels, C., Ditiu, L., Chin, D. P., Wang, L., Chadha, V. K., Rade, K., Dewan, P., Hippner, P., Charalambous, S., Grant, A. D., Churchyard, G., Pillay, Y., Mametja, L. D., Kimerling, M. E., Vassall, A., White, R. G. 2016; 4 (11): e806-e815

    Abstract

    The post-2015 End TB Strategy proposes targets of 50% reduction in tuberculosis incidence and 75% reduction in mortality from tuberculosis by 2025. We aimed to assess whether these targets are feasible in three high-burden countries with contrasting epidemiology and previous programmatic achievements.11 independently developed mathematical models of tuberculosis transmission projected the epidemiological impact of currently available tuberculosis interventions for prevention, diagnosis, and treatment in China, India, and South Africa. Models were calibrated with data on tuberculosis incidence and mortality in 2012. Representatives from national tuberculosis programmes and the advocacy community provided distinct country-specific intervention scenarios, which included screening for symptoms, active case finding, and preventive therapy.Aggressive scale-up of any single intervention scenario could not achieve the post-2015 End TB Strategy targets in any country. However, the models projected that, in the South Africa national tuberculosis programme scenario, a combination of continuous isoniazid preventive therapy for individuals on antiretroviral therapy, expanded facility-based screening for symptoms of tuberculosis at health centres, and improved tuberculosis care could achieve a 55% reduction in incidence (range 31-62%) and a 72% reduction in mortality (range 64-82%) compared with 2015 levels. For India, and particularly for China, full scale-up of all interventions in tuberculosis-programme performance fell short of the 2025 targets, despite preventing a cumulative 3·4 million cases. The advocacy scenarios illustrated the high impact of detecting and treating latent tuberculosis.Major reductions in tuberculosis burden seem possible with current interventions. However, additional interventions, adapted to country-specific tuberculosis epidemiology and health systems, are needed to reach the post-2015 End TB Strategy targets at country level.Bill and Melinda Gates Foundation.

    View details for DOI 10.1016/S2214-109X(16)30199-1

    View details for PubMedID 27720688

  • Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries. The lancet. Diabetes & endocrinology Manne-Goehler, J., Atun, R., Stokes, A., Goehler, A., Houinato, D., Houehanou, C., Hambou, M. M., Mbenza, B. L., Sobngwi, E., Balde, N., Mwangi, J. K., Gathecha, G., Ngugi, P. W., Wesseh, C. S., Damasceno, A., Lunet, N., Bovet, P., Labadarios, D., Zuma, K., Mayige, M., Kagaruki, G., Ramaiya, K., Agoudavi, K., Guwatudde, D., Bahendeka, S. K., Mutungi, G., Geldsetzer, P., Levitt, N. S., Salomon, J. A., Yudkin, J. S., Vollmer, S., Bärnighausen, T. 2016; 4 (11): 903-912

    Abstract

    Despite widespread recognition that the burden of diabetes is rapidly growing in many countries in sub-Saharan Africa, nationally representative estimates of unmet need for diabetes diagnosis and care are in short supply for the region. We use national population-based survey data to quantify diabetes prevalence and met and unmet need for diabetes diagnosis and care in 12 countries in sub-Saharan Africa. We further estimate demographic and economic gradients of met need for diabetes diagnosis and care.We did a pooled analysis of individual-level data from nationally representative population-based surveys that met the following inclusion criteria: the data were collected during 2005-15; the data were made available at the individual level; a biomarker for diabetes was available in the dataset; and the dataset included information on use of core health services for diabetes diagnosis and care. We first quantified the population in need of diabetes diagnosis and care by estimating the prevalence of diabetes across the surveys; we also quantified the prevalence of overweight and obesity, as a major risk factor for diabetes and an indicator of need for diabetes screening. Second, we determined the level of met need for diabetes diagnosis, preventive counselling, and treatment in both the diabetic and the overweight and obese population. Finally, we did survey fixed-effects regressions to establish the demographic and economic gradients of met need for diabetes diagnosis, counselling, and treatment.We pooled data from 12 nationally representative population-based surveys in sub-Saharan Africa, representing 38 311 individuals with a biomarker measurement for diabetes. Across the surveys, the median prevalence of diabetes was 5% (range 2-14) and the median prevalence of overweight or obesity was 27% (range 16-68). We estimated seven measures of met need for diabetes-related care across the 12 surveys: (1) percentage of the overweight or obese population who received a blood glucose measurement (median 22% [IQR 11-37]); and percentage of the diabetic population who reported that they (2) had ever received a blood glucose measurement (median 36% [IQR 27-63]); (3) had ever been told that they had diabetes (median 27% [IQR 22-51]); (4) had ever been counselled to lose weight (median 15% [IQR 13-23]); (5) had ever been counselled to exercise (median 15% [IQR 11-30]); (6) were using oral diabetes drugs (median 25% [IQR 18-42]); and (7) were using insulin (median 11% [IQR 6-13]). Compared with those aged 15-39 years, the adjusted odds of met need for diabetes diagnosis (measures 1-3) were 2·22 to 3·53 (40-54 years) and 3·82 to 5·01 (≥55 years) times higher. The adjusted odds of met need for diabetes diagnosis also increased consistently with educational attainment and were between 3·07 and 4·56 higher for the group with 8 years or more of education than for the group with less than 1 year of education. Finally, need for diabetes care was significantly more likely to be met (measures 4-7) in the oldest age and highest educational groups.Diabetes has already reached high levels of prevalence in several countries in sub-Saharan Africa. Large proportions of need for diabetes diagnosis and care in the region remain unmet, but the patterns of unmet need vary widely across the countries in our sample. Novel health policies and programmes are urgently needed to increase awareness of diabetes and to expand coverage of preventive counselling, diagnosis, and linkage to diabetes care. Because the probability of met need for diabetes diagnosis and care consistently increases with age and educational attainment, policy makers should pay particular attention to improved access to diabetes services for young adults and people with low educational attainment.None.

    View details for DOI 10.1016/S2213-8587(16)30181-4

    View details for PubMedID 27727123

  • Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Kassebaum, N. J., Barber, R. M., Bhutta, Z. A., Dandona, L., Gething, P. W., Hay, S. I., Kinfu, Y., Larson, H. J., Liang, X., Lim, S. S., Lopez, A. D., Lozano, R., Mensah, G. A., Mokdad, A. H., Naghavi, M., Pinho, C., Salomon, J. A., Steiner, C., Vos, T., Wang, H., Abajobir, A. A., Abate, K. H., Abbas, K. M., Abd-Allah, F., Abdallat, M. A., Abdulle, A. M., Abera, S. F., Aboyans, V., Abubakar, I., Abu-Rmeileh, N. M., Achoki, T., Adebiyi, A. O., Adedeji, I. A., Adelekan, A. L., Adou, A. K., Afanvi, K. A., Agarwal, A., Kiadaliri, A. A., Ajala, O. N., Akinyemiju, T. F., Akseer, N., Al-Aly, Z., Alam, K., Alam, N. K., Alasfoor, D., Aldhahri, S. F., Aldridge, R. W., Alhabib, S., Ali, R., Alkerwi, A., Alla, F., Al-Raddadi, R., Alsharif, U., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, G. M., Antoine, R. M., Antonio, C. A., Aregay, A. F., Arnlov, J., Arora, M., Arsenijevic, V. S., Al Artaman, Asayesh, H., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Bahit, M. C., Balakrishnan, K., Banerjee, A., Barac, A., Barker-Collo, S. L., Barnighausen, T., Basu, S., Bayou, T. A., Bayou, Y. T., Bazargan-Hejazi, S., Beardsley, J., Bedi, N. W., Bekele, T., Bell, M. L., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Biadgilign, S., Bikbov, B., Bin Abdulhak, A. A., Biroscak, B. J., Biryukov, S., Bisanzio, D., Bjertness, E., Blore, J. D., Brainin, M., Brazinova, A., Breitborde, N. J., Brugha, T. S., Butt, Z. A., Campos-Nonato, I. R., Campuzano, J. C., Cardenas, R., Carrero, J. J., Carter, A., Casey, D. C., Castaneda-Oquela, C. A., Castro, R. E., Catala-Lopez, F., Cavalleri, F., Chang, H., Chang, J. -., Chavan, L., Chibueze, C. E., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christopher, D. J., Ciobanu, L. G., Cirillo, M., Coates, M. M., Coggeshall, M., Colistro, V., Colquhoun, S. M., Cooper, C., Cooper, L. T., Cortinovis, M., Dahiru, T., Damasceno, A., Danawi, H., Dandona, R., das Neves, J., De Leo, D., Dellavalle, R. P., Deribe, K., Deribew, A., Jarlais, D. C., Dharmaratne, S. D., Dicker, D. J., Ding, E. L., Dossou, E., Dubey, M., Ebel, B. E., Ellingsen, C. L., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Faraon, E. J., Farid, T. A., Farinha, C. S., Faro, A., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S., Fernandes, J. C., Fischer, F., Fitchett, J. R., Fleming, T., Gt, N. F., Franca, E. B., Franklin, R. C., Fraser, M. S., Friedman, J., Pullman, N., Furst, T., Futran, N. D., Gambashidze, K., Gamkrelidze, A., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Gebremedhin, M., Gebru, A. A., Geleijnse, J. M., Gibney, K. B., Giref, A. Z., Giroud, M., Gishu, M. D., Glaser, E., Goenka, S., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Goto, A., Graetz, N., Gugnani, H. C., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Hafezi-Nejad, N., Hailu, A. D., Hailu, G. B., Hamadeh, R. R., Hamidi, S., Hancock, J., Handal, A. J., Hankey, G. J., Harb, H. L., Harikrishnan, S., Harun, K. M., Havmoeller, R., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Htet, A. S., Hu, G., Huang, H., Huang, J. J., Huybrechts, I., Huynh, C., Iannarone, M., Iburg, K. M., Idrisov, B. T., Iyer, V. J., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jonas, J. B., Kabir, Z., Kamal, R., Kan, H., Karch, A., Karletsos, D., Kasaeian, A., Kaul, A., Kawakami, N., Kayibanda, J. F., Kazanjan, K., Kazi, D. S., Keiyoro, P. N., Kemmer, L., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Kesavachandran, C. N., Khader, Y. S., Khan, A. R., Khan, E. A., Khang, Y., Khonelidze, I., Khosravi, A., Khubchandani, J., Kim, Y. J., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kosen, S., Koul, P. A., Koyanagi, A., Krishnaswami, S., Defo, B. K., Bicer, B. K., Kudom, A. A., Kulikoff, X. R., Kulkarni, C., Kumar, G. A., Kutz, M. J., Lal, D. K., Lalloo, R., Lam, H., Lamadrid-Figueroa, H., Lan, Q., Larsson, A., Laryea, D. O., Leigh, J., Leung, R., Li, Y., Li, Y., Lipshultz, S. E., Liu, P. Y., Liu, S., Liu, Y., Lloyd, B. K., Lotufo, P. A., Lunevicius, R., Ma, S., El Razek, H. M., El Razek, M. M., Majdan, M., Majeed, A., Malekzadeh, R., Mapoma, C. C., Marcenes, W., Margolis, D. J., Marquez, N., Masiye, F., Marzan, M. B., Mason-Jones, A. J., Mazorodze, T. T., Meaney, P. A., Mehari, A., Mehndiratta, M. M., Mena-Rodriguez, F., Mekonnen, A. B., Melaku, Y. A., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F. A., Miller, T. R., Mills, E. J., Mirarefin, M., Misganaw, A., Ibrahim, N. M., Mohammad, K. A., Mohammadi, A., Mohammed, S., Mola, G. L., Monasta, L., Monis, J. d., Hernandez, J. C., Montero, P., Montico, M., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Morawska, L., Mori, R., Mueller, U., Murthy, G. V., Murthy, S., Nachega, J. B., Naheed, A., Naldi, L., Nand, D., Nangia, V., Nash, D., Neupane, S., Newton, J. N., Ng, M., Ngalesoni, F. N., Nguhiu, P., Nguyen, G., Le Nguyen, Q., Nisar, M. I., Nomura, M., Norheim, O. F., Norman, R. E., Nyakarahuka, L., Obermeyer, C. M., Ogbo, F. A., Oh, I., Ojelabi, F. A., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Ota, E., Oyekale, A. S., Pa, M., Pain, A., Papantoniou, N., Park, E., Park, H., Caicedo, A. J., Patten, S. B., Paul, V. K., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Pillay, J. D., Pishgar, F., Polinder, S., Pope, D., Pourmalek, F., Qorbani, M., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Ram, U., Ranabhat, C. L., Rangaswamy, T., Rao, P. V., Refaat, A. H., Remuzzi, G. 2016; 388 (10053): 1775-1812

    Abstract

    In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015.We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility.Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance.Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000012

    View details for PubMedCentralID PMC5224694

  • Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Wang, H., Bhutta, Z. A., Coates, M. M., Coggeshall, M., Dandona, L., Diallo, K., Franca, E., Fraser, M., Fullman, N., Gething, P. W., Hay, S. I., Kinfu, Y., Kita, M., Kulikoff, X., Larson, H. J., Liang, J., Liang, X., Lim, S. S., Lind, M., Lopez, A. D., Lozano, R., Mensah, G. A., Mikesell, J. B., Mokdad, A. H., Mooney, M. D., Naghavi, M., Nguyen, G., Rakovac, I., Salomon, J. A., Silpakit, N., Sligar, A., Sorensen, R. D., Vos, T., Zhu, J., Abajobir, A., Abate, K., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abera, S., Aboyans, V., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. E., Abyu, G., Achoki, T., Adebiyi, A., Adedeji, I., Adelekan, A., Adou, A., Agarwal, A., Ajala, O. N., Akinyemiju, T. F., Akseer, N., Alam, K., Alam, N. M., Alasfoor, D., Aldridge, R., Alegretti, M., Alemu, Z., Ali, R., Alkerwi, A., Alla, F., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Martin, E., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A., Ameh, E. A., Ammar, W., Amrock, S., Andersen, H. H., Anderson, G. M., Antonio, C. T., Arlov, J., Artaman, A., Asayesh, H., Asghar, R., Assadi, R., Atique, S., Avokpaho, E., Awasthi, A., Quintanilla, B., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Banigbe, B. F., Barac, A., Barber, R. M., Barker-Collo, S. L., Barnighausen, T., Barrero, L. H., Bayou, T., Bayou, Y., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Bekele, T., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B., Beyene, A., Bhatt, S., Biadgilign, S., Bikbov, B., Birlik, S., Bisanzio, D., Bjertness, E., Blore, J. D., Bourne, R. A., Brainin, M., Brazinova, A., Breitborde, N. K., Brown, A., Colin Buckle, G., Burch, M., Butt, Z. A., Ricardo Campos-Nonato, I., Cesar Campuzano, J., Cardenas, R., Carpenter, D. O., Jesus Carrero, J., Carter, A., Casey, D. C., Castaneda-Orjuela, C. A., Rivas, J., Castro, R., Catala-Lopez, F., Cercy, K., Chang, H., Chang, J., Chibueze, C., Chisumpa, V., Choi, J., Chowdhury, R., Christopher, D., Ciobanu, L. G., Colquhoun, S. M., Cooper, C., Cornaby, L., Damtew, S., Danawi, H., Dandona, R., das Neves, J., Davis, A. C., de Jager, P., De Leo, D., Degenhardt, L., Deribe, K., Deribew, A., Jarlais, D., deVeber, G. A., Dharmaratne, S. D., Dhillon, P. K., Ding, E. L., Doshi, P., Doyle, K. E., Duan, L., Dubey, M., Ebrahimi, H., Ellingsen, C., Elyazar, I., Endries, A., Ermakov, S., Eshrati, B., Esteghamati, A., Faraon, E., Farid, T. A., Farinha, C., Faro, A., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S., Fernandes, J. C., Fischer, F., Fitchett, J. A., Foigt, N., Franklin, R. C., Friedman, J., Furst, T., Gambashidze, K., Gamkrelidze, A., Ganguly, P., Gebre, T., Gebrehiwot, T., Gebremedhin, A., Gebru, A., Geleijnse, J. M., Gessner, B. D., Ginawi, I., Giref, A., Gishu, M., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S., Goto, A., Gouda, H. N., Gugnani, H., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gyawali, B., Haagsma, J. A., Hafezi-Nejad, N., Haile, D., Hailu, A., Hailu, G., Hamadeh, R., Hamidi, S., Hancock, J., Handal, A. J., Hankey, G. J., Harb, H. L., Harikrishnan, S., Harun, K. M., Havmoeller, R., Hay, R. J., Heredia-Pi, I., Hoek, H. W., Horino, M., Horita, N., Hosgood, H., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, G., Huang, C., Huang, J. J., Huang, H., Huiart, L., Huynh, C., Iburg, K., Idrisov, B. T., Innos, K., Jacobsen, K. H., Jahanmehr, N., Javanbakht, M., Jayatilleke, A., Jee, S., Jeemon, P., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jin, Y., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Kang, G., Karch, A., Karema, C., Kasaeian, A., Kaul, A., Kawakami, N., Kayibanda, J., Kazanjan, K., Keiyoro, P., Kemp, A., Kengne, A., Keren, A., Kereselidze, M., Kesavachandran, C., Khader, Y., Khalil, I. A., Khan, A., Khan, E., Khang, Y., Khonelidze, I., Khubchandani, J., Kim, C., Kim, D., Kim, Y., Kissoon, N., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kosen, S., Koul, P. A., Koyanagi, A., Defo, B., Bicer, B., Kudom, A. A., Kumar, G., Kutz, M. J., Kyu, H. H., Lal, D., Lalloo, R., Lam, H., Lam, J. O., Lansingh, V. C., Larsson, A., Leigh, J., Leung, R., Li, Y., Li, Y., Lindsay, M., Liu, P. Y., Liu, S., Lloyd, B. K., Lo, W. D., Logroscino, G., Low, N., Lunevicius, R., Lyons, R. A., Ma, S., Abd El Razek, H., Abd El Razek, M., Mahdavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Mapoma, C. C., Marcenes, W., Martinez-Raga, J., Marzan, M., Masiye, F., McGrath, J. J., Meaney, P. A., Mehari, A., Mehndiratta, M., Mekonnen, A. B., Melaku, Y., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F., Miller, T. R., Mills, E. J., Mirarefin, M., Misganaw, A., Mock, C. N., Mohammad, K., Mohammadi, A., Mohammed, S. U., Monasta, L., Hernandez, J., Montico, M., Moore, A. R., Moradi-Lakeh, M., Morawska, L., Mori, R., Mueller, U. O., Murphy, G. V., Murthy, S., Nachega, J. B., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Neupane, S., Newton, C. R., Newton, J. N., Ng, M., Ngalesoni, F., Nguhiu, P., Quyen Le Nguyen, Nisar, M., Pete, P., Norheim, O. F., Norman, R. E., Ogbo, F., Oh, I., Ojelabi, F., Olivares, P. R., Olusanya, B., Olusanya, J., Oren, E., Ota, E., Mahesh, P. A., Park, E., Park, H., Parsaeian, M., Caicedo, A., Patten, S. B., Pedro, J., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M., Pillay, J., Pishgar, F., Polinder, S., Pope, D., Popova, S., Pourmalek, F., Qorbani, M., Rabiee, R. S., Rafay, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, S., Rai, R., Raju, M., Ram, U., Rana, S. M., Ranabhat, C., Rao, P., Refaat, A. H., Remuzzi, G., Resnikoff, S., Reynolds, A., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roth, G. A., Roy, A., Ruhago, G., Sagar, R., Saleh, M., Sanabria, J. R., Sanchez-Nino, M., Santos, I. S., Santos, J., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schneider, I. C., Schottker, B., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Setegn, T., Shahraz, S., Shaikh, M., Shakh-Nazarova, M., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Sheth, K. N., Shibuya, K., Shin, H., Shin, M., Shiri, R., Shuie, I., Sigfusdottir, I., Silva, D., Silverberg, J., Simard, E. P., Sindi, S., Singh, A., Singh, J. A., Singh, O., Singh, P., Singh, V., Soriano, J. B., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stathopoulou, V., Steel, N., Stroumpoulis, K., Sturua, L., Sunguya, B. F., Swaminathan, S., Sykes, B. L., Szoeke, C. I., Tabares-Seisdedos, R., Tavakkoli, M., Taye, B., Tedla, B., Tefera, W., Tekle, T., Shifa, G., Terkawi, A., Tesfay, F., Tessema, G., Thapa, K., Thomson, A. J., Thorne-Lyman, A. L., Tobe-Gai, R., Tonelli, M., Topor-Madry, R., Topouzis, F., Tran, B., Troeger, C., Truelsen, T., Dimbuene, Z., Tura, A., Tyrovolas, S., Ukwaja, K. N., Uneke, C., Uthman, O. A., Vaezghasemi, M., Vasankari, T., Vasconcelos, A., Venketasubramanian, N., Verma, R., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vollset, S., Wang, L., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Weiss, D. J., Werdecker, A., Westerman, R., Widdowson, M., Wijeratne, T., Williams, T., Wiysonge, C., Wolfe, C. A., Wolfe, I., Won, S., Wubshet, M., Xiao, Q., Xu, G., Yadav, A., Yakob, B., Yano, Y., Yaseri, M., Ye, P., Yebyo, H., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M., Zeeb, H., Zhang, H., Zhao, Y., Zheng, Y., Zhou, M., Zodpey, S., Murray, C. L., GBD 2015 Child Mortality Collabora 2016; 388 (10053): 1725–74

    Abstract

    Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time.Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone.Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000423462600001

    View details for PubMedID 27733285

    View details for PubMedCentralID PMC5224696

  • Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015 LANCET Lim, S. S., Allen, K., Bhutta, Z. A., Dandona, L., Forouzanfar, M. H., Fullman, N., Gething, P. W., Goldberg, E. M., Hay, S. I., Holmberg, M., Kinfu, Y., Kutz, M. J., Larson, H. J., Liang, X., Lopez, A. D., Lozano, R., McNellan, C. R., Mokdad, A. H., Mooney, M. D., Naghavi, M., Olsen, H. E., Pigott, D. M., Salomon, J. A., Vos, T., Wang, H., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Abyu, G. Y., Achoki, T., Adebiyi, A. O., Adedeji, I. A., Afanvi, K. A., Afshin, A., Agarwal, A., Agrawal, A., Kiadaliri, A. A., Ahmadieh, H., Ahmed, K. Y., Akanda, A. S., Akinyemi, R. O., Akinyemiju, T. F., Akseer, N., Al-Aly, Z., Alam, K., Alam, U., Alasfoor, D., Albuhairan, F. S., Aldhahri, S. F., Dge, R. W., Alemu, Z. A., Ali, R., Alkerwi, A., Alkhateeb, M. A., Alla, F., Allebeck, P., Allen, C., Al-Raddadi, R., Altirkawi, K. A., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, B. O., Anderson, G. M., Antonio, C. A., Anwari, P., Arnlov, J., Artaman, A., Asayesh, H., Asghar, R. J., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Barac, A., Barber, R., Barker-Collo, S. L., Barnighausen, T., Barrero, L. H., Barrientos-Gutierrez, T., Basu, S., Bayou, T. A., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Benzian, H., Berhane, A., Bernabe, E., Bernal, O. A., Betsu, B. D., Beyene, A. S., Bhala, N., Bhatt, S., Biadgilign, S., Bienhoff, K. A., Bikbov, B., Binagwaho, A., Bisanzio, D., Bjertness, E., Blore, J., Bourne, R. R., Brainin, M., Brauer, M., Brazinova, A., Breitborde, N. J., Broday, D. M., Brugha, T. S., Buchbinder, R., Butt, Z. A., Cahill, L. E., Campos-Nonato, I. R., Campuzano, J. C., Carabin, H., Cardenas, R., Carrero, J. J., Carter, A., Casey, D., Caso, V., Castaneda-Orjuela, C. A., Rivas, J. C., Catala-Lopez, F., Cavalleri, F., Cecilio, P., Chang, H., Chang, J., Charlson, F. J., Che, X., Chen, A. Z., Chiang, P. P., Chibalabala, M., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christensen, H., Ciobanu, L. G., Cirillo, M., Coates, M. M., Coggeshall, M., Cohen, A. J., Cooke, G. S., Cooper, C., Cooper, L. T., Cowie, B. C., Crump, J. A., Damtew, S. A., Dandona, R., Dargan, P. I., das Neves, J., Davis, A. C., Davletov, K., de Castro, E. F., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Deribe, K., Derrett, S., Jarlais, D. C., Deshpande, A., deVeber, G. A., Dey, S., Dharmaratne, S. D., Dhillon, P. K., Ding, E. L., Dorsey, E. R., Doyle, K. E., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Ebrahimi, H., Endries, A. Y., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Fahimi, S., Farid, T. A., Farinha, C. S., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Felicio, M. M., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Ferrari, A. J., Fischer, F., Fitchett, J. R., Fitzmaurice, C., Foigt, N., Foreman, K., Fowkes, F. G., Franca, E. B., Franklin, R. C., Fraser, M., Friedman, J., Frostad, J., Furst, T., Gabbe, B., Garcia-Basteiro, A. L., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Gebru, A. A., Gessner, B. D., Gillum, R. F., Ginawi, I. A., Giref, A. Z., Giroud, M., Gishu, M. D., Godwin, W., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Graetz, N., Greenwell, K. F., Griswold, M., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Gyawali, B., Haagsma, J. A., Haakenstad, A., Hafezi-Nejad, N., Haile, D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Hammami, M., Hankey, G. J., Harb, H. L., Haro, J. M., Hassanvand, M. S., Havmoeller, R., Heredia-Pi, I. B., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Htet, A. S., Hu, G., Huang, H., Iburg, K. M., Idrisov, B. T., Inoue, M., Islami, F., Jacobs, T. A., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., James, P., Jansen, H. A., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jha, V., Jiang, Y., Jibat, T., Jin, Y., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Kandel, A., Karch, A., Karema, C. K., KarimIchani, C., Karunapema, P., Kasaeian, A., Kassebaum, N. J., Kaul, A., Kawakami, N., Kayibanda, J. F., Keiyoro, P. N., Kemmer, L., Kemp, A. H., Kengne, A. P., Keren, A., Kesavachandran, C. N., Khader, Y. S., Khan, A. R., Khan, E. A., Khan, G., Khang, Y., Khoja, T. A., Khosravi, A., Khubchandani, J., Kieling, C., Kim, C., Kim, D., Kim, S., Kim, Y. J., Kimokoti, R. W., Kissoon, N., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kolte, D., Kosen, S., Kotsakis, G. A., Koul, P. A., Koyanagi, A., Kravchenko, M., Krueger, H., Defo, B. K., Kuchenbecker, R. S., Kuipers, E. J., Kulikoff, X. R., Kulkarni, V. S., Kumar, G. A., Kwan, G. F., Kyu, H. H., Lal, A., Lal, D. K., Lalloo, R., Lam, H., Lan, Q., Langan, S. M., Larsson, A., Laryea, D. O., Latif, A. A., Leasher, J. L., Leigh, J., Leinsalu, M., Leung, J., Leung, R., Levi, M., Li, Y., Li, Y., Lind, M., Linn, S., Lipshultz, S. E., Liu, P. Y., Liu, S., Liu, Y., Lloyd, B. K., Lo, L., Logroscino, G., Lotufo, P. A., Lucas, R. M., Lunevicius, R., Abd El Razek, M. M., Magis-Rodriguez, C., Mandavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Malta, D. C., Mapoma, C. C., Margolis, D. J., Martin, R. V., Martinez-Raga, J., Masiye, F., Mason-Jones, A. J., Massano, J., Matzopoulos, R., Mayosi, B. M., McGrath, J. J., McKee, M., Meaney, P. A., Mehari, A., Mekonnen, A. B., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Mensink, G. B., Meretoja, A., Meretoja, T. J., Mesfin, Y. M., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Mirarefin, M., Misganaw, A., Mitchell, P. B., Mock, C. N., Mohammadi, A., Mohammed, S., Monasta, L., Monis, J. d., Hernandez, J. C., Montico, M., Moradi-Lakeh, M., Morawska, L., Mori, R., Mueller, U. O., Murdoch, M. E., Murimira, B., Murray, J., Murthy, G. V., Murthy, S., Musa, K. I., Nachega, J. B., Nagel, G., Naidoo, K. S., Naldi, L., Nangia, V., Neal, B., Nejjari, C., Newton, C. R., Newton, J. N., Ngalesoni, F. N., Nguhiu, P., Nguyen, G., Quyen Le Nguyen, Q. L., Nisar, M. I., Pete, P. M., Nolte, S., Nomura, M., Norheim, O. F., Norrving, B., Obermeyer, C. M., Ogbo, F. A., Oh, I., Oladimeji, O., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Ortiz, A., Osborne, R. H., Ota, E., Owolabi, M. O., Mahesh, P. A., Park, E., Park, H., Parry, C. D., Parsaeian, M., Patel, T., Patel, V., Caicedo, A. J., Patil, S. T., Patten, S. B., Patton, G. C., Paudel, D., Pedro, J. M., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Pinho, C., Pishgar, F., Polinder, S., Poulton, R. G., Pourmalek, F., Qorbani, M., Rabiee, R. H., Radfar, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Rajsic, S., Raju, M., Ram, U., Rana, S. M., Ranabhat, C. L., Ranganathan, K., Rao, P. C., Refaat, A. H., Reitsma, M. B., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Blancas, M. J., Rolm, H. S., Roberts, B., Rodriguez, M., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roth, G. A., Rothenbacher, D., Roy, A., Roy, N., Sackey, B. B., Sagar, R., Saleh, M. M., Sanabria, J. R., Santomauro, D. F., Santos, I. S., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Sawyer, S. M., Schmidhuber, J., Schmidt, M. I., Schneider, I. J., Schutte, A. E., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K., Shaheen, A., Shaikh, M. A., Levy, T. S., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Sheth, K. 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    Abstract

    In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices.In 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8-61·8) and varied widely by country, ranging from 85·5 (84·2-86·5) in Iceland to 20·4 (15·4-24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2)=0·88) and the MDG index (r(2)=0·92), whereas the non-MDG index had a weaker relation with SDI (r(2)=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0-10·4), and gains on the MDG index (a median change of 10·0 [6·7-13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1-8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened.GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000013

    View details for PubMedID 27665228

    View details for PubMedCentralID PMC5055583

  • Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., Coggeshall, M., Cornaby, L., Dandona, L., Dicker, D. J., Dilegge, T., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Fleming, T., Forouzanfar, M. H., Fullman, N., Gething, P. W., Goldberg, E. M., Graetz, N., Haagsma, J. A., Johnson, C. O., Kassebaum, N. J., Kawashima, T., Kemmer, L., Khalil, I. A., Kinfu, Y., Kyu, H. H., Leung, J., Liang, X., Lim, S. S., Lopez, A. D., Lozano, R., Marczak, L., Mensah, G. A., Mokdad, A. H., Naghavi, M., Nguyen, G., Nsoesie, E., Olsen, H., Pigott, D. M., Pinho, C., Rankin, Z., Reinig, N., Salomon, J. A., Sandar, L., Smith, A., Stanaway, J., Steiner, C., Teeple, S., Thomas, B. A., Troeger, C., Wagner, J. A., Wang, H., Wanga, V., Whiteford, H. A., Zoeckler, L., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Ackerman, I. N., Adebiyi, A. O., Ademi, Z., Adou, A. K., Afanvi, K. A., Agardh, E. E., Agarwal, A., Kiadaliri, A. A., Ahmadieh, H., Ajala, O. N., Akinyemi, R. O., Akseer, N., Al-Aly, Z., Alam, K., Alam, N. K., Aldhahri, S. F., Alegretti, M. A., Alemu, Z. A., Alexander, L. T., Alhabib, S., Ali, R., Alkerwi, A., Alla, F., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, G. M., Anderson, B., Antonio, C. A., Aregay, A. F., Arnlov, J., Al Artaman, Asayesh, H., Assadi, R., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Barac, A., Barker-Collo, S. L., Barnighausen, T., Barregard, L., Barrero, L. H., Basu, A., Bazargan-Hejazi, S., Bell, B., Bell, M. L., Bennett, D. A., Bensenor, I. M., Benzian, H., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Bhala, N., Bhatt, S., Biadgilign, S., Bienhofff, K., Bikbov, B., Biryukov, S., Bisanzio, D., Bjertness, E., Blore, J., Borschmann, R., Boufous, S., Brainin, M., Brazinova, A., Breitborde, N. J., Brown, J., Buchbinder, R., Buckle, G. C., Butt, Z. A., Calabria, B., Ricardo Campos-Nonato, I., Cesar Campuzano, J., Carabin, H., Cardenas, R., Carpenter, D. O., Carrero, J. J., Castaneda-Orjuela, C. A., Castillo Rivas, J., Catala-Lopez, F., Chang, J., Chiang, P. P., Chibueze, C. E., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christensen, H., Christopher, D. J., Ciobanu, L. G., Cirillo, M., Coates, M. M., Colquhoun, S. M., Cooper, C., Cortinovis, M., Crump, J. A., Damtew, S. A., Dandona, R., Daoud, F., Dargan, P. I., das Neves, J., Davey, G., Davis, A. C., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Dellavalle, R. P., Deribe, K., Deribew, A., Derrett, S., Des Jarlais, D. C., Dharmaratne, S. D., Dhillon, P. K., Diaz-Torne, C., Ding, E. L., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Ebrahimi, H., Ellenbogen, R. G., Elyazar, I., Endres, M., Endries, A. Y., Ermakov, S. P., Eshrati, B., Estep, K., Farid, T. A., Sofia e Sa Farinha, C., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Felson, D. T., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Fischer, F., Fitchett, J. R., Foreman, K., Fowkes, G. R., Fox, J., Franklin, R. C., Friedman, J., Frostad, J., Furst, T., Futran, N. D., Gabbe, B., Ganguly, P., Gankpe, F. G., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Ginawi, I. A., Giref, A. Z., Giroud, M., Gishu, M. D., Glaser, E., Godwin, W. W., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Grainger, R., Greaves, F., Guillemin, F., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Haile, D., Hailu, A. D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Hammami, M., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Maria Haro, J., Havmoeller, R., Hay, R. J., Beatriz Heredia-Pi, I., Heydarpour, P., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Htet, A. S., Huang, H., Huang, J. J., Huynh, C., Iannarone, M., Iburg, K. M., Innos, K., Inoue, M., Iyer, V. J., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jensen, P. N., Jiang, Y., Jibat, T., Jimenez-Corona, A., Jin, Y., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Karch, A., Karema, C. K., Karimkhani, C., Kasaeian, A., Kaul, A., Kawakami, N., Karimkhani, C., Kasaeian, A., Kaul, A., Kawakami, N., Keiyoro, P. N., Kemp, A. H., Keren, A., Kesavachandran, C. N., Khader, Y. S., Khaiff, A. R., Khaiff, E. A., Khang, Y., Khera, S., Khoja, T. A., Khubchandani, J., Kieling, C., Kim, P., Kim, C., Kim, D., Kim, Y. J., Kissoon, N., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kolte, D., Kopec, J. A., Kosen, S., Kotsakis, G. A., Koul, P. A., Koyanagi, A., Kravchenko, M., Defo, B. K., Bicer, B. K., Kudom, A. A., Kuipers, E. J., Kumar, G. A., Kutz, M., Kwan, G. F., Lal, A., Lalloo, R., Lallukka, T., Lam, H., Lam, J. O., Langan, S. M., Larsson, A., Lavados, P. M., Leasher, J. L., Leigh, J., Leung, R., Levi, M., Li, Y., Li, Y., Liang, J., Liu, S., Liu, Y., Lloyd, B. K., Lo, W. D., Logroscino, G., Looker, K. J., Lotufo, P. A., Lunevicius, R., Lyons, R. A., Mackay, M. T., Abd El Razek, M. M., Mahdavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Marcenes, W., Margolis, D. J., Martinez-Raga, J., Masiye, F., Massano, J., McGarvey, S. T., McGrath, J. J., McKee, M., McMahon, B. J., Meaney, P. A., Mehari, A., Meija-Rodriguez, F., Mekonnen, A. B., Melaku, Y. 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R., Waller, S. G., Wang, L., Watkins, D. A., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., White, R. A., Williams, H. C., Wiysonge, C. S., Wolfe, C. D., Won, S., Woodbrook, R., Wubshet, M., Xavier, D., Xu, G., Yadav, A. K., Yan, L. L., Yano, Y., Yaseri, M., Ye, P., Yebyo, H. G., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zeeb, H., Zhou, M., Zodpey, S., Zuhlke, L. J., Murray, C. J. 2016; 388 (10053): 1545-1602

    Abstract

    Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015.We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores.We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4-19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30-2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35-2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo.Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000008

    View details for PubMedCentralID PMC5055577

  • Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Kassebaum, N. J., Arora, M., Barber, R. M., Bhutta, Z. A., Carter, A., Casey, D. C., Charlson, F. J., Coates, M. M., Coggeshall, M., Cornaby, L., Dandona, L., Dicker, D. J., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Foreman, K., Forouzanfar, M. H., Fullman, N., Gething, P. W., Goldberg, E. M., Graetz, N., Haagsma, J. A., Johnson, C., Kemmer, L., Khalil, I. A., Kinfu, Y., Kutz, M. J., Kyu, H. H., Leung, J., Liang, X., Lim, S. S., Lim, S. S., Lozano, R., Mensah, G. A., Mikesell, J., Mokdad, A. H., Mooney, M. D., Naghavi, M., Nguyen, G., Nsoesie, E., Pigott, D. M., Pinho, C., Rankin, Z., Reinig, N., Salomon, J. A., Sandar, L., Smith, A., Sorensen, R. J., Stanaway, J., Steiner, C., Teeple, S., Thomas, B. A., Troeger, C., VanderZanden, A., Wagner, J. 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L., Yan, Y., Yaseri, M., Ye, P., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zeeb, H., Zodpey, S., Zonies, D., Zuhlke, L. J., Zeeb, H., Zodpey, S., Zonies, D., Zuhlke, L. J., Vos, T., Lopez, A. D., Murray, C. J. 2016; 388 (10053): 1603-1658

    Abstract

    Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development.We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate.Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs.Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000009

    View details for PubMedCentralID PMC5388857

  • Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Wang, H., Naghavi, M., Allen, C., Barber, R. M., Bhutta, Z. A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., Coates, M. M., Coggeshall, M., Dandona, L., Dicker, D. J., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Foreman, K., Forouzanfar, M. H., Fraser, M. S., Pullman, N., Gething, P. W., Goldberg, E. M., Graetz, N., Haagsma, J. A., Hay, S. I., Huynh, C., Johnson, C., Kassebaum, N. J., Kinfu, Y., Kulikoff, X. R., Kutz, M., Kyu, H. H., Larson, H. J., Leung, J., Liang, X., Lim, S. S., Lind, M., Lozano, R., Marquez, N., Mensah, G. A., Mikesell, J., Mokdad, A. H., Mooney, M. D., Nguyen, G., Nsoesie, E., Pigott, D. M., Pinho, C., Roth, G. A., Salomon, J. A., Sandar, L., Silpakit, N., Sligar, A., Sorensen, R. J., Stanaway, J., Steiner, C., Teeple, S., Thomas, B. A., Troeger, C., VanderZanden, A., Vollset, S. E., Wanga, V., Whiteford, H. A., Wolock, T., Zoeckler, L., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S. F., Abreu, D. M., Abu-Raddad, L. J., Abyu, G. Y., Achoki, T., Adelekan, A. L., Ademi, Z., Adou, A. K., Adsuar, J. C., Afanvi, K. A., Afshin, A., Agardh, E. E., Agarwal, A., Agrawal, A., Kiadaliri, A. A., Ajala, O. N., Akanda, A. S., Akinyemi, R. O., Akinyemiju, T. F., Akseer, N., Al Lami, F. H., Alabed, S., Al-Aly, Z., Alam, K., Alam, N. K., Alasfoor, D., Aldhahri, S. F., Aldridge, R. W., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alexander, L. T., Alhabib, S., Ali, R., Alkerwi, A., Alla, F., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amegah, A. K., Ameh, E. A., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, B., Anderson, G. M., Antonio, C. A., Aregay, A. F., Arnlov, J., Arsenijevic, V. S., Al Artaman, Asayesh, H., Asghar, R. J., Atique, S., Arthur Avokpaho, E. F., Awasthi, A., Azzopardi, P., Bacha, U., Badawi, A., Bahit, M. C., Balakrishnan, K., Banerjee, A., Barac, A., Barker-Collo, S. L., Barnighausen, T., Barregard, L., Barrero, L. H., Basu, A., Basu, S., Bayou, Y. T., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Beghi, E., Belay, H. A., Bell, B., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Bhala, N., Bhalla, A., Biadgilign, S., Bikbov, B., Bin Abdulhak, A. A., Biroscak, B. J., Biryukov, S., Bjertness, E., Blore, J. D., Blosser, C. D., Bohensky, M. A., Borschmann, R., Bose, D., Bourne, R. R., Brainin, M., Brayne, C. E., Brazinova, A., Breitborde, N. J., Brenner, H., Brewer, J. D., Brown, A., Brown, J., Brugha, T. S., Buckle, G. C., Butt, Z. A., Calabria, B., Campos-Novato, I. R., Campuzano, J. C., Carapetis, J. R., Cardenas, R., Carpenter, D., Carrero, J. J., Castaneda-Oquela, C. A., Rivas, J. C., Catala-Lopez, F., Cavalleri, F., Cercy, K., Cerda, J., Chen, W., Chew, A., Chiang, P. P., Chibalabala, M., Chibueze, C. E., Chimed-Ochir, O., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christensen, H., Christopher, D. J., Ciobanu, L. G., Cirillo, M., Cohen, A. J., Colistro, V., Colomar, M., Colquhoun, S. M., Cooper, C., Cooper, L. T., Cortinovis, M., Cowie, B. C., Crump, J. A., Damsere-Derry, J., Danawi, H., Dandona, R., Daoud, F., Darby, S. C., Dargan, P. I., das Neves, J., Davey, G., Davis, A. C., Davitoiu, D. V., de Castro, E. F., de Jager, P., De Leo, D., Degenhardt, L., Dellavalle, R. P., Deribe, K., Deribew, A., Dharmaratne, S. D., Dhillon, P. K., Diaz-Torne, C., Ding, E. L., dos Santos, K. P., Dossou, E., Driscoll, T. R., Duan, L., Dubey, M., Bartholow, B., Ellenbogen, R. G., Lycke, C., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Estep, K., Faghmous, I. D., Fahimi, S., Jose, E., Farid, T. A., Sa Farinha, C. S., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Fischer, F., Fitchett, J. R., Flaxman, A., Foigt, N., Fowkes, F. G., Franca, E. B., Franklin, R. C., Friedman, J., Frostad, J., Hirst, T., Futran, N. D., Gall, S. L., Gambashidze, K., Gamkrelidze, A., Ganguly, P., Gankpe, F. G., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Gebru, A. A., Geleijnse, J. M., Gessner, B. D., Ghoshal, A. G., Gibney, K. B., Gillum, R. F., Gilmour, S., Giref, A. Z., Giroud, M., Gishu, M. D., Giussani, G., Glaser, E., Godwin, W. W., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Gosselin, R. A., Gotay, C. C., Goto, A., Gouda, H. N., Greaves, F., Gugnani, H. C., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Hafezi-Nejad, N., Haile, D., Hailu, A. D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Haro, J. M., Havmoeller, R., Heckbert, S. R., Heredia-Pi, I. B., Heydarpour, P., Hilderink, H. B., Hoek, H. W., Hogg, R. S., Horino, M., Horita, N., Hosgood, H. D., Hotez, P. J., Hoy, D. G., Hsairi, M., Htet, A. S., Than Htike, M. M., Hu, G., Huang, C., Huang, H., Huiart, L., Husseini, A., Huybrechts, I., Huynh, G., Iburg, K. M., Innos, K., Inoue, M., Iyer, V. J., Jacobs, T. A., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., James, P., Javanbakht, M., Jayaraman, S. P., Jayatilleke, A. U., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jimenez-Corona, A., Jonas, J. B., Joshi, T. K., Kabir, Z., Karnak, R., Kan, H., Kant, S., Karch, A., Karema, C. K., Karimkhani, C., Karletsos, D., Karthikeyan, G., Kasaeian, A., Katibeh, M., Kaul, A., Kawakami, N., Kayibanda, J. F., Keiyoro, P. N., Kemmer, L., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Kesavachandran, C. N., Khader, Y. S., Khalil, I. A., Khan, A. R., Khan, E. A., Khang, Y., Khera, S., Muthafer Khoja, T. A., Kieling, C., Kim, D., Kim, Y. J., Kissela, B. M., Kissoon, N., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kolte, D., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Krog, N. H., Defo, B. K., Bicer, B. K., Kudom, A. A., Kuipers, E. J., Kulkarni, V. S., Kumar, G. A., Kwan, G. F., Lal, A., Lal, D. K., Lalloo, R., Lam, H., Lam, J. O., Langan, S. M., Lansingh, V. C., Larsson, A., Laryea, D. O., Latif, A. A., Lawrynowicz, A. E., Leigh, J., Levi, M., Li, Y., Lindsay, M. P., Lipshultz, S. E., Liu, P. Y., Liu, S., Liu, Y., Lo, L., Logroscino, G., Lotufo, P. A., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, S., Pedro Machado, V. M., Mackay, M. T., Maclachlan, J. H., Abd El Razek, H. M., Abd El Razek, M. M., Majdan, M., Majeed, A., Malekzadeh, R., Ayele Manamo, W. A., Mandisarisa, J., Mangalam, S., Mapoma, C. C., Marcenes, W., Margolis, D. J., Martin, G. R., Martinez-Raga, J., Marzan, M. B., Masiye, F., Mason-Jones, A. J., Massano, J., Matzopoulos, R., Mayosi, B. M., McGarvey, S. T., McGrath, J. J., McKee, M., McMahon, B. J., Meaney, P. A., Mehari, A., Mehndiratta, M. M., Mena-Rodriguez, F., Mekonnen, A. B., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mhimbira, F. A., Micha, R., Miller, T. R., Mirarefin, M., Misganaw, A., Mock, C. N., Abdulmuhsin Mohammad, K., Mohammadi, A., Mohammed, S., Mohan, V., Mola, G. L., Monasta, L., Montanez Hernandez, J. C., Montero, P., Montico, M., Montine, T. J., Moradi-Lakeh, M., Morawska, L., Morgan, K., Mori, R., Mozaffarian, D., Mueller, U., Satyanarayana Murthy, G. V., Murthy, S., Musa, K. I., Nachega, J. B., Nagel, G., Naidoo, K. S., Naik, N., Naldi, L., Nangia, V., Nash, D., Nejjari, C., Neupane, S., Newton, C. R., Newton, J. N., Ng, M., Ngalesoni, F. N., Ngirabega, J. d., Quyen Le Nguyen, Q., Nisar, M. I., Nkamedjie Pete, P. M., Nomura, M., Norheim, O. F., Norman, P. E., Norrving, B., Nyakarahuka, L., Ogbo, F. A., Ohkubo, T., Ojelabi, F. A., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Ortiz, A., Osman, M., Ota, E., Ozdemir, R., Pa, M., Pandian, J. D., Pant, P. R., Papachristou, C., Park, E., Park, J., Parry, C. D., Parsaeian, M., Caicedo, A. J., Patten, S. B., Patton, G. C., Paul, V. K., Pearce, N., Pedro, J. M., Stokic, L. P., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Plass, D., Platts-Mills, J. A., Polinder, S., Pope, C. A., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Qorbani, M., Quame-Amaglo, J., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Rajavi, Z., Rajsic, S., Raju, M., Rakovac, I., Rana, S. M., Ranabhat, C. L., Rangaswamy, T., Rao, P., Rao, S. R., Refaat, A. H., Rehm, J., Reitsma, M. B., Remuzzi, G., Resnikofff, S., Ribeiro, A. L., Ricci, S., Blancas, M. J., Roberts, B., Roca, A., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Rothenbacher, D., Roy, A., Roy, N. K., Ruhago, G. M., Sagar, R., Saha, S., Sahathevan, R., Saleh, M. M., Sanabria, J. R., Sanchez-Nino, M. D., Sanchez-Riera, L., Santos, I. S., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schaub, M. P., Schmidt, M. I., Schneider, I. J., Schottker, B., Schutte, A. E., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K. A., Shaddick, G., Shaheen, A., Shahraz, S., Shaikh, M. A., Shakh-Nazarova, M., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Shen, Z., Shepard, D. S., Sheth, K. N., Shetty, B. P., Shi, P., Shibuya, K., Shin, M., Shiri, R., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Silva, D. A., Silveira, D. G., Silverberg, J. I., Simard, E. P., Singh, A., Singh, G. M., Singh, J. A., Singh, O. P., Singh, P. K., Singh, V., Soneji, S., Soreide, K., Soriano, J. B., Sposato, L. A., Sreeramareddy, C. T., Stathopoulou, V., Stein, D. J., Stein, M. B., Stranges, S., Stroumpoulis, K., Sunguya, B. F., Sur, P., Swaminathan, S., Sykes, B. L., Szoeke, C. E., Tabares-Seisdedos, R., Tabb, K. M., Takahashi, K., Takala, J. S., Talongwa, R. T., Tandon, N., Tavakkoli, M., Taye, B., Taylor, H. R., Ao, B. J., Tedla, B. A., Tefera, W. M., ten Have, M., Terkawi, A. S., Tesfay, F. H., Tessema, G. A., Thomson, A. J., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tirschwell, D. L., Tonelli, M., Topor-Madry, R., Topouzis, F., Nx, J. A., Traebert, J., Tran, B. X., Truelsen, T., Trujillo, U., Tura, A. K., Tuzcu, E. M., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Uthman, O. A., Van Dingenen, R., van Donkelaar, A., Vasankari, T., Vasconcelos, A. M., Venketasubramanian, N., Vidavalur, R., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Wagner, J. A., Wagner, G. R., Wallin, M. T., Wang, L., Watkins, D. A., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., White, R. A., Wijeratne, T., Wilkinson, J. D., Williams, H. C., Wiysonge, C. S., Woldeyohannes, S. M., Wolfe, C. D., Won, S., Wong, J. Q., Woolf, A. D., Xavier, D., Xiao, Q., Xu, G., Yakob, B., Yalew, A. Z., Yan, L. L., Yano, Y., Yaseri, M., Ye, P., Yebyo, H. G., Yip, P., Yirsaw, B. D., Yonemoto, N., Yonga, G., Younis, M. Z., Yu, S., Zaidi, Z., Zaki, M. E., Zannad, F., Zavala, D. E., Zeeb, H., Zeleke, B. M., Zhang, H., Zodpey, S., Zonies, D., Zuhlke, L. J., Vos, T., Lopez, A. D., Murray, C. J. 2016; 388 (10053): 1459-1544

    Abstract

    Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000007

    View details for PubMedCentralID PMC5388903

  • Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 LANCET Forouzanfar, M. H., Afshin, A., Alexander, L. T., Anderson, H. R., Bhutta, Z. A., Biryukov, S., Brauer, M., Burnett, R., Cercy, K., Charlson, F. J., Cohen, A. J., Dandona, L., Estep, K., Ferrari, A. J., Frostad, J. J., Fullman, N., Gething, P. W., Godwin, W. W., Griswold, M., Kinfu, Y., Kyu, H. H., Larson, H. J., Liang, X., Lim, S. S., Liu, P. Y., Lopez, A. D., Lozano, R., Marczak, L., Mensah, G. A., Mokdad, A. H., Moradi-Lakeh, M., Naghavi, M., Neal, B., Reitsma, M. B., Roth, G. A., Salomon, J. A., Sur, P. J., Vos, T., Wagner, J. A., Wang, H., Zhao, Y., Zhou, M., Aasvang, G. M., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abera, S. F., Abraham, B., Abu-Raddad, L. J., Abyu, G. Y., Adebiyi, A. O., Adedeji, I. A., Ademi, Z., Adou, A. K., Adsuar, J. C., Agardh, E. E., Agarwal, A., Agrawal, A., Kiadaliri, A. A., Ajala, O. N., Akinyemiju, T. F., Al-Aly, Z., Alam, K., Alam, N. K., Aldhahri, S. F., Aldridge, R. W., Alemu, Z. A., Ali, R., Alkerwi, A., Alla, F., Allebeck, P., Alsharif, U., Altirkawi, K. A., Alvarez Martin, E., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, B. O., Antonio, C. A., Anwar, P., Arnlov, J., Al Artaman, Asayesh, H., Asghar, R. J., Assadi, R., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Bahit, M. C., Balakrishnan, K., Barac, A., Barber, R. M., Barker-Collo, S. L., Baernighausen, T., Barquera, S., Barregard, L., Barrero, L. H., Basu, S., Bans, C., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Beghi, E., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Bhala, N., Bhansali, A., Bhatt, S., Biadgilign, S., Bikbov, B., Bisanzio, D., Bjertness, E., Blore, J. D., Borschmann, R., Boufous, S., Bourne, R. R., Brainin, M., Brazinova, A., Breitborde, N. J., Brenner, H., Broday, D. M., Brugha, T. S., Brunekreef, B., Butt, Z. A., Cahill, L. E., Calabria, B., Ricardo Campos-Nonato, I., Cardenas, R., Carpenter, D., Casey, D. C., Castaneda-Oquela, C. A., Castillo Rivas, J., Estanislao Castro, R., Catala-Lopez, F., Chang, J., Chiang, P. P., Chibalabala, M., Chimed-Ochir, O., Chisumpa, V. H., Chitheer, A. A., Choi, J. J., Christensen, H., Christopher, D. J., Ciobanu, L. G., Coates, M. M., Colquhoun, S. M., Cooper, L. T., Cooperrider, K., Cornaby, L., Cortinovis, M., Crump, J. A., Cuevas-Nasu, L., Damasceno, A., Dandona, R., Darby, S. C., Dargan, P. I., das Neves, J., Davis, A. C., Davletov, K., Filipa de Castro, E., De la Cruz-Gongora, V., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Del Pozo-Cruz, B., Dellavalle, R. P., Deribew, A., Des Jarlais, D. C., Dharmaratne, S. D., Dhillon, P. K., Diaz-Tome, C., Dicker, D., Ding, E. L., Dorsey, E. R., Doyle, K. E., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Elyazar, I., Endries, A. Y., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Fahimi, S., Aquino Faraon, E. J., Farid, T. A., Sofia e Sa Farinha, C., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. G., Fischer, F., Fitchett, J. R., Fleming, T., Foigt, N., Foreman, K., Fowkes, F. G., Franklin, R. C., Fuerst, T., Futran, N. D., Gakidou, E., Garcia-Basteiro, A. L., Gebrehiwot, T. T., Gebremedhin, A. T., Geleijnse, J. M., Gessner, B. D., Giref, A. Z., Giroud, M., Gishu, M. D., Goenka, S., Carmen Gomez-Cabrera, M., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Gugnani, H. C., Guillemin, F., Guo, Y., Gupta, R., Gupta, R., Gutierrez, R. A., Haagsma, J. A., Hafezi-Nejad, N., Haile, D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Maria Haro, J., Hassanvand, M. S., Hassen, T. A., Havmoeller, R., Beatriz Heredia-Pi, I., Francisco Hernandez-Llanes, N., Heydarpour, P., Hoek, H. W., Hoffman, H. J., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Hsairi, M., Htet, A. S., Hu, G., Huang, J. J., Husseini, A., Hutchings, S. J., Huybrechts, I., Iburg, K. M., Idrisov, B. T., Ileanu, B. V., Inoue, M., Jacobs, T. A., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Jansen, H. A., Jassal, S. K., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jha, V., Jiang, Y., Jibat, T., Jin, Y., Johnson, C. O., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Karch, A., Karema, C. K., Karimkhani, C., Kasaeian, A., Kaul, A., Kawakami, N., Kazi, D. S., Keiyoro, P. N., Kemp, A. H., Kengne, A. P., Keren, A., Kesavachandran, C. N., Khader, Y. S., Khan, A. R., Khan, E. A., Khan, G., Khang, Y., Khatibzadeh, S., Khera, S., Khoja, T. A., Khubchandani, J., Kieling, C., Kim, C., Kim, D., Kimokoti, R. W., Kissoon, N., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kopec, J. A., Koul, P. A., Koyanagi, A., Kravchenko, M., Kromhout, H., Krueger, H., Ku, T., Defo, B. K., Kuchenbecker, R. S., Bicer, B. K., Kuipers, E. J., Kumar, G. A., Kwan, G. F., Lal, D. K., Lalloo, R., Lallukka, T., Lan, Q., Larsson, A., Latif, A. A., Beatriz Lawrynowicz, A. E., Leasher, J. L., Leigh, J., Leung, J., Levi, M., Li, X., Li, Y., Liang, J., Liu, S., Lloyd, B. K., Logroscino, G., Lotufo, P. A., Lunevicius, R., Maclntyre, M., Mahdavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Malta, D. C., Manamo, W. A., Mapoma, C. C., Marcenes, W., Martin, R. V., Martinez-Raga, J., Masiye, F., Matsushita, K., Matzopoulos, R., Mayosi, B. M., McGrath, J. J., McKee, M., Meaney, P. A., Medina, C., Mehari, A., Mena-Rodriguez, F., Mekonnen, A. B., Melaku, Y. A., Memish, Z. A., Mendoza, W., Mensink, G. B., Meretoja, A., Meretoja, T. J., Mesfin, Y. M., Mhimbira, F. A., Miller, T. R., Mills, E. J., Mirarefin, M., Misganaw, A., Mock, C. N., Mohammadi, A., Mohammed, S., Mola, G. L., Monasta, L., Montanez Hernandez, J. C., Montico, M., Morawska, L., Mori, R., Mozaffarian, D., Mueller, U. O., Mullany, E., Mumford, J. E., Murthy, G. V., Nachega, J. B., Naheed, A., Nangia, V., Nassiri, N., Newton, J. N., Ng, M., Quyen Le Nguyen, Q., Nisar, M. I., Pete, P. M., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Obermeyer, C. M., Ogbo, F. A., Oh, I., Oladimeji, O., Olivares, P. R., Olsen, H., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Orozco, R., Ortiz, A., Ota, E., Mahesh, P. A., Pana, A., Park, E., Parry, C. D., Parsaeian, M., Patel, T., Caicedo, A. J., Patil, S. T., Patten, S. B., Patton, G. C., Pearce, N., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Plass, D., Polinder, S., Pond, C. D., Pope, C. A., Pope, D., Popova, S., Poulton, R. G., Pourmalek, F., Prasad, N. M., Qorbani, M., Rabiee, R. H., Radfar, A., Rafay, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Rajsic, S., Raju, M., Ram, U., Rana, S. M., Ranganathan, K., Rao, P., Razo Garcia, C. A., Refaat, A. H., Rehm, C. D., Rehm, J., Reinig, N., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Rivera, J. A., Rolm, H. S., Rodriguez, A., Rodriguez-Ramirez, S., Rojas-Rueda, D., Roman, Y., Ronfani, L., Roshandel, G., Rothenbacher, D., Roy, A., Saleh, M. M., Sanabria, J. R., Dolores Sanchez-Nino, M., Sanchez-Pimienta, T. G., Sandar, L., Santomauro, D. F., Santos, I. S., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schmidhuber, J., Schmidt, M. I., Schneider, I. J., Schoettker, B., Schutte, A. E., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shaheen, A., Shahraz, S., Shaikh, M. A., Levy, T. S., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Sheth, K. N., Shi, P., Shibuya, K., Shigematsu, M., Shin, M., Shiri, R., Shishani, K., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silva, D. A., Alves Silveira, D. G., Silverberg, J. I., Simard, E. P., Sindi, S., Singh, A., Singh, J. A., Singh, P. K., Slepak, E. L., Soljak, M., Soneji, S., Sorensen, R. J., Sposato, L. A., Sreeramareddy, C. T., Stathopoulou, V., Steckling, N., Steel, N., Stein, D. J., Stein, M. B., Stockl, H., Stranges, S., Stroumpoulis, K., Sunguya, B. F., Swaminathan, S., Sykes, B. L., Szoeke, C. E., Tabares-Seisdedos, R., Takahashi, K., Talongwa, R. T., Landon, N., Tanne, D., Tavakkoli, M., Taye, B. W., Taylor, H. R., Tedla, B. A., Tefera, W. M., Tegegne, T. K., Tekle, D. Y., Terkawi, A. S., Thakur, J. S., Thomas, B. A., Thomas, M. L., Thomson, A. J., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tobe-Gai, R., Tobollik, M., Topor-Madry, R., Topouzis, F., Towbin, J. A., Bach Xuan Tran, B. X., Dimbuene, Z. T., Tsilimparis, N., Tura, A. K., Tuzcu, E. M., Tyrovolas, S., Ukwaja, K. N., Undurraga, E. A., Uneke, C. J., Uthman, O. A., van Donkelaar, A., van Os, J., Varakin, Y. Y., Vasankari, T., Veerman, J. L., Venketasubramanian, N., Violante, F. S., Vollset, S. E., Wagner, G. R., Waller, S. G., Wang, J., Wang, L., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., Whiteford, H. A., Wijeratne, T., Wiysonge, C. S., Wolfe, C. D., Won, S., Woolf, A. D., Wubshet, M., Xavier, D., Xu, G., Yadav, A. K., Yakob, B., Yalew, A. Z., Yano, Y., Yaseri, M., Ye, P., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zhu, J., Zipkin, B., Zodpey, S., Zuhlke, L. J., Murray, C. J. 2016; 388 (10053): 1659-1724

    Abstract

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000385285000010

    View details for PubMedCentralID PMC5388856

  • Cost, Value and Clinical Consequences Associated with Treatment Restrictions for Hepatitis C-infected Medicaid Beneficiaries Pho, M. T., Morgan, J. R., Huang, E. S., Salomon, J. A., White, L. F., Nocon, R., Linas, B. P. WILEY. 2016: 851A
  • CHARACTERIZING SEXUAL BEHAVIOR AND MIXING PATTERNS OF AMERICAN ADULTS OF DIFFERENT RACES/ETHNICITIES Tuite, A., Ronn, M., Wolf, E., Menzies, N. A., Galer, K., Gift, T., Hsu, K., Salomon, J. A. LIPPINCOTT WILLIAMS & WILKINS. 2016: S187
  • A LITERATURE REVIEW: ADDRESSING PUBLIC HEALTH POLICY QUESTIONS WITH CHLAMYDIA TRANSMISSION MODELS Ronn, M., Wolf, E., Chesson, H., Menzies, N. A., Galer, K., Gorwitz, R. J., Gift, T., Hsu, K., Salomon, J. A. LIPPINCOTT WILLIAMS & WILKINS. 2016: S215–S216
  • Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA Sanders, G. D., Neumann, P. J., Basu, A., Brock, D. W., Feeny, D., Krahn, M., Kuntz, K. M., Meltzer, D. O., Owens, D. K., Prosser, L. A., Salomon, J. A., Sculpher, M. J., Trikalinos, T. A., Russell, L. B., Siegel, J. E., Ganiats, T. G. 2016; 316 (10): 1093-1103

    Abstract

    Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years.To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers.In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process.The concept of a "reference case" and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an "impact inventory," which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health outcomes, and the reporting of cost-effectiveness analyses.The Second Panel reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations. Major changes include the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences.

    View details for DOI 10.1001/jama.2016.12195

    View details for PubMedID 27623463

  • The Effect of HIV and the Modifying Effect of Anti-Retroviral Therapy (ART) on Body Mass Index (BMI) and Blood Pressure Levels in Rural South Africa PLOS ONE Feigl, A. B., Bloom, D. E., Danaei, G., Pillay, D., Salomon, J. A., Tanser, F., Baernighausen, T. W. 2016; 11 (8): e0158264

    Abstract

    High BMI and blood pressure are leading chronic disease risk factors in South Africa. Longterm effects of HIV and ART on adiposity and blood pressure are poorly understood, and direct comparisons of risk factor trajectories in HIV- versus HIV+ populations are rare.In 2003 and 2010, height, weight, and blood pressure were recorded in a study population (n = 505) in KwaZulu-Natal, South Africa (30% adult HIV prevalence). We modeled change in BMI and BP longitudinally in HIV- individuals (n = 315), seroconverters (n = 32), HIV+ patients not on ART (HIV+ART-; n = 52), HIV+ patients on ART for 0-<2 years as of 2010 (HIV+ART0-<2 yrs; n = 18), patients on ART for 2-5 years (HIV+ART2-5yrs; n = 44), and a subgroup with unknown HIV status (n = 44). Difference-in-differences were assessed in reference to the HIV- population.Between 2003 and 2010, BMI increased significantly in the HIV- group, by 0.874 (95% CI 0.339, 1.41; p = 0.001), to 30.4. BMI drop was significantly greater in HIV+ART0-<2yrs than in HIV+ART2-5yrs (p = 0.005). DID in BMI in HIV+ART0-<2yrs versus the reference was -5.21 (95% CI -7.53, -2.90; p = 0.001), and DID in HIV+ART2-5yrs versus reference was -1.35 (95% CI -2.89, 0.189; p = 0.086). DID in SBP in HIV+ART-vs HIV- DID was -7.55 mmHg (95% CI -13.2 to -1.90; p = 0.009).Short-term ART (0-<2 years) was associated with larger weight loss than either no ART or long-term ART. Once on ART for 2+ years, individuals 'caught up' on weight gain with the HIV- population. Our results showcase the importance of health system readiness to address the burgeoning double burden of disease in South Africa.

    View details for PubMedID 27552195

  • Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015 LANCET HIV Wang, H., Wolock, T. M., Carter, A., Nguyen, G., Kyu, H. H., Gakidou, E., Hay, S. I., Mills, E. J., Trickey, A., Msemburi, W., Coates, M. M., Mooney, M. D., Fraser, M. S., Sligar, A., Salomon, J., Larson, H. J., Friedman, J., Abajobir, A. A., Abate, K. H., Abbas, K. M., Abd El Razek, M. M., Abd-Allah, F., Abdulle, A. M., Abera, S. F., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Abyu, G. Y., Adebiyi, A. O., Adedeji, I. A., Adelekan, A. L., Adofo, K., Adou, A. K., Ajala, O. N., Akinyemiju, T. F., Akseer, N., Al Lami, F. H., Al-Aly, Z., Alam, K., Alam, N. K., Alasfoor, D., Aldhahri, S. F., Aldridge, R. W., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Ali, R., Alkerwi, A., Alla, F., Al-Raddadi, R. M., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Ammar, W., Amrock, S. M., Antonio, C. A., Anwari, P., Arnlov, J., Al Artaman, Asayesh, H., Asghar, R. J., Assadi, R., Atique, S., Atkins, L. S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Bacha, U., Badawi, A., Barac, A., Barnighausen, T., Basu, A., Bayou, T. A., Bayou, Y. T., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Bennett, D. A., Bensenor, I. M., Betsu, B. D., Beyene, A. S., Bhatia, E., Bhutta, Z. A., Biadgilign, S., Bikbov, B., Birlik, S. M., Bisanzio, D., Brainin, M., Brazinova, A., Breitborde, N. J., Brown, A., Burch, M., Butt, Z. A., Campuzano, J. C., Cardenas, R., Carrero, J. J., Castaneda-Orjuela, C. A., Rivas, J. C., Catala-Lopez, F., Chang, H., Chang, J., Chavan, L., Chen, W., Chiang, P. P., Chibalabala, M., Chisumpa, V. H., Choi, J. J., Christopher, D. J., Ciobanu, L. G., Cooper, C., Dahiru, T., Damtew, S. A., Dandona, L., Dandona, R., das Neves, J., de Jager, P., De Leo, D., Degenhardt, L., Dellavalle, R. P., Deribe, K., Deribew, A., Jarlais, D. C., Dharmaratne, S. D., Ding, E. L., Doshi, P. P., Driscoll, T. R., Dubey, M., Elshrek, Y. M., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Faghmous, I. D., Sofia e Sa Farinha, C., Faro, A., Farvid, M. S., Farzadfar, F., Fereshtehnejad, S., Fernandes, J. C., Fischer, F., Fitchett, J. R., Foigt, N., Fullman, N., Furst, T., Gankpe, F. G., Gebre, T., Gebremedhin, A. T., Gebru, A. A., Geleijnse, J. M., Gessner, B. D., Gething, P. W., Ghiwot, T. T., Giroud, M., Gishu, M. D., Glaser, E., Goenka, S., Goodridge, A., Gopalani, S. V., Goto, A., Gugnani, H. C., Guimaraes, M. D., Gupta, R., Gupta, R., Gupta, V., Haagsma, J., Hafezi-Nejad, N., Hagan, H., Hailu, G. B., Hamadeh, R. R., Hamidi, S., Hammami, M., Hankey, G. J., Hao, Y., Harb, H. L., Harikrishnan, S., Haro, J. M., Harun, K. M., Havmoeller, R., Hedayati, M. T., Heredia-Pi, I. B., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Hsairi, M., Hu, G., Huang, H., Huang, J. J., Iburg, K. 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S., Tesfay, F. H., Tessema, G. A., Thapa, K., Thomson, A. J., Thorne-Lyman, A. L., Tobe-Gai, R., Topor-Madry, R., Towbin, J. A., Bach Xuan Tran, B. X., Dimbuene, Z. T., Tsilimparis, N., Tura, A. K., Ukwaja, K. N., Uneke, C. J., Uthman, O. A., Venketasubramanian, N., Vladimirov, S. K., Vlassov, V. V., Vollset, S. E., Wang, L., Weiderpass, E., Weintraub, R. G., Werdecker, A., Westerman, R., Wijeratne, T., Wilkinson, J. D., Wiysonge, C. S., Wolfe, C. D., Won, S., Wong, J. Q., Xu, G., Yadav, A. K., Yakob, B., Yalew, A. Z., Yano, Y., Yaseri, M., Yebyo, H. G., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Yu, S., Zaidi, Z., Zaki, M. E., Zeeb, H., Zhang, H., Zhao, Y., Zodpey, S., Zoeckler, L., Zuhlke, L. J., Lopez, A. D., Murray, C. J. 2016; 3 (8): E361-E387

    Abstract

    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.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.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.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.Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health.

    View details for DOI 10.1016/S2352-3018(16)30087-X

    View details for Web of Science ID 000380842400010

    View details for PubMedID 27470028

    View details for PubMedCentralID PMC5056319

  • Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement PLOS MEDICINE Stevens, G. A., Alkema, L., Black, R. E., Boerma, J., Collins, G. S., Ezzati, M., Grove, J. T., Hogan, D. R., Hogan, M. C., Horton, R., Lawn, J. E., Marusic, A., Mathers, C. D., Murray, C. L., Rudan, I., Salomon, J. A., Simpson, P. J., Vos, T., Welch, V., GATHER Working Grp 2016; 13 (6): e1002056

    Abstract

    Gretchen Stevens and colleagues present the GATHER statement, which seeks to promote good practice in the reporting of global health estimates.

    View details for PubMedID 27351744

  • Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial HEALTH POLICY AND PLANNING McBain, R. K., Salhi, C., Hann, K., Salomon, J. A., Kim, J. J., Betancourt, T. S. 2016; 31 (4): 415–24

    Abstract

    One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis.The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline.Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers' interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained.The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that the YRI translated into a range of benefits, such as improved school enrolment, not captured by cost-effectiveness analysis. We also outline areas for modification to improve cost-effectiveness in future trials.clinicaltrials.gov Identifier: RPCGA-YRI-21003.

    View details for PubMedID 26345320

    View details for PubMedCentralID PMC5007601

  • Comparative Effectiveness of Personalized Lifestyle Management Strategies for Cardiovascular Disease Risk Reduction JOURNAL OF THE AMERICAN HEART ASSOCIATION Chu, P., Pandya, A., Salomon, J. A., Goldie, S. J., Hunink, M. 2016; 5 (3): e002737

    Abstract

    Evidence shows that healthy diet, exercise, smoking interventions, and stress reduction reduce cardiovascular disease risk. We aimed to compare the effectiveness of these lifestyle interventions for individual risk profiles and determine their rank order in reducing 10-year cardiovascular disease risk.We computed risks using the American College of Cardiology/American Heart Association Pooled Cohort Equations for a variety of individual profiles. Using published literature on risk factor reductions through diverse lifestyle interventions-group therapy for stopping smoking, Mediterranean diet, aerobic exercise (walking), and yoga-we calculated the risk reduction through each of these interventions to determine the strategy associated with the maximum benefit for each profile. Sensitivity analyses were conducted to test the robustness of the results. In the base-case analysis, yoga was associated with the largest 10-year cardiovascular disease risk reductions (maximum absolute reduction 16.7% for the highest-risk individuals). Walking generally ranked second (max 11.4%), followed by Mediterranean diet (max 9.2%), and group therapy for smoking (max 1.6%). If the individual was a current smoker and successfully quit smoking (ie, achieved complete smoking cessation), then stopping smoking yielded the largest reduction. Probabilistic and 1-way sensitivity analysis confirmed the demonstrated trend.This study reports the comparative effectiveness of several forms of lifestyle modifications and found smoking cessation and yoga to be the most effective forms of cardiovascular disease prevention. Future research should focus on patient adherence to personalized therapies, cost-effectiveness of these strategies, and the potential for enhanced benefit when interventions are performed simultaneously rather than as single measures.

    View details for PubMedID 27025969

  • Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Forouzanfar, M. H., Alexander, L., Anderson, H. R., Bachman, V. F., Biryukov, S., Brauer, M., Burnett, R., Casey, D., Coates, M. M., Cohen, A., Delwiche, K., Estep, K., Frostad, J. J., Astha, K. C., Kyu, H. H., Moradi-Lakeh, M., Ng, M., Slepak, E. L., Thomas, B. A., Wagner, J., Aasvang, G. M., Abbafati, C., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Aboyans, V., Abraham, B., Abraham, J. P., Abubakar, I., Abu-Rmeileh, N. M., Aburto, T. C., Achoki, T., Adelekan, A., Adofo, K., Adou, A. K., Adsuar, J. C., Afshin, A., Agardh, E. E., Al Khabouri, M. J., Al Lami, F. H., Alam, S. S., Alasfoor, D., Albittar, M. I., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Ali, M. K., Alla, F., Allebeck, P., Allen, P. J., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Ameh, E. A., Ameli, O., Amini, H., Ammar, W., Anderson, B. O., Antonio, C. A., Anwari, P., Cunningham, S. A., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Atkinson, C., Avila, M. A., Awuah, B., Badawi, A., Bahit, M. C., Bakfalouni, T., Balakrishnan, K., Balalla, S., Balu, R. K., Banerjee, A., Barber, R. M., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Barrientos-Gutierrez, T., Basto-Abreu, A. C., Basu, A., Basu, S., Basulaiman, M. O., Ruvalcaba, C. B., Beardsley, J., Bedi, N., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Benzian, H., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. Q., Bikbov, B., Bin Abdulhak, A. A., Blore, J. D., Blyth, F. M., Bohensky, M. A., Basara, B. B., Borges, G., Bornstein, N. M., Bose, D., Boufous, S., Bourne, R. R., Brainin, M., Brazinova, A., Breitborde, N. 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P., Deribe, K., Derrett, S., Jarlais, D. C., Dessalegn, M., deVeber, G. A., Devries, K. M., Dharmaratne, S. D., Dherani, M. K., Dicker, D., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duan, L., Durrani, A. M., Ebel, B. E., Ellenbogen, R. G., Elshrek, Y. M., Endres, M., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Fahimi, S., Faraon, E. J., Farzadfar, F., Fay, D. F., Feigin, V. L., Feigl, A. B., Fereshtehnejad, S., Ferrari, A. J., Ferri, C. P., Flaxman, A. D., Fleming, T. D., Foigt, N., Foreman, K. J., Paleo, U. F., Franklin, R. C., Gabbe, B., Gaffikin, L., Gakidou, E., Gamkrelidze, A., Gankpe, F. G., Gansevoort, R. T., Garcia-Guerra, F. A., Gasana, E., Geleijnse, J. M., Gessner, B. D., Gething, P., Gibney, K. B., Gillum, R. F., Ginawi, I. A., Giroud, M., Giussani, G., Goenka, S., Goginashvili, K., Dantes, H. G., Gona, P., de Cosio, T. G., Gonzalez-Castell, D., Gotay, C. C., Goto, A., Gouda, H. N., Guerrant, R. L., Gugnani, H. 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E., Khan, E. A., Khang, Y., Khatibzadeh, S., Khonelidze, I., Kieling, C., Kim, D., Kim, S., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kinge, J. M., Kissela, B. M., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kose, M. R., Kosen, S., Kraemer, A., Kravchenko, M., Krishnaswami, S., Kromhout, H., Ku, T., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kwan, G. F., Lai, T., Balaji, A. L., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Laryea, D. O., Lavados, P. M., Lawrynowicz, A. E., Leasher, J. L., Lee, J., Leigh, J., Leung, R., Levi, M., Li, Y., Li, Y., Liang, J., Liang, X., Lim, S. S., Lindsay, M. P., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Logroscino, G., London, S. J., Lopez, N., Lortet-Tieulent, J., Lotufo, P. A., Lozano, R., Lunevicius, R., Ma, J., Ma, S., Machado, V. M., MacIntyre, M. F., Magis-Rodriguez, C., Mahdi, A. A., Majdan, M., Malekzadeh, R., Mangalam, S., Mapoma, C. C., Marape, M., Marcenes, W., Margolis, D. J., Margono, C., Marks, G. B., Martin, R. V., Marzan, M. B., Mashal, M. T., Masiye, F., Mason-Jones, A. J., Matsushita, K., Matzopoulos, R., Mayosi, B. M., Mazorodze, T. T., Mckay, A. C., McKee, M., McLain, A., Meaney, P. A., Medina, C., Mehndiratta, M. M., Mejia-Rodriguez, F., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Misganaw, A., Mishra, S., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Hernandez, J. C., Montico, M., Moore, A. R., Morawska, L., Mori, R., Moschandreas, J., Moturi, W. N., Arian, D. M., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murthy, K. S., Naghavi, M., Nahas, Z., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nash, D., Neal, B., Nejjari, C., Neupane, S. P., Newton, C. R., Ngalesoni, F. N., Ngirabega, J. d., Nguyen, G., Nguyen, N. T., Nieuwenhuijsen, M. J., Nisar, M. I., Nogueira, J. R., Nolla, J. M., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orozco, R., Pagcatipunan, R. S., Pain, A. W., Pandian, J. D., Panelo, C. I., Papachristou, C., Park, E., Parry, C. D., Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pedraza, L. S., Pedroza, A., Stokic, L. P., Pekericli, A., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Perry, S. A., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phua, H. P., Plass, D., Poenaru, D., Polanczyk, G. V., Polinder, S., Pond, C. D., Pope, C. A., Pope, D., Popova, S., Pourmalek, F., Powles, J., Prabhakaran, D., Prasad, N. M., Qato, D. M., Quezada, A. D., Quistberg, D. A., Racape, L., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rakovac, I., Rana, S. M., Rao, M., Razavi, H., Reddy, K. S., Refaat, A. H., Rehm, J., Remuzzi, G., Ribeiro, A. L., Riccio, P. M., Richardson, L., Riederer, A., Robinson, M., Roca, A., Rodriguez, A., Rojas-Rueda, D., Romieu, I., Ronfani, L., Room, R., Roy, N., Ruhago, G. M., Rushton, L., Sabin, N., Sacco, R. L., Saha, S., Sahathevan, R., Sahraian, M. A., Salomon, J. A., Salvo, D., Sampson, U. K., Sanabria, J. R., Sanchez, L. M., Sanchez-Pimienta, T. G., Sanchez-Riera, L., Sandar, L., Santos, I. S., Sapkota, A., Satpathy, M., Saunders, J. E., Sawhney, M., Saylan, M. I., Scarborough, P., Schmidt, J. C., Schneider, I. J., Schoettker, B., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Serdar, B., Servan-Mori, E. E., Shaddick, G., Shahraz, S., Levy, T. S., Shangguan, S., She, J., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shinohara, Y., Shiri, R., Shishani, K., Shiue, I., Sigfusdottir, I. D., Silberberg, D. H., Simard, E. P., Sindi, S., Singh, A., Singh, G. M., Singh, J. A., Skirbekk, V., Sliwa, K., Soljak, M., Soneji, S., Soreide, K., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stapelberg, N. J., Stathopoulou, V., Steckling, N., Stein, D. J., Stein, M. B., Stephens, N., Stoeckl, H., Straif, K., Stroumpoulis, K., Sturua, L., Sunguya, B. F., Swaminathan, S., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Talongwa, R. T., Tandon, N., Tanne, D., Tanner, M., Tavakkoli, M., Ao, B. J., Teixeira, C. M., Rojo, M. M., Terkawi, A. S., Texcalac-Sangrador, J. L., Thackway, S. V., Thomson, B., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tobollik, M., Tonelli, M., Topouzis, F., Towbin, J. R., Toyoshima, H., Traebert, J. E., Tran, B. X., Trasande, L., Trillini, M., Trujillo, U., Dimbuene, Z. T., Tsilimbaris, M., Tuzcu, E. M., Uchendu, U. S., Ukwaja, K. N., Uzun, S. B., van de Vijver, S., Van Dingenen, R., van Gool, C. H., van Os, J., Varakin, Y. Y., Vasankari, T. J., Vasconcelos, A. M., Vavilala, M. S., Veerman, L. J., Velasquez-Melendez, G., Venketasubramanian, N., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Waller, S. G., Wallin, M. T., Wan, X., Wang, H., Wang, J., Wang, L., Wang, W., Wang, Y., Warouw, T. S., Watts, C. H., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wessells, K. R., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Williams, H. C., Williams, T. N., Woldeyohannes, S. M., Wolfe, C. D., Wong, J. Q., Woolf, A. D., Wright, J. L., Wurtz, B., Xu, G., Yan, L. L., Yang, G., Yano, Y., Ye, P., Yenesew, M., Yentuer, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Younoussi, Z., Yu, C., Zaki, M. E., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zhu, S., Zou, X., Zunt, J. R., Lopez, A. D., Vos, T., Murray, C. J. 2015; 386 (10010): 2287-2323

    Abstract

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

    View details for DOI 10.1016/S0140-6736(15)00128-2

    View details for Web of Science ID 000365993200031

    View details for PubMedCentralID PMC4685753

  • Stopping tuberculosis: a biosocial model for sustainable development LANCET Ortblad, K. F., Salomon, J. A., Baernighausen, T., Atun, R. 2015; 386 (10010): 2354–62

    Abstract

    Tuberculosis transmission and progression are largely driven by social factors such as poor living conditions and poor nutrition. Increased standards of living and social approaches helped to decrease the burden of tuberculosis before the introduction of chemotherapy in the 1940s. Since then, management of tuberculosis has been largely biomedical. More funding for tuberculosis since 2000, coinciding with the Millennium Development Goals, has yielded progress in tuberculosis mortality but smaller reductions in incidence, which continues to pose a risk to sustainable development, especially in poor and susceptible populations. These at-risk populations need accelerated progress to end tuberculosis as resolved by the World Health Assembly in 2015. Effectively addressing the worldwide tuberculosis burden will need not only enhancement of biomedical approaches but also rebuilding of the social approaches of the past. To combine a biosocial approach, underpinned by social, economic, and environmental actions, with new treatments, new diagnostics, and universal health coverage, will need multisectoral coordination and action involving the health and other governmental sectors, as well as participation of the civil society, and especially the poor and susceptible populations. A biosocial approach to stopping tuberculosis will not only target morbidity and mortality from disease but would also contribute substantially to poverty alleviation and sustainable development that promises to meet the needs of the present, especially the poor, and provide them and subsequent generations an opportunity for a better future.

    View details for PubMedID 26515678

  • Improving outcomes for caregivers through treatment of young people affected by war: a randomized controlled trial in Sierra Leone BULLETIN OF THE WORLD HEALTH ORGANIZATION McBain, R. K., Salhi, C., Hann, K., Kellie, J., Kamara, A., Salomon, J. A., Kim, J. J., Betancourt, T. S. 2015; 93 (12): 834–41

    Abstract

    To measure the benefits to household caregivers of a psychotherapeutic intervention for adolescents and young adults living in a war-affected area.Between July 2012 and July 2013, we carried out a randomized controlled trial of the Youth Readiness Intervention--a cognitive-behavioural intervention for war-affected young people who exhibit depressive and anxiety symptoms and conduct problems--in Freetown, Sierra Leone. Overall, 436 participants aged 15-24 years were randomized to receive the intervention (n = 222) or care as usual (n = 214). Household caregivers for the participants in the intervention arm (n = 101) or control arm (n = 103) were interviewed during a baseline survey and again, if available (n = 155), 12 weeks later in a follow-up survey. We used a burden assessment scale to evaluate the burden of care placed on caregivers in terms of emotional distress and functional impairment. The caregivers' mental health--i.e. internalizing, externalizing and prosocial behaviour--was evaluated using the Oxford Measure of Psychosocial Adjustment. Difference-in-differences multiple regression analyses were used, within an intention-to-treat framework, to estimate the treatment effects.Compared with the caregivers of participants of the control group, the caregivers of participants of the intervention group reported greater reductions in emotional distress (scale difference: 0.252; 95% confidence interval, CI: 0.026-0.4782) and greater improvements in prosocial behaviour (scale difference: 0.249; 95% CI: 0.012-0.486) between the two surveys.A psychotherapeutic intervention for war-affected young people can improve the mental health of their caregivers.

    View details for PubMedID 26668435

    View details for PubMedCentralID PMC4669723

  • Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition LANCET Murray, C. J., Barber, R. M., Foreman, K. J., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Aboyans, V., Abraham, J. P., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Ackerman, I. N., Ademi, Z., Adou, A. K., Adsuar, J. C., Afshin, A., Agardh, E. E., Alam, S. S., Alasfoor, D., Albittar, M. I., Alegretti, M. A., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allebeck, P., AlMazroa, M. A., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amare, A. T., Ameh, E. A., Amini, H., Ammar, W., Anderson, H. R., Anderson, B. O., Antonio, C. A., Anwari, P., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Avila, M. A., Awuah, B., Bachman, V. F., Badawi, A., Bahit, M. C., Balakrishnan, K., Banerjee, A., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Basu, A., Basu, S., Basulaiman, M. O., Beardsley, J., Bedi, N., Beghi, E., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Benzian, H., Bernabe, E., Bertozzi-Villa, A., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Bienhoff, K., Bikbov, B., Biryukov, S., Blore, J. D., Blosser, C. D., Blyth, F. M., Bohensky, M. A., Bolliger, I. W., Basara, B. B., Bornstein, N. M., Bose, D., Boufous, S., Bourne, R. R., Boyers, L. N., Brainin, M., Brayne, C. E., Brazinova, A., Breitborde, N. J., Brenner, H., Briggs, A. D., Brooks, P. M., Brown, J. C., Brugha, T. S., Buchbinder, R., Buckle, G. C., Budke, C. M., Bulchis, A., Bulloch, A. G., Campos-Nonato, I. R., Carabin, H., Carapetis, J. R., Cardenas, R., Carpenter, D. O., Caso, V., Castaneda-Orjuela, C. A., Castro, R. E., Catala-Lopez, F., Cavalleri, F., Cavlin, A., Chadha, V. K., Chang, J., Charlson, F. J., Chen, H., Chen, W., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christensen, H., Christophi, C. A., Cirillo, M., Coates, M. M., Coffeng, L. E., Coggeshall, M. S., Colistro, V., Colquhoun, S. M., Cooke, G. S., Cooper, C., Cooper, L. T., Coppola, L. M., Cortinovis, M., Criqui, M. H., Crump, J. A., Cuevas-Nasu, L., Danawi, H., Dandona, L., Dandona, R., Dansereau, E., Dargan, P. I., Davey, G., Davis, A., Davitoiu, D. V., Dayama, A., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Dellavalle, R. P., Deribe, K., Derrett, S., Des Jarlais, D. C., Dessalegn, M., Dharmaratne, S. D., Dherani, M. K., Diaz-Torne, C., Dicker, D., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duan, L., Duber, H. C., Ebel, B. E., Edmond, K. M., Elshrek, Y. M., Endres, M., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Estep, K., Faraon, E. J., Farzadfar, F., Fay, D. F., Feigin, V. L., Felson, D. T., Fereshtehnejad, S., Fernandes, J. G., Ferrari, A. J., Fitzmaurice, C., Flaxman, A. D., Fleming, T. D., Foigt, N., Forouzanfar, M. H., Fowkes, F. G., Paleo, U. F., Franklin, R. C., Fuerst, T., Gabbe, B., Gaffikin, L., Gankpe, F. G., Geleijnse, J. M., Gessner, B. D., Gething, P., Gibney, K. B., Giroud, M., Giussani, G., Gomez Dantes, H., Gona, P., Gonzalez-Medina, D., Gosselin, R. A., Gotay, C. C., Goto, A., Gouda, H. N., Graetz, N., Gugnani, H. C., Gupta, R., Gupta, R., Gutierrez, R. A., Haagsma, J., Hafezi-Nejad, N., Hagan, H., Halasa, Y. A., Hamadeh, R. R., Hamavid, H., Hammami, M., Hancock, J., Hankey, G. J., Hansen, G. M., Hao, Y., Harb, H. L., Maria Haro, J., Havmoeller, R., Hay, S. I., Hay, R. J., Heredia-Pi, I. B., Heuton, K. R., Heydarpour, P., Higashi, H., Hijar, M., Hoek, H. W., Hoffman, H. J., Hosgood, H. D., Hossain, M., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, G., Huang, C., Huang, J. J., Husseini, A., Huynh, C., Iannarone, M. L., Iburg, K. M., Innos, K., Inoue, M., Islami, F., Jacobsen, K. H., Jarvis, D. L., Jassal, S. K., Jee, S. H., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jonas, J. B., Juel, K., Kan, H., Karch, A., Karema, C. K., Karimkhani, C., Karthikeyan, G., Kassebaum, N. J., Kaul, A., Kawakami, N., Kazanjan, K., Kemp, A. H., Kengne, A. P., Keren, A., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khan, G., Khang, Y., Kieling, C., Kim, D., Kim, S., Kim, Y., Kinfu, Y., Kinge, J. M., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kosen, S., Krishnaswami, S., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kyu, H. H., Lai, T., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larsson, A., Lawrynowicz, A. E., Leasher, J. L., Leigh, J., Leung, R., Levitz, C. E., Li, B., Li, Y., Li, Y., Lim, S. S., Lind, M., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lofgren, K. T., Logroscino, G., Looker, K. J., Lortet-Tieulent, J., Lotufo, P. A., Lozano, R., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, S., MacIntyre, M. F., Mackay, M. T., Majdan, M., Malekzadeh, R., Marcenes, W., Margolis, D. J., Margono, C., Marzan, M. B., Masci, J. R., Mashal, M. T., Matzopoulos, R., Mayosi, B. M., Mazorodze, T. T., McGill, N. W., McGrath, J. J., McKee, M., McLain, A., Meaney, P. A., Medina, C., Mehndiratta, M. M., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Mitchell, P. B., Mock, C. N., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Montanez Hernandez, J. C., Montico, M., Montine, T. J., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Moran, A. E., Mori, R., Moschandreas, J., Moturi, W. N., Moyer, M. L., Mozaffarian, D., Msemburi, W. T., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murdoch, M. E., Murray, J., Murthy, K. S., Naghavi, M., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nejjari, C., Neupane, S. P., Newton, C. R., Ng, M., Ngalesoni, F. N., Nguyen, G., Nisar, M. I., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I., Ohkubo, T., Ohno, S. L., Olusanya, B. O., Opio, J. N., Ortblad, K., Ortiz, A., Pain, A. W., Pandian, J. D., Panelo, C. I., Papachristou, C., Park, E., Park, J., Patten, S. B., Patton, G. C., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phillips, B. K., Phillips, D. E., Piel, F. B., Plass, D., Poenaru, D., Polinder, S., Pope, D., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Prasad, N. M., Pullan, R. L., Qato, D. M., Quistberg, D. A., Rafay, A., Rahimi, K., Rahman, S. U., Raju, M., Rana, S. M., Razavi, H., Reddy, K. S., Refaat, A., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Richardson, L., Richardus, J. H., Roberts, D. A., Rojas-Rueda, D., Ronfani, L., Roth, G. A., Rothenbacher, D., Rothstein, D. H., Rowley, J. T., Roy, N., Ruhago, G. M., Saeedi, M. Y., Saha, S., Sahraian, M. A., Sampson, U. K., Sanabria, J. R., Sandar, L., Santos, I. S., Satpathy, M., Sawhney, M., Scarborough, P., Schneider, I. J., Schoettker, B., Schumacher, A. E., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Serina, P. T., Servan-Mori, E. E., Shackelford, K. A., Shaheen, A., Shahraz, S., Levy, T. S., Shangguan, S., She, J., Sheikhbahaei, S., Shi, P., Shibuya, K., Shinohara, Y., Shiri, R., Shishani, K., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Simard, E. P., Sindi, S., Singh, A., Singh, J. A., Singh, L., Skirbekk, V., Slepak, E. L., Sliwa, K., Soneji, S., Soreide, K., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stanaway, J. D., Stathopoulou, V., Stein, D. J., Stein, M. B., Steiner, C., Steiner, T. J., Stevens, A., Stewart, A., Stovner, L. J., Stroumpoulis, K., Sunguya, B. F., Swaminathan, S., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Tandon, N., Tanne, D., Tanner, M., Tavakkoli, M., Taylor, H. R., Te Ao, B. J., Tediosi, F., Temesgen, A. M., Templin, T., ten Have, M., Tenkorang, E. Y., Terkawi, A. S., Thomson, B., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tonelli, M., Topouzis, F., Toyoshima, H., Traebert, J., Tran, B. X., Trillini, M., Truelsen, T., Tsilimbaris, M., Tuzcu, E. M., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Uzun, S. B., Van Brakel, W. H., van de Vijver, S., van Gool, C. H., van Os, J., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Wagner, J., Waller, S. G., Wan, X., Wang, H., Wang, J., Wang, L., Warouw, T. S., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Wang Wenzhi, W. Z., Werdecker, A., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Williams, T. N., Wolfe, C. D., Wolock, T. M., Woolf, A. D., Wulf, S., Wurtz, B., Xu, G., Yan, L. L., Yano, Y., Ye, P., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaki, M. E., Zhao, Y., Zheng, Y., Zonies, D., Zou, X., Salomon, J. A., Lopez, A. D., Vos, T. 2015; 386 (10009): 2145-2191

    Abstract

    Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(15)61340-X

    View details for Web of Science ID 000365992600030

    View details for PubMedCentralID PMC5388903

  • Estimating distributions of health state severity for the global burden of disease study POPULATION HEALTH METRICS Burstein, R., Fleming, T., Haagsma, J., Salomon, J. A., Vos, T., Murray, C. L. 2015; 13: 31

    Abstract

    Many major causes of disability in the Global Burden of Disease (GBD) study present with a range of severity, and for most causes finding population distributions of severity can be difficult due to issues of sparse data, inconsistent measurement, and need to account for comorbidities. We developed an indirect approach to obtain severity distributions empirically from survey data.Individual-level data were used from three large population surveys from the US and Australia that included self-reported prevalence of major diseases and injuries as well as generic health status assessments using the 12-Item Short Form Health Survey (SF-12). We developed a mapping function from SF-12 scores to GBD disability weights. Mapped scores for each individual respondent were regressed against the reported diseases and injuries using a mixed-effects model with a logit-transformed response variable. The regression outputs were used to predict comorbidity-corrected health-state weights for the group of individuals with each condition. The distribution of these comorbidity-corrected weights were used to estimate the fraction of individuals with each condition falling into different GBD severity categories, including asymptomatic (implying disability weight of zero).After correcting for comorbid conditions, all causes analyzed had some proportion of the population in the asymptomatic category. For less severe conditions, such as alopecia areata, we estimated that 44.1 % [95 % CI: 38.7 %-49.4 %] were asymptomatic while 28.3 % [26.8 %-29.6 %] of anxiety disorders had asymptomatic cases. For 152 conditions, full distributions of severity were estimated. For anxiety disorders for example, we estimated the mean population proportions in the mild, moderate, and severe states to be 40.9 %, 18.5 %, and 12.3 % respectively. Thirty-seven of the analyzed conditions were used in the GBD 2013 estimates and are reported here.There is large heterogeneity in the disabling severity of conditions among individuals. The GBD 2013 approach allows explicit accounting for this heterogeneity in GBD estimates. Existing survey data that have collected health status together with information on the presence of a series of comorbid conditions can be used to fill critical gaps in the information on condition severity while correcting for effects of comorbidity. Our ability to make these estimates may be limited by lack of geographic variation in the data and by the current methodology for disability weights, which implies that severity must be binned rather than expressed in as a full distribution. Future country-specific data collection efforts will be needed to advance this research.

    View details for PubMedID 26582970

  • Disability weights for the Global Burden of Disease 2013 study LANCET GLOBAL HEALTH Salomon, J. A., Haagsma, J. A., Davis, A., de Noordhout, C., Polinder, S., Havelaar, A. H., Cassini, A., Devleesschauwer, B., Kretzschmar, M., Speybroeck, N., Murray, C. L., Vos, T. 2015; 3 (11): E712–E723

    Abstract

    The Global Burden of Disease (GBD) study assesses health losses from diseases, injuries, and risk factors using disability-adjusted life-years, which need a set of disability weights to quantify health levels associated with non-fatal outcomes. The objective of this study was to estimate disability weights for the GBD 2013 study.We analysed data from new web-based surveys of participants aged 18-65 years, completed in four European countries (Hungary, Italy, the Netherlands, and Sweden) between Sept 23, 2013, and Nov 11, 2013, combined with data previously collected in the GBD 2010 disability weights measurement study. Surveys used paired comparison questions for which respondents considered two hypothetical individuals with different health states and specified which person they deemed healthier than the other. These surveys covered 183 health states pertinent to GBD 2013; of these states, 30 were presented with descriptions revised from previous versions and 18 were new to GBD 2013. We analysed paired comparison data using probit regression analysis and rescaled results to disability weight units between 0 (no loss of health) and 1 (loss equivalent to death). We compared results with previous estimates, and an additional analysis examined sensitivity of paired comparison responses to duration of hypothetical health states.The total analysis sample consisted of 30 230 respondents from the GBD 2010 surveys and 30 660 from the new European surveys. For health states common to GBD 2010 and GBD 2013, results were highly correlated overall (Pearson's r 0·992 [95% uncertainty interval 0·989-0·994]). For health state descriptions that were revised for this study, resulting disability weights were substantially different for a subset of these weights, including those related to hearing loss (eg, complete hearing loss: GBD 2010 0·033 [0·020-0·052]; GBD 2013 0·215 [0·144-0·307]) and treated spinal cord lesions (below the neck: GBD 2010 0·047 [0·028-0·072]; GBD 2013 0·296 [0·198-0·414]; neck level: GBD 2010 0·369 [0·243-0·513]; GBD 2013 0·589 [0·415-0·748]). Survey responses to paired comparison questions were insensitive to whether the comparisons were framed in terms of temporary or chronic outcomes (Pearson's r 0·981 [0·973-0·987]).This study substantially expands the empirical basis for assessment of non-fatal outcomes in the GBD study. Findings from this study substantiate the notion that disability weights are sensitive to particular details in descriptions of health states, but robust to duration of outcomes.European Centre for Disease Prevention and Control, Bill and Melinda Gates Foundation.

    View details for PubMedID 26475018

  • Estimating The Potential Impact Of Insurance Expansion On Undiagnosed And Uncontrolled Chronic Conditions HEALTH AFFAIRS Hogan, D. R., Danaei, G., Ezzati, M., Clarke, P. M., Jha, A. K., Salomon, J. A. 2015; 34 (9): 1554–62

    Abstract

    Policy makers have paid considerable attention to the financial implications of insurance expansion under the Affordable Care Act (ACA), but there is little evidence of the law's potential health effects. To gain insight into these effects, we analyzed data for 1999-2012 from the National Health and Nutrition Examination Survey to evaluate relationships between health insurance and the diagnosis and management of diabetes, hypercholesterolemia, and hypertension. People with insurance had significantly higher probabilities of diagnosis than matched uninsured people, by 14 percentage points for diabetes and hypercholesterolemia and 9 percentage points for hypertension. Among those with existing diagnoses, insurance was associated with significantly lower hemoglobin A1c (-0.58 percent), total cholesterol (-8.0 mg/dL), and systolic blood pressure (-2.9 mmHg). If the number of nonelderly Americans without health insurance were reduced by half, we estimate that there would be 1.5 million more people with a diagnosis of one or more of these chronic conditions and 659,000 fewer people with uncontrolled cases. Our findings suggest that the ACA could have significant effects on chronic disease identification and management, but policy makers need to consider the possible implications of those effects for the demand for health care services and spending for chronic disease.

    View details for PubMedID 26355058

  • A Latent Transition Analysis for the Assessment of Structured Diagnostic Interviews PSYCHOLOGICAL ASSESSMENT Scorza, P., Masyn, K. E., Salomon, J. A., Betancourt, T. S. 2015; 27 (3): 975–84

    Abstract

    Structured diagnostic interviews administered by lay people are commonly used to assess psychiatric disorders, including depression, in large epidemiologic studies. Many interviews utilize "gate" questions, such as screening questions, that allow interviewers to skip entire survey sections for a particular respondent, saving time and reducing respondent fatigue. However, most depression estimates based on these response data are predicated on the assumption that the gate questions function without measurement error or bias. The tenability of this assumption is questionable, and its violation could compromise the reliability and validity of those estimates of depression. In this study, we used a novel application of latent transition analysis to cross-sectional data, accounting for measurement error in different response pathways through the depression module in the World Mental Health Composite International Diagnostic Interview. The analysis included data from 19,734 participants ≥18 years of age in the Comprehensive Psychiatric Epidemiologic Surveys. The latent transition analysis, allowing for measurement error in screening questions and exclusion criteria, produced a higher estimate of the lifetime probability of experiencing depression than did the algorithm based on the Diagnostic and Statistical Manual for Mental Disorders, 4th Edition, Text Revision. This illustration of latent transition analysis applied to item-level data from a complex structured diagnostic tool with gate questions demonstrates the potential utility of an analytic approach that does not automatically assume gate questions function without measurement error. This model could also be used to probe for evidence of measurement bias in the form of differential item function when using structured diagnostic tools in different cultures and languages.

    View details for PubMedID 25894707

    View details for PubMedCentralID PMC5729585

  • Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., Charlson, F., Davis, A., Degenhardt, L., Dicker, D., Duan, L., Erskine, H., Feigin, V. L., Ferrari, A. J., Fitzmaurice, C., Fleming, T., Graetz, N., Guinovart, C., Haagsma, J., Hansen, G. M., Hanson, S. W., Heuton, K. R., Higashi, H., Kassebaum, N., Kyu, H., Laurie, E., Liang, X., Lofgren, K., Lozano, R., MacIntyre, M. F., Moradi-Lakeh, M., Naghavi, M., Nguyen, G., Odell, S., Ortblad, K., Roberts, D. A., Roth, G. A., Sandar, L., Serina, P. T., Stanaway, J. D., Steiner, C., Thomas, B., Vollset, S. E., Whiteford, H., Wolock, T. M., Ye, P., Zhou, M., Avila, M. A., Aasvang, G. M., Abbafati, C., Ozgoren, A. A., Abd-Allah, F., Aziz, M. I., Abera, S. F., Aboyans, V., Abraham, J. P., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Aburto, T. C., Achoki, T., Ackerman, I. N., Adelekan, A., Ademi, Z., Adou, A. K., Adsuar, J. C., Arnlov, J., Agardh, E. E., Al Khabouri, M. J., Alam, S. S., Alasfoor, D., Albittar, M. I., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allebeck, P., Allen, P. J., AlMazroa, M. A., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Ameli, O., Amini, H., Ammar, W., Anderson, B. O., Anderson, H. R., Antonio, C. A., Anwari, P., Apfel, H., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Atkinson, C., Badawi, A., Bahit, M. C., Bakfalouni, T., Balakrishnan, K., Balalla, S., Banerjee, A., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Basu, S., Basu, A., Baxter, A., Beardsley, J., Bedi, N., Beghi, E., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Benzian, H., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. Q., Bienhoff, K., Bikbov, B., Bin Abdulhak, A., Blore, J. D., Blyth, F. M., Bohensky, M. A., Basara, B. B., Borges, G., Bornstein, N. M., Bose, D., Boufous, S., Bourne, R. R., Boyers, L. N., Brainin, M., Brauer, M., Brayne, C. E., Brazinova, A., Breitborde, N. J., Brenner, H., Briggs, A. D., Brooks, P. M., Brown, J., Brugha, T. S., Buchbinder, R., Buckle, G. C., Bukhman, G., Bulloch, A. G., Burch, M., Burnett, R., Cardenas, R., Cabral, N. L., Nonato, I. R., Campuzano, J. C., Carapetis, J. R., Carpenter, D. O., Caso, V., Castaneda-Orjuela, C. A., Catala-Lopez, F., Chadha, V. K., Chang, J., Chen, H., Chen, W., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christensen, H., Christophi, C. A., Chugh, S. S., Cirillo, M., Coggeshall, M., Cohen, A., Colistro, V., Colquhoun, S. M., Contreras, A. G., Cooper, L. T., Cooper, C., Cooperrider, K., Coresh, J., Cortinovis, M., Criqui, M. H., Crump, J. A., Cuevas-Nasu, L., Dandona, R., Dandona, L., Dansereau, E., Dantes, H. G., Dargan, P. I., Davey, G., Davitoiu, D. V., Dayama, A., De la Cruz-Gongora, V., de la Vega, S. F., De Leo, D., Del Pozo-Cruz, B., Dellavalle, R. P., Deribe, K., Derrett, S., Des Jarlais, D. C., Dessalegn, M., de Veber, G. A., Dharmaratne, S. D., Diaz-Torne, C., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duber, H., Durrani, A. M., Edmond, K. M., Ellenbogen, R. G., Endres, M., Ermakov, S. P., Eshrati, B., Esteghamati, A., Estep, K., Fahimi, S., Farzadfar, F., Fay, D. F., Felson, D. T., Fereshtehnejad, S., Fernandes, J. G., Ferri, C. P., Flaxman, A., Foigt, N., Foreman, K. J., Fowkes, F. G., Franklin, R. C., Furst, T., Futran, N. D., Gabbe, B. J., Gankpe, F. G., Garcia-Guerra, F. A., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Gillum, R. F., Ginawi, I. A., Giroud, M., Giussani, G., Goenka, S., Goginashvili, K., Gona, P., de Cosio, T. G., Gosselin, R. A., Gotay, C. C., Goto, A., Gouda, H. N., Guerrant, R. L., Gugnani, H. C., Gunnell, D., Gupta, R., Gupta, R., Gutierrez, R. A., Hafezi-Nejad, N., Hagan, H., Halasa, Y., Hamadeh, R. R., Hamavid, H., Hammami, M., Hankey, G. J., Hao, Y., Harb, H. L., Haro, J. M., Havmoeller, R., Hay, R. J., Hay, S., Hedayati, M. T., Pi, I. B., Heydarpour, P., Hijar, M., Hoek, H. W., Hoffman, H. J., Hornberger, J. C., Hosgood, H. D., Hossain, M., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, H., Hu, G., Huang, J. J., Huang, C., Huiart, L., Husseini, A., Iannarone, M., Iburg, K. M., Innos, K., Inoue, M., Jacobsen, K. H., Jassal, S. K., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jonas, J. B., Joseph, J., Juel, K., Kan, H., Karch, A., Karimkhani, C., Karthikeyan, G., Katz, R., Kaul, A., Kawakami, N., Kazi, D. S., Kemp, A. H., Kengne, A. P., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khan, G., Khang, Y., Khonelidze, I., Kieling, C., Kim, D., Kim, S., Kimokoti, R. W., Kinfu, Y., Kinge, J. M., Kissela, B. M., Kivipelto, M., Knibbs, L., Knudsen, A. K., Kokubo, Y., Kosen, S., Kramer, A., Kravchenko, M., Krishnamurthi, R. V., Krishnaswami, S., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, V. S., Kumar, K., Kumar, G. A., Kwan, G. F., Lai, T., Lalloo, R., Lam, H., Lan, Q., Lansingh, V. C., Larson, H., Larsson, A., Lawrynowicz, A. E., Leasher, J. L., Lee, J., Leigh, J., Leung, R., Levi, M., Li, B., Li, Y., Li, Y., Liang, J., Lim, S., Lin, H., Lind, M., Lindsay, M. P., Lipshultz, S. E., Liu, S., Lloyd, B. K., Ohno, S. L., Logroscino, G., Looker, K. J., Lopez, A. D., Lopez-Olmedo, N., Lortet-Tieulent, J., Lotufo, P. A., Low, N., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, J., Ma, S., Mackay, M. T., Majdan, M., Malekzadeh, R., Mapoma, C. C., Marcenes, W., March, L. M., Margono, C., Marks, G. B., Marzan, M. B., Masci, J. R., Mason-Jones, A. J., Matzopoulos, R. G., Mayosi, B. M., Mazorodze, T. T., McGill, N. W., McGrath, J. J., McKee, M., McLain, A., McMahon, B. J., Meaney, P. A., Mehndiratta, M. M., Mejia-Rodriguez, F., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mensah, G., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Mitchell, P. B., Mock, C. N., Moffitt, T. E., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Montico, M., Montine, T. J., Moore, A. R., Moran, A. E., Morawska, L., Mori, R., Moschandreas, J., Moturi, W. N., Moyer, M., Mozaffarian, D., Mueller, U. O., Mukaigawara, M., Murdoch, M. E., Murray, J., Murthy, K. S., Naghavi, P., Nahas, Z., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nash, D., Nejjari, C., Neupane, S. P., Newman, L. M., Newton, C. R., Ng, M., Ngalesoni, F. N., Nhung, N. T., Nisar, M. I., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I. H., Ohkubo, T., Omer, S. B., Opio, J. N., Ortiz, A., Pandian, J. D., Panelo, C. I., Papachristou, C., Park, E., Parry, C. D., Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pedraza, L. S., Pellegrini, C. A., Pereira, D. M., Perez-Ruiz, F. P., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phillips, D., Phillips, B., Piel, F. B., Plass, D., Poenaru, D., Polanczyk, G. V., Polinder, S., Pope, C. A., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Prasad, N. M., Qato, D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rakovac, I., Rana, S. M., Razavi, H., Refaat, A., Rehm, J., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Riccio, P. M., Richardson, L., Richardus, J. H., Riederer, A. M., Robinson, M., Roca, A., Rodriguez, A., Rojas-Rueda, D., Ronfani, L., Rothenbacher, D., Roy, N., Ruhago, G. M., Sabin, N., Sacco, R. L., Ksoreide, K., Saha, S., Sahathevan, R., Sahraian, M. A., Sampson, U., Sanabria, J. R., Sanchez-Riera, L., Santos, I. S., Satpathy, M., Saunders, J. E., Sawhney, M., Saylan, M. I., Scarborough, P., Schoettker, B., Schneider, I. J., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Serdar, B., Servan-Mori, E. E., Shackelford, K., Shaheen, A., Shahraz, S., Levy, T. S., Shangguan, S., She, J., Sheikhbahaei, S., Shepard, D. S., Shi, P., Shibuya, K., Shinohara, Y., Shiri, R., Shishani, K., Shiue, I., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Simard, E. P., Sindi, S., Singh, J. A., Singh, L., Skirbekk, V., Sliwa, K., Soljak, M., Soneji, S., Soshnikov, S. S., Speyer, P., Sposato, L. A., Sreeramareddy, C. T., Stoeckl, H., Stathopoulou, V. K., Steckling, N., Stein, M. B., Stein, D. J., Steiner, T. J., Stewart, A., Stork, E., Stovner, L. J., Stroumpoulis, K., Sturua, L., Sunguya, B. F., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Tan, F., Tandon, N., Tanne, D., Tanner, M., Tavakkoli, M., Taylor, H. R., Ao, B. J., Temesgen, A. M., ten Have, M., Tenkorang, E. Y., Terkawi, A. S., Theadom, A. M., Thomas, E., Thorne-Lyman, A. L., Thrift, A. G., Tleyjeh, I. M., Tonelli, M., Topouzis, F., Towbin, J. A., Toyoshima, H., Traebert, J., Tran, B. X., Trasande, L., Trillini, M., Truelsen, T., Trujillo, U., Tsilimbaris, M., Tuzcu, E. M., Ukwaja, K. N., Undurraga, E. A., Uzun, S. B., Van Brakel, W. H., de Vijver, S. v., Van Dingenen, R., van Gool, C. H., Varakin, Y. Y., Vasankari, T. J., Vavilala, M. S., Veerman, L. J., Velasquez-Melendez, G., Venketasubramanian, N., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Waller, S., Wallin, M. T., Wan, X., Wang, L., Wang, J., Wang, Y., Warouw, T. S., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wessells, K. R., Westerman, R., Wilkinson, J. D., Williams, H. C., Williams, T. N., Woldeyohannes, S. M., Wolfe, C. D., Wong, J. Q., Wong, H., Woolf, A. D., Wright, J. L., Wurtz, B., Xu, G., Yang, G., Yano, Y., Yenesew, M. A., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M., Yu, C., Kim, K. Y., Zaki, M. E., Zhang, Y., Zhao, Z., Zhao, Y., Zhu, J., Zonies, D., Zunt, J. R., Salomon, J. A., Murray, C. J. 2015; 386 (9995): 743-800

    Abstract

    Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(15)60692-4

    View details for Web of Science ID 000360287900025

    View details for PubMedCentralID PMC4561509

  • HIV burden in men who have sex with men: a prospective cohort study 2007-2012 SCIENTIFIC REPORTS Jia, Z., Huang, X., Wu, H., Zhang, T., Li, N., Ding, P., Sun, Y., Liu, Z., Wei, F., Zhang, H., Jiao, Y., Ji, Y., Zhang, Y., Guo, C., Li, W., Mou, D., Xia, W., Li, Z., Chen, D., Yan, H., Chen, X., Zhao, J., Meyers, K., Cohen, T., Mayer, K., Salomon, J. A., Lu, Z., Dye, C. 2015; 5: 11205

    Abstract

    We conducted a prospective cohort study among HIV-negative MSM aged 18 years or older between 2007 and 2012 in Beijing, China to measure the rates of incident HIV and identify risk factors for infection. Among 5,800 participants evaluated at enrollment, we identified 486 prevalent cases of HIV (8.4%). Among the 3,625 enrollees who were HIV-negative at enrollment and completed at least one follow-up interview, we identified 440 incident cases of HIV in the follow up period: this constituted an HIV incidence rate of 7.1 per 100 person-years (95% CI: 6.4-7.7). Early treatment of syphilis may have significantly reduced risk of HIV infection (RR: 1.45, 95% CI: 1.11-1.93), while MSM presenting perfect compliance in the cohort did not show reduction in HIV infection. Our study suggested that HIV incidence has been remained high in this sample of Chinese MSM during the intensive preventive intervention, suggesting that we need to find new strategies to prevent HIV infection in this population.

    View details for PubMedID 26135810

  • The Global Burden of Cancer 2013 Global Burden of Disease Cancer Collaboration JAMA ONCOLOGY Fitzmaurice, C., Dicker, D., Pain, A., Hamavid, H., Moradi-Lakeh, M., Maclntyre, M. F., Allen, C., Hansen, G., Woodbrook, R., Wolfe, C., Hamadeh, R. R., Moore, A., Werdecker, A., Gessner, B. D., Te Ao, B., McMahon, B., Karimkhani, C., Yu, C., Cooke, G. S., Schwebel, D. C., Carpenter, D. O., Pereira, D. M., Nash, D., Kazi, D. S., De Leo, D., Plass, D., Ukwaja, K. N., Thurston, G. D., Jin, K., Simard, E. P., Mills, E., Park, E., Catala-Lopez, F., DeVeber, G., Gotay, C., Khan, G., Hosgood, H., Santos, I. S., Leasher, J. L., Singh, J., Leigh, J., Jonas, J. B., Sanabria, J., Beardsley, J., Jacobsen, K. H., Takahashi, K., Franklin, R. C., Ronfani, L., Montico, M., Naldi, L., Tonelli, M., Geleijnse, J., Petzold, M., Shrime, M. G., Younis, M., Yonemoto, N., Breitborde, N., Yip, P., Pourmalek, F., Lotufo, P. A., Esteghamati, A., Hankey, G. J., Ali, R., Lunevicius, R., Malekzadeh, R., Dellavalle, R., Weintraub, R., Lucas, R., Hay, R., Rojas-Rueda, D., Westerman, R., Sepanlou, S. G., Nolte, S., Patten, S., Weichenthal, S., Abera, S., Fereshtehnejad, S., Shiue, I., Driscoll, T., Vasankari, T., Alsharif, U., Rahimi-Movaghar, V., Vlassov, V. V., Marcenes, W. S., Mekonnen, W., Melaku, Y., Yano, Y., Al Artaman, Campos, I., MacLachlan, J., Mueller, U., Kim, D., Trillini, M., Eshrati, B., Williams, H. C., Shibuya, K., Dandona, R., Murthy, K., Cowie, B., Amare, A. T., Antonio, C., Castaneda-Orjuela, C., van Gool, C. H., Violante, F., Oh, I., Deribe, K., Soreide, K., Knibbs, L., Kereselidze, M., Green, M., Cardenas, R., Roy, N., Tillmann, T., Li, Y., Krueger, H., Monasta, L., Dey, S., Sheikhbahaei, S., Hafezi-Nejad, N., Kumar, G., Sreeramareddy, C. T., Dandona, L., Wang, H., Vollset, S., Mokdad, A., Salomon, J. A., Lozano, R., Vos, T., Forouzanfar, M., Lopez, A., Murray, C., Naghavi, M., Global Burden Dis 2015; 1 (4): 505–27

    Abstract

    Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013.The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs.In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries.Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

    View details for PubMedID 26181261

    View details for PubMedCentralID PMC4500822

  • Teenage smoking behaviour following a high-school smoking ban in Chile: interrupted time-series analysis BULLETIN OF THE WORLD HEALTH ORGANIZATION Feigl, A. B., Salomon, J. A., Danaei, G., Ding, E. L., Calvo, E. 2015; 93 (7): 468–75

    Abstract

    To evaluate the effect of a smoking ban in high schools on smoking behaviour among Chilean students.We conducted an interrupted time-series analysis, using repeated cross-sectional data from Chile's school population survey (2000-2011) for high-school students aged 12-18 years and a control group of persons aged 19-24 years. Poisson regression models were used to assess trends in smoking behaviour before and after the policy changes. The outcome measures were self-reported smoking prevalence (any smoking in the past month) and high frequency of smoking (smoking 15 days or more per month).From 2005 to 2011, the prevalence of smoking declined among high-school students by 6.8% per year compared with 3.6% decline per year in the control group. The decline in the target group was 2.9% (95% confidence interval, CI: 0.18 to 5.00) greater. We estimated that 5-6 years after enforcing the law, smoking prevalence among high-school students was 13.7% lower as a result of the ban. The impact of the smoking ban was primarily driven by declines in smoking prevalence among students in grades 8 to 10. The smoking ban did not significantly alter the frequency of smoking.The 2005 school smoking ban reduced smoking prevalence among younger high-school students in Chile. Further interventions targeting older individuals and frequent smokers may be needed.

    View details for PubMedID 26170504

    View details for PubMedCentralID PMC4490811

  • Evaluating the potential impact of enhancing HIV treatment and tuberculosis control programmes on the burden of tuberculosis JOURNAL OF THE ROYAL SOCIETY INTERFACE Chindelevitch, L., Menzies, N. A., Pretorius, C., Stover, J., Salomon, J. A., Cohen, T. 2015; 12 (106)

    Abstract

    HIV has fuelled increasing tuberculosis (TB) incidence in sub-Saharan Africa. Better control of TB in this region may be achieved directly through TB programme improvements and indirectly through expanded use of antiretroviral therapy (ART) among those with HIV. We used a mathematical model of TB and HIV in South Africa to examine the potential epidemiological impact in scenarios involving improvements in three dimensions of TB programmes: coverage, diagnosis and treatment effectiveness, as well as expanded ART use through broadened eligibility. We projected the effect of alternative scenarios on TB prevalence, incidence and TB-related mortality over 20 years. Of the three dimensions of TB programme improvement, expanding coverage would produce the greatest reduction in TB burden. Compared with current performance, combined TB programme improvements were projected to decrease TB incidence by 30% over 5 years and 46% over 20 years, and decrease TB-related mortality by 45% over 5 years and 69% over 20 years. Expanded ART eligibility was projected to decrease TB incidence by 22% over 5 years and 45% over 20 years, and TB-related mortality by 22% over 5 years and 50% over 20 years. We found that over a 20-year horizon, TB-specific and HIV-specific programme changes contribute equally to incidence reductions, whereas the TB-specific changes produce a majority of the mortality benefits. An aggressive expansion of ART alongside traditional TB-specific control measures has the potential to greatly reduce TB burden, with the different elements of a combined approach having a synergistic effect in reducing long-term TB incidence and mortality.

    View details for PubMedID 25878131

    View details for PubMedCentralID PMC4424692

  • The Cost-Effectiveness of Sofosbuvir-Based Regimens for Treatment of Hepatitis C Virus Genotype 2 or 3 Infection ANNALS OF INTERNAL MEDICINE Linas, B. P., Barter, D. M., Morgan, J. R., Pho, M. T., Leff, J. A., Schackman, B. R., Horsburgh, C., Assoumou, S. A., Salomon, J. A., Weinstein, M. C., Freedberg, K. A., Kim, A. Y. 2015; 162 (9): 619–U220

    Abstract

    Chronic infection with hepatitis C virus (HCV) genotype 2 or 3 can be treated with sofosbuvir without interferon. Because sofosbuvir is costly, its benefits should be compared with the additional resources used.To estimate the cost-effectiveness of sofosbuvir-based treatments for HCV genotype 2 or 3 infection in the United States.Monte Carlo simulation, including deterministic and probabilistic sensitivity analyses.Randomized trials, observational cohorts, and national health care spending surveys.8 patient types defined by HCV genotype (2 vs. 3), treatment history (naive vs. experienced), and cirrhosis status (noncirrhotic vs. cirrhotic).Lifetime.Payer.Sofosbuvir-based therapies, pegylated interferon-ribavirin, and no therapy.Discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).The ICER of sofosbuvir-based treatment was less than $100,000 per QALY in cirrhotic patients (genotype 2 or 3 and treatment-naive or treatment-experienced) and in treatment-experienced noncirrhotic patients but was greater than $200,000 per QALY in treatment-naive noncirrhotic patients.The ICER of sofosbuvir-based therapy for treatment-naive noncirrhotic patients with genotype 2 or 3 infection was less than $100,000 per QALY when the cost of sofosbuvir was reduced by approximately 40% and 60%, respectively. In probabilistic sensitivity analyses, cost-effectiveness conclusions were robust to uncertainty in treatment efficacy.The analysis did not consider possible benefits of preventing HCV transmission.Sofosbuvir provides good value for money for treatment-experienced patients with HCV genotype 2 or 3 infection and those with cirrhosis. At their current cost, sofosbuvir-based regimens for treatment-naive noncirrhotic patients exceed willingness-to-pay thresholds commonly cited in the United States.National Institute on Drug Abuse and National Institute of Allergy and Infectious Diseases.

    View details for DOI 10.7326/M14-1313

    View details for Web of Science ID 000354119100006

    View details for PubMedID 25820703

    View details for PubMedCentralID PMC4420667

  • A novel risk score to predict cardiovascular disease risk in national populations (Globorisk): a pooled analysis of prospective cohorts and health examination surveys LANCET DIABETES & ENDOCRINOLOGY Hajifathalian, K., Ueda, P., Lu, Y., Woodward, M., Ahmadvand, A., Aguilar-Salinas, C. A., Azizi, F., Cifkova, R., Di Cesare, M., Eriksen, L., Farzadfar, F., Ikeda, N., Khalili, D., Khang, Y., Lanska, V., Leon-Munoz, L., Magliano, D., Msyamboza, K. P., Oh, K., Rodriguez-Artalejo, F., Rojas-Martinez, R., Shaw, J. E., Stevens, G. A., Tolstrup, J., Zhou, B., Salomon, J. A., Ezzati, M., Danaei, G. 2015; 3 (5): 339–55

    Abstract

    Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information.We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA).The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico.We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries.US National Institutes of Health, UK Medical Research Council, Wellcome Trust.

    View details for PubMedID 25819778

  • Long-term Disability Associated With War-related Experience Among Vietnam Veterans Retrospective Cohort Study MEDICAL CARE Clarke, P. M., Gregory, R., Salomon, J. A. 2015; 53 (5): 401–8

    Abstract

    Recent combat operations have involved large numbers of personnel. Long-term health effects of military deployment remain largely unknown.To examine patterns and trends in long-term disability among combat veterans and to relate disability to aspects of wartime experience.A total of 60,228 Australian military personnel deployed between 1962 and 1975 during the Vietnam War, and 82,877 military personnel who were not deployed overseas.Accepted physician-assessed disability claims were evaluated over follow-up periods up to 50 years after deployment, and compared with age-matched controls. Multivariable analysis was used to examine differences by service branch, rank, age, and deployment duration.The steepest rise in disability incidence was observed among Vietnam veterans starting in the 1990s, around 20-30 years after deployment for most veterans. After 1994, when Statements of Principles were introduced to guide evaluation of disability claims, the hazard ratio for disability incidence was 1.53 (95% confidence interval, 1.32-1.77) compared with the prior period. By January 2011, after an average follow-up of 42.5 years, 69.7% (95% confidence interval, 69.4%-70.1%) of veterans had at least 1 war-related disability. Many veterans had multiple disabilities, with leading causes being eye and ear disorders (48.0%), mental health conditions (47.9%), and musculoskeletal disorders (18.4%). For specific categories of disability, relative risks for accepted claims among veterans compared with controls were highest for mental health disorders, at 22.9 (21.9-24.0) and lowest for injuries, at 1.5 (1.4-1.6) with a relative risk for any disability of 3.7 (3.7-3.8). Veterans with service of >1 year were 2.5 (2.2-2.7) times more likely to have a mental health disability than those who served <100 days, and 2.3 (2.1-2.5) times more likely to have other disabilities.Long-term effects of deployment into military conflicts are substantial, and likelihood of war-related disability is associated with service history. If similar patterns follow from more recent conflicts, significant additional resources will be needed to prevent and treat long-term health conditions among veterans.

    View details for PubMedID 25768060

  • Assessing disability weights based on the responses of 30,660 people from four European countries POPULATION HEALTH METRICS Haagsma, J. A., de Noordhout, C., Polinder, S., Vos, T., Havelaar, A. H., Cassini, A., Devleesschauwer, B., Kretzschmar, M. E., Speybroeck, N., Salomon, J. A. 2015; 13: 10

    Abstract

    In calculations of burden of disease using disability-adjusted life years, disability weights are needed to quantify health losses relating to non-fatal outcomes, expressed as years lived with disability. In 2012 a new set of global disability weights was published for the Global Burden of Disease 2010 (GBD 2010) study. That study suggested that comparative assessments of different health outcomes are broadly similar across settings, but the significance of this conclusion has been debated. The aim of the present study was to estimate disability weights for Europe for a set of 255 health states, including 43 new health states, by replicating the GBD 2010 Disability Weights Measurement study among representative population samples from four European countries.For the assessment of disability weights for Europe we applied the GBD 2010 disability weights measurement approach in web-based sample surveys in Hungary, Italy, Netherlands, and Sweden. The survey included paired comparisons (PC) and population health equivalence questions (PHE) formulated as discrete choices. Probit regression analysis was used to estimate cardinal values from PC responses. To locate results onto the 0-to-1 disability weight scale, we assessed the feasibility of using the GBD 2010 scaling approach based on PHE questions, as well as an alternative approach using non-parametric regression.In total, 30,660 respondents participated in the survey. Comparison of the probit regression results from the PC responses for each country indicated high linear correlations between countries. The PHE data had high levels of measurement error in these general population samples, which compromises the ability to infer ratio-scaled values from discrete choice responses. Using the non-parametric regression approach as an alternative rescaling procedure, the set of disability weights were bounded by distance vision mild impairment and anemia with the lowest weight (0.004) and severe multiple sclerosis with the highest weight (0.677).PC assessments of health outcomes in this study resulted in estimates that were highly correlated across four European countries. Assessment of the feasibility of rescaling based on a discrete choice formulation of the PHE question indicated that this approach may not be suitable for use in a web-based survey of the general population.

    View details for PubMedID 26778920

  • Using interviewer random effects to remove selection bias from HIV prevalence estimates BMC MEDICAL RESEARCH METHODOLOGY McGovern, M. E., Baernighausen, T., Salomon, J. A., Canning, D. 2015; 15: 8

    Abstract

    Selection bias in HIV prevalence estimates occurs if non-participation in testing is correlated with HIV status. Longitudinal data suggests that individuals who know or suspect they are HIV positive are less likely to participate in testing in HIV surveys, in which case methods to correct for missing data which are based on imputation and observed characteristics will produce biased results.The identity of the HIV survey interviewer is typically associated with HIV testing participation, but is unlikely to be correlated with HIV status. Interviewer identity can thus be used as a selection variable allowing estimation of Heckman-type selection models. These models produce asymptotically unbiased HIV prevalence estimates, even when non-participation is correlated with unobserved characteristics, such as knowledge of HIV status. We introduce a new random effects method to these selection models which overcomes non-convergence caused by collinearity, small sample bias, and incorrect inference in existing approaches. Our method is easy to implement in standard statistical software, and allows the construction of bootstrapped standard errors which adjust for the fact that the relationship between testing and HIV status is uncertain and needs to be estimated.Using nationally representative data from the Demographic and Health Surveys, we illustrate our approach with new point estimates and confidence intervals (CI) for HIV prevalence among men in Ghana (2003) and Zambia (2007). In Ghana, we find little evidence of selection bias as our selection model gives an HIV prevalence estimate of 1.4% (95% CI 1.2% - 1.6%), compared to 1.6% among those with a valid HIV test. In Zambia, our selection model gives an HIV prevalence estimate of 16.3% (95% CI 11.0% - 18.4%), compared to 12.1% among those with a valid HIV test. Therefore, those who decline to test in Zambia are found to be more likely to be HIV positive.Our approach corrects for selection bias in HIV prevalence estimates, is possible to implement even when HIV prevalence or non-participation is very high or very low, and provides a practical solution to account for both sampling and parameter uncertainty in the estimation of confidence intervals. The wide confidence intervals estimated in an example with high HIV prevalence indicate that it is difficult to correct statistically for the bias that may occur when a large proportion of people refuse to test.

    View details for PubMedID 25656226

  • Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Naghavi, M., Wang, H., Lozano, R., Davis, A., Liang, X., Zhou, M., Vollset, S. E., Ozgoren, A. A., Abdalla, S., Abd-Allah, F., Aziz, M. I., Abera, S. F., Aboyans, V., Abraham, B., Abraham, J. P., Abuabara, K. E., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Adelekan, A., Ademi, Z. N., Adofo, K., Adou, A. K., Adsuar, J. C., Aernlov, J., Agardh, E. E., Akena, D., Al Khabouri, M. J., Alasfoor, D., Albittar, M., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, M. K., Ali, R., Alla, F., Al Lami, F., Allebeck, P., AlMazroa, M. A., Salman, R. A., Alsharif, U., Alvarez, E., Alviz-Guzman, N., Amankwaa, A. A., Amare, A. T., Ameli, O., Amini, H., Ammar, W., Anderson, H. R., Anderson, B. O., Antonio, C. A., Anwari, P., Apfel, H., Cunningham, S. A., Arsenijevic, V. S., Al Artaman, Asad, M. M., Asghar, R. J., Assadi, R., Atkins, L. S., Atkinson, C., Badawi, A., Bahit, M. C., Bakfalouni, T., Balakrishnan, K., Balalla, S., Banerjee, A., Barber, R. M., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Barrientos-Gutierrez, T., Basu, A., Basu, S., Basulaiman, M. O., Beardsley, J., Bedi, N., Beghi, E., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Benzian, H., Bertozzi-Villa, A., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Bikbov, B., Bin Abdulhak, A., Biryukov, S., Blore, J. D., Blyth, F. M., Bohensky, M. A., Borges, G., Bose, D., Boufous, S., Bourne, R. R., Boyers, L. N., Brainin, M., Brauer, M., Brayne, C. E., Brazinova, A., Breitborde, N., Brenner, H., Briggs, A. D., Brown, J. C., Brugha, T. S., Buckle, G. C., Bui, L. N., Bukhman, G., Burch, M., Nonato, I. R., Carabin, H., Cardenas, R., Carapetis, J., Carpenter, D. O., Caso, V., Castaneda-Orjuela, C. A., Castro, R. E., Catala-Lopez, F., Cavalleri, F., Chang, J., Charlson, F. C., Che, X., Chen, H., Chen, Y., Chen, J. S., Chen, Z., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christensen, H., Christophi, C. A., Chuang, T., Chugh, S. S., Cirillo, M., Coates, M. M., Coffeng, L. E., Coggeshall, M. S., Cohen, A., Colistro, V., Colquhoun, S. M., Colomar, M., Cooper, L. T., Cooper, C., Coppola, L. M., Cortinovis, M., Courville, K., Cowie, B. C., Criqui, M. H., Crump, J. A., Cuevas-Nasu, L., Leite, I. d., Dabhadkar, K. C., Dandona, L., Dandona, R., Dansereau, E., Dargan, P. I., Dayama, A., De la Cruz-Gongora, V., de la Vega, S. F., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Dellavalle, R. P., Deribe, K., Jarlais, D. C., Dessalegn, M., deVeber, G. A., Dharmaratne, S. D., Dherani, M., Diaz-Ortega, J., Diaz-Torne, C., Dicker, D., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duan, L., Duber, H. C., Durrani, A. M., Ebel, B. E., Edmond, K. M., Ellenbogen, R. G., Elshrek, Y., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Estep, K., Fuerst, T., Fahimi, S., Fahrion, A. S., Faraon, E. J., Farzadfar, F., Fay, D. F., Feigl, A. B., Feigin, V. L., Felicio, M. M., Fereshtehnejad, S., Fernandes, J. G., Ferrari, A. J., Fleming, T. D., Foigt, N., Foreman, K., Forouzanfar, M. H., Fowkes, F. G., Fra Paleo, U., Franklin, R. C., Futran, N. D., Gaffikin, L., Gambashidze, K., Gankpe, F. G., Garcia-Guerra, F. A., Garcia, A. C., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Gillum, R. F., Gilmour, S., Abdelmageem, I., Ginawi, M., Giroud, M., Glaser, E. L., Goenka, S., Dantes, H. G., Gona, P., Gonzalez-Medina, D., Guinovart, C., Gupta, R., Gupta, R., Gosselin, R. A., Gotay, C. C., Goto, A., Gowda, H. N., Graetz, N., Greenwell, K. F., Gugnani, H. C., Gunnell, D., Gutierrez, R. A., Haagsma, J., Hafezi-Nejad, N., Hagan, H., Hagstromer, M., Halasa, Y. A., Hamadeh, R. R., Hamavid, H., Hammami, M., Hancock, J., Hankey, G. J., Hansen, G. M., Harb, H. L., Harewood, H., Haro, J. M., Havmoeller, R., Hay, R. J., Hay, S. I., Hedayati, M. T., Pi, I. B., Heuton, K. R., Heydarpour, P., Higashi, H., Hijar, M., Hoek, H. W., Hoffman, H. J., Hornberger, J. C., Hosgood, H. D., Hossain, M., Hotez, P. J., Hoy, D. G., Hsairi, M., Hu, G., Huang, J. J., Huffman, M. D., Hughes, A. J., Husseini, A., Huynh, C., Iannarone, M., Iburg, K. M., Idrisov, B. T., Ikeda, N., Innos, K., Inoue, M., Islami, F., Ismayilova, S., Jacobsen, K. H., Jassal, S., Jayaraman, S. P., Jensen, P. N., Jha, V., Jiang, G., Jiang, Y., Jonas, J. B., Joseph, J., Juel, K., Kabagambe, E. K., Kan, H., Karch, A., Karimkhani, C., Karthikeyan, G., Kassebaum, N., Kaul, A., Kawakami, N., Kazanjan, K., Kazi, D. S., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khan, G., Khang, Y., Kieling, C., Kinfu, Y., Kinge, J. M., Kim, D., Kim, S., Kivipelto, M., Knibbs, L., Knudsen, A. K., Kokubo, Y., Kosen, S., Kotagal, M., Kravchenko, M. A., Krishnaswami, S., Krueger, H., Defo, B. K., Kuipers, E. J., Bicer, B. K., Kulkarni, C., Kulkarni, V. S., Kumar, K., Kumar, R. B., Kwan, G. F., Kyu, H., Lai, T., Balaji, A. L., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Lavados, P. M., Lawrynowicz, A. E., Leasher, J. L., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Levitz, C., Li, B., Li, Y., Li, Y., Liddell, C., Lim, S. S., de Lima, G. M., Lind, M. L., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lofgren, K. T., Logroscino, G., London, S. J., Lortet-Tieulent, J., Lotufo, P. A., Lucas, R. M., Lunevicius, R., Lyons, R. A., Ma, S., Machado, V. M., MacIntyre, M. F., Mackay, M. T., Maclachlan, J. H., Magis-Rodriguez, C., Mahdi, A. A., Majdan, M., Malekzadeh, R., Mangalam, S., Mapoma, C. C., Marape, M., Marcenes, W., Margono, C., Marks, G. B., Marzan, M. B., Masci, J. R., Mashal, M. T., Masiye, F., Mason-Jones, A. J., Matzopolous, R., Mayosi, B. M., Mazorodze, T. T., McGrath, J. J., Mckay, A. C., McKee, M., McLain, A., Meaney, P. A., Mehndiratta, M. M., Mejia-Rodriguez, F., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Miller, T. R., Mills, E. J., Misganaw, A., Mishra, S. K., Mock, C. N., Moffitt, T. E., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Monis, J. d., Hernandez, J. C., Montico, M., Montine, T. J., Mooney, M. D., Moore, A. R., Moradi-Lakeh, M., Moran, A. E., Mori, R., Moschandreas, J., Moturi, W. N., Moyer, M. L., Mozaffarian, D., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murray, J., Mustapha, A., Naghavi, P., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nash, D., Nasher, J., Nejjari, C., Nelson, R. G., Neuhouser, M., Neupane, S. P., Newcomb, P. A., Newman, L., Newton, C. R., Ng, M., Ngalesoni, F. N., Nguyen, G., Nhung Thi Trang Nguyen, N. T., Nisar, M. I., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Odell, S., O'Donnell, M., Ohkubo, T., Ohno, S. L., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Ortblad, K. F., Ortiz, A., Otayza, M. L., Pain, A. W., Pandian, J. D., Panelo, C. I., Panniyammakal, J., Papachristou, C., Paternina Caicedo, A. J., Patten, S. B., Patton, G. C., Paul, V. K., Pavlin, B., Pearce, N., Pellegrini, C. A., Pereira, D. M., Peresson, S. C., Perez-Padilla, R., Perez-Ruiz, F. P., Perico, N., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, B. K., Phillips, D. E., Phillips, M. R., Plass, D., Piel, F. B., Poenaru, D., Polinder, S., Popova, S., Poulton, R. G., Pourmalek, F., Prabhakaran, D., Qato, D., Quezada, A. D., Quistberg, D. A., Rabito, F., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rakovac, I., Rana, S. M., Refaat, A., Remuzzi, G., Ribeiro, A. L., Ricci, S., Riccio, P. M., Richardson, L., Richardus, J. H., Roberts, B., Roberts, D. A., Robinson, M., Roca, A., Rodriguez, A., Rojas-Rueda, D., Ronfani, L., Room, R., Roth, G. A., Rothenbacher, D., Rothstein, D. H., Rowley, J. T., Roy, N., Ruhago, G. M., Rushton, L., Sambandam, S., Soreide, K., Saeedi, M. Y., Saha, S., Sahathevan, R., Sahraian, M. A., Sahle, B. W., Salomon, J. A., Salvo, D., Samonte, G. M., Sampson, U., Sanabria, J. R., Sandar, L., Santos, I. S., Satpathy, M., Sawhney, M., Saylan, M., Scarborough, P., Schoettker, B., Schmidt, J. C., Schneider, I. J., Schumacher, A. E., Schwebel, D. C., Scott, J. G., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K., Shaheen, A., Shahraz, S., Shakh-Nazarova, M., Shangguan, S., She, J., Sheikhbahaei, S., Shepard, D. S., Shibuya, K., Shinohara, Y., Shishani, K., Shiue, I., Shivakoti, R., Shrime, M. G., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Simard, E. P., Sindi, S., Singh, J. A., Singh, L., Sioson, E., Skirbekk, V., Sliwa, K., So, S., Soljak, M., Soneji, S., Soshnikov, S. S., Sposato, L. A., Sreeramareddy, C. T., Stanaway, J. R., Stathopoulou, V. K., Steenland, K., Stein, C., Steiner, C., Stevens, A., Stoeckl, H., Straif, K., Stroumpoulis, K., Sturua, L., Sunguya, B. F., Swaminathan, S., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Talongwa, R. T., Tan, F., Tanne, D., Tanner, M., Tavakkoli, M., Ao, B. T., Teixeira, C. M., Templin, T., Tenkorang, E. Y., Terkawi, A. S., Thomas, B. A., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tirschwell, D. L., Tleyjeh, I. M., Tonelli, M., Topouzis, F., Towbin, J. A., Toyoshima, H., Traebert, J., Tran, B. X., Truelsen, T., Trujillo, U., Trillini, M., Dimbuene, Z. T., Tsilimbaris, M., Tuzcu, E. M., Ubeda, C., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Vallely, A. J., van de Vijver, S., van Gool, C. H., Varakin, Y. Y., Vasankari, T. J., Vasconcelos, A. M., Vavilala, M. S., Venketasubramanian, N., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Wagner, G. R., Waller, S. G., Wang, J., Wang, L., Wang, X., Wang, Y., Warouw, T. S., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Wenzhi, W., Werdecker, A., Wessells, K. R., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Williams, T. N., Woldeyohannes, S. M., Wolfe, C. D., Wolock, T. M., Woolf, A. D., Wong, J. Q., Wright, J. L., Wulf, S., Wurtz, B., Xu, G., Yang, Y. C., Yano, Y., Yatsuya, H., Yip, P., Yonemoto, N., Yoon, S., Younis, M., Yu, C., Jin, K. Y., Zaki, M. E., Zamakhshary, M. F., Zeeb, H., Zhang, Y., Zhao, Y., Zheng, Y., Zhu, J., Zhu, S., Zonies, D., Zou, X. N., Zunt, J. R., Vos, T., Lopez, A. D., Murray, C. J. 2015; 385 (9963): 117-171

    Abstract

    Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries.We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions.Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions.For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)61682-2

    View details for Web of Science ID 000347715900024

    View details for PubMedCentralID PMC4340604

  • Effect of empirical treatment on outcomes of clinical trials of diagnostic assays for tuberculosis LANCET INFECTIOUS DISEASES Menzies, N. A., Cohen, T., Murray, M., Salomon, J. A. 2015; 15 (1): 16–17

    View details for PubMedID 25541164

  • Assessing and adjusting for differences between HIV prevalence estimates derived from national population-based surveys and antenatal care surveillance, with applications for Spectrum 2013 AIDS Marsh, K., Mahy, M., Salomon, J. A., Hogan, D. R. 2014; 28: S497–S505

    Abstract

    To assess differences between HIV prevalence estimates derived from national population surveys and antenatal care (ANC) surveillance sites and to improve the calibration of ANC-derived estimates in Spectrum 2013 to more appropriately account for differences between these data.Retrospective analysis of national population survey and ANC surveillance data from 25 countries with generalized epidemics in sub-Saharan Africa and 8 countries with concentrated epidemics.Adult national population survey and ANC surveillance HIV prevalence estimates were compared for all available national population survey data points for the years 1999-2012. For sub-Saharan Africa, a mixed-effects linear regression model determined whether the relationship between national population and ANC estimates was constant across surveys. A new calibration method was developed to incorporate national population survey data directly into the likelihood for HIV prevalence in countries with generalized epidemics. Results were used to develop default rules for adjusting ANC data for countries with no national population surveys.ANC surveillance data typically overestimate population prevalence, although a wide variation, particularly in rural areas, is observed across countries and survey years. The new calibration method yields similar point estimates to previous approaches, but leads to an average 44% increase in the width of 95% uncertainty intervals.Important biases remain in ANC surveillance data for HIV prevalence. The new approach to model-fitting in Spectrum 2013 more appropriately accounts for this bias when producing national estimates in countries with generalized epidemics. In countries with concentrated epidemics, local sex ratios should be used to calibrate ANC surveillance estimates.

    View details for PubMedID 25203158

    View details for PubMedCentralID PMC4247262

  • More Evidence on the Impact of India's Conditional Cash Transfer Program, Janani Suraksha Yojana: Quasi-Experimental Evaluation of the Effects on Childhood Immunization and Other Reproductive and Child Health Outcomes PLOS ONE Carvalho, N., Thacker, N., Gupta, S. S., Salomon, J. A. 2014; 9 (10): e109311

    Abstract

    In 2005, India established a conditional cash transfer program called Janani Suraksha Yojana (JSY), to increase institutional delivery and encourage the use of reproductive and child health-related services.To assess the effect of maternal receipt of financial assistance from JSY on childhood immunizations, post-partum care, breastfeeding practices, and care-seeking behaviors.We use data from the latest district-level household survey (2007-2008) to conduct a propensity score matching analysis with logistic regression. We conduct the analyses at the national level as well as separately across groups of states classified as high-focus and non-high-focus. We carry out several sensitivity analyses including a subgroup analysis stratified by possession of an immunization card.Receipt of financial assistance from JSY led to an increase in immunization rates ranging from 3.1 (95%CI 2.2-4.0) percentage points for one dose of polio vaccine to 9.1 (95%CI 7.5-10.7) percentage points in the proportion of fully vaccinated children. Our findings also indicate JSY led to increased post-partum check-up rates and healthy early breastfeeding practices around the time of childbirth. No effect of JSY was found on exclusive breastfeeding practices and care-seeking behaviors. Effect sizes were consistently larger in states identified as being a key focus for the program. In an analysis stratified by possession of an immunization card, there was little to no effect of JSY among those with vaccination cards, while the effect size was much larger than the base case results for those missing vaccination cards, across nearly all immunization outcomes.Early results suggest the JSY program led to a significant increase in childhood immunization rates and some healthy reproductive health behaviors, but the structuring of financial incentives to pregnant women and health workers warrants further review. Causal interpretation of our results relies on the assumption that propensity scores balance unobservable characteristics.

    View details for PubMedID 25303078

  • Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Murray, C. J., Ortblad, K. F., Guinovart, C., Lim, S. S., Wolock, T. M., Roberts, D. A., Dansereau, E. A., Graetz, N., Barber, R. M., Brown, J. C., Wang, H., Duber, H. C., Naghavi, M., Dicker, D., Dandona, L., Salomon, J. A., Heuton, K. R., Foreman, K., Phillips, D. E., Fleming, T. D., Flaxman, A. D., Phillips, B. K., Johnson, E. K., Coggeshall, M. S., Abd-Allah, F., Abera, S. F., Abraham, J. P., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Adeyemo, A. O., Adou, A. K., Adsuar, J. C., Agardh, E. E., Akena, D., Al Kahbouri, M. J., Alasfoor, D., Albittar, M. I., Alcalá-Cerra, G., Alegretti, M. A., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allen, P. J., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Amini, H., Ammar, W., Anderson, B. O., Antonio, C. A., Anwari, P., Arnlöv, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Badawi, A., Balakrishnan, K., Banerjee, A., Basu, S., Beardsley, J., Bekele, T., Bell, M. L., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Abdulhak, A. B., Binagwaho, A., Blore, J. D., Basara, B. B., Bose, D., Brainin, M., Breitborde, N., Castañeda-Orjuela, C. A., Catalá-López, F., Chadha, V. K., Chang, J., Chiang, P. P., Chuang, T., Colomar, M., Cooper, L. T., Cooper, C., Courville, K. J., Cowie, B. C., Criqui, M. H., Dandona, R., Dayama, A., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Deribe, K., Des Jarlais, D. C., Dessalegn, M., Dharmaratne, S. D., Dilmen, U., Ding, E. L., Driscoll, T. R., Durrani, A. M., Ellenbogen, R. G., Ermakov, S. P., Esteghamati, A., Faraon, E. J., Farzadfar, F., Fereshtehnejad, S., Fijabi, D. O., Forouzanfar, M. H., Fra Paleo, U., Gaffikin, L., Gamkrelidze, A., Gankpé, F. G., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Ginawi, I. A., Glaser, E. L., Gona, P., Goto, A., Gouda, H. N., Gugnani, H. C., Gupta, R., Gupta, R., Hafezi-Nejad, N., Hamadeh, R. R., Hammami, M., Hankey, G. J., Harb, H. L., Haro, J. M., Havmoeller, R., Hay, S. I., Hedayati, M. T., Pi, I. B., Hoek, H. W., Hornberger, J. C., Hosgood, H. D., Hotez, P. J., Hoy, D. G., Huang, J. J., Iburg, K. M., Idrisov, B. T., Innos, K., Jacobsen, K. H., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kan, H., Kankindi, I., Karam, N. E., Karch, A., Karema, C. K., Kaul, A., Kawakami, N., Kazi, D. S., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Khonelidze, I., Kinfu, Y., Kinge, J. M., Knibbs, L., Kokubo, Y., Kosen, S., Defo, B. K., Kulkarni, V. S., Kulkarni, C., Kumar, K., Kumar, R. B., Kumar, G. A., Kwan, G. F., Lai, T., Balaji, A. L., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Li, Y., Li, Y., de Lima, G. M., Lin, H., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lotufo, P. A., Machado, V. M., Maclachlan, J. H., Magis-Rodriguez, C., Majdan, M., Mapoma, C. C., Marcenes, W., Marzan, M. B., Masci, J. R., Mashal, M. T., Mason-Jones, A. J., Mayosi, B. M., Mazorodze, T. T., Mckay, A. C., Meaney, P. A., Mehndiratta, M. M., Mejia-Rodriguez, F., Melaku, Y. A., Memish, Z. A., Mendoza, W., Miller, T. R., Mills, E. J., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Montico, M., Moore, A. R., Mori, R., Moturi, W. N., Mukaigawara, M., Murthy, K. S., Naheed, A., Naidoo, K. S., Naldi, L., Nangia, V., Narayan, K. M., Nash, D., Nejjari, C., Nelson, R. G., Neupane, S. P., Newton, C. R., Ng, M., Nisar, M. I., Nolte, S., Norheim, O. F., Nowaseb, V., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Pandian, J. D., Papachristou, C., Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Pervaiz, A., Pesudovs, K., Petzold, M., Pourmalek, F., Qato, D., Quezada, A. D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Ur Rahman, S., Raju, M., Rana, S. M., Razavi, H., Reilly, R. Q., Remuzzi, G., Richardus, J. H., Ronfani, L., Roy, N., Sabin, N., Saeedi, M. Y., Sahraian, M. A., Samonte, G. M., Sawhney, M., Schneider, I. J., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shiue, I., Shivakoti, R., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Simard, E. P., Singh, J. A., Skirbekk, V., Sliwa, K., Soneji, S., Soshnikov, S. S., Sreeramareddy, C. T., Stathopoulou, V. K., Stroumpoulis, K., Swaminathan, S., Sykes, B. L., Tabb, K. M., Talongwa, R. T., Tenkorang, E. Y., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Towbin, J. A., Traebert, J., Tran, B. X., Dimbuene, Z. T., Tsilimbaris, M., Uchendu, U. S., Ukwaja, K. N., Uzun, S. B., Vallely, A. J., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Waller, S., Wallin, M. T., Wang, L., Wang, X., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., White, R. A., Wilkinson, J. D., Williams, T. N., Woldeyohannes, S. M., Wong, J. Q., Xu, G., Yang, Y. C., Yano, Y., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M., Yu, C., Jin, K. Y., El Sayed Zaki, M., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zou, X. N., Lopez, A. D., Vos, T. 2014; 384 (9947): 1005-1070

    Abstract

    The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration.To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets.Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)60844-8

    View details for PubMedID 25059949

  • Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., Gonzalez-Medina, D., Barber, R., Huynh, C., Dicker, D., Templin, T., Wolock, T. M., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Abubakar, I., Achoki, T., Adelekan, A., Ademi, Z., Adou, A. K., Adsuar, J. C., Agardh, E. E., Akena, D., Alasfoor, D., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Al Kahbouri, M. J., Alla, F., Allen, P. J., AlMazroa, M. A., Alsharif, U., Alvarez, E., Alvis-Guzmán, N., Amankwaa, A. A., Amare, A. T., Amini, H., Ammar, W., Antonio, C. A., Anwari, P., Arnlöv, J., Arsenijevic, V. S., Artaman, A., Asad, M. M., Asghar, R. J., Assadi, R., Atkins, L. S., Badawi, A., Balakrishnan, K., Basu, A., Basu, S., Beardsley, J., Bedi, N., Bekele, T., Bell, M. L., Bernabe, E., Beyene, T. J., Bhutta, Z., Bin Abdulhak, A., Blore, J. D., Basara, B. B., Bose, D., Breitborde, N., Cárdenas, R., Castañeda-Orjuela, C. A., Castro, R. E., Catalá-López, F., Cavlin, A., Chang, J., Che, X., Christophi, C. A., Chugh, S. S., Cirillo, M., Colquhoun, S. M., Cooper, L. T., Cooper, C., da Costa Leite, I., Dandona, L., Dandona, R., Davis, A., Dayama, A., Degenhardt, L., De Leo, D., Del Pozo-Cruz, B., Deribe, K., Dessalegn, M., deVeber, G. A., Dharmaratne, S. D., Dilmen, U., Ding, E. L., Dorrington, R. E., Driscoll, T. R., Ermakov, S. P., Esteghamati, A., Faraon, E. J., Farzadfar, F., Felicio, M. M., Fereshtehnejad, S., de Lima, G. M., Forouzanfar, M. H., França, E. B., Gaffikin, L., Gambashidze, K., Gankpé, F. G., Garcia, A. C., Geleijnse, J. M., Gibney, K. B., Giroud, M., Glaser, E. L., Goginashvili, K., Gona, P., González-Castell, D., Goto, A., Gouda, H. N., Gugnani, H. C., Gupta, R., Gupta, R., Hafezi-Nejad, N., Hamadeh, R. R., Hammami, M., Hankey, G. J., Harb, H. L., Havmoeller, R., Hay, S. I., Pi, I. B., Hoek, H. W., Hosgood, H. D., Hoy, D. G., Husseini, A., Idrisov, B. T., Innos, K., Inoue, M., Jacobsen, K. H., Jahangir, E., Jee, S. H., Jensen, P. N., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kabagambe, E. K., Kan, H., Karam, N. E., Karch, A., Karema, C. K., Kaul, A., Kawakami, N., Kazanjan, K., Kazi, D. S., Kemp, A. H., Kengne, A. P., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Knibbs, L., Kokubo, Y., Kosen, S., Defo, B. K., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kumar, K., Kumar, R. B., Kwan, G., Lai, T., Lalloo, R., Lam, H., Lansingh, V. C., Larsson, A., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Li, X., Li, Y., Li, Y., Liang, J., Liang, X., Lim, S. S., Lin, H., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., London, S. J., Lotufo, P. A., Ma, J., Ma, S., Machado, V. M., Mainoo, N. K., Majdan, M., Mapoma, C. C., Marcenes, W., Marzan, M. B., Mason-Jones, A. J., Mehndiratta, M. M., Mejia-Rodriguez, F., Memish, Z. A., Mendoza, W., Miller, T. R., Mills, E. J., Mokdad, A. H., Mola, G. L., Monasta, L., de la Cruz Monis, J., Hernandez, J. C., Moore, A. R., Moradi-Lakeh, M., Mori, R., Mueller, U. O., Mukaigawara, M., Naheed, A., Naidoo, K. S., Nand, D., Nangia, V., Nash, D., Nejjari, C., Nelson, R. G., Neupane, S. P., Newton, C. R., Ng, M., Nieuwenhuijsen, M. J., Nisar, M. I., Nolte, S., Norheim, O. F., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Pandian, J. D., Papachristou, C., Park, J., Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Pesudovs, K., Petzold, M., Poenaru, D., Polanczyk, G. V., Polinder, S., Pope, D., Pourmalek, F., Qato, D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., ur Rahman, S., Raju, M., Rana, S. M., Refaat, A., Ronfani, L., Roy, N., Pimienta, T. G., Sahraian, M. A., Salomon, J. A., Sampson, U., Santos, I. S., Sawhney, M., Sayinzoga, F., Schneider, I. J., Schumacher, A., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shakh-Nazarova, M., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shiue, I., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Singh, J. A., Skirbekk, V., Sliwa, K., Soshnikov, S. S., Sposato, L. A., Sreeramareddy, C. T., Stroumpoulis, K., Sturua, L., Sykes, B. L., Tabb, K. M., Talongwa, R. T., Tan, F., Teixeira, C. M., Tenkorang, E. Y., Terkawi, A. S., Thorne-Lyman, A. L., Tirschwell, D. L., Towbin, J. A., Tran, B. X., Tsilimbaris, M., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Uzun, S. B., Vallely, A. J., van Gool, C. H., Vasankari, T. J., Vavilala, M. S., Venketasubramanian, N., Villalpando, S., Violante, F. S., Vlassov, V. V., Vos, T., Waller, S., Wang, H., Wang, L., Wang, X., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., Wilkinson, J. D., Woldeyohannes, S. M., Wong, J. Q., Wordofa, M. A., Xu, G., Yang, Y. C., Yano, Y., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Jin, K. Y., El Sayed Zaki, M., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zou, X. N., Lopez, A. D., Naghavi, M., Murray, C. J., Lozano, R. 2014; 384 (9947): 980-1004

    Abstract

    The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)60696-6

    View details for PubMedID 24797575

  • Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., Apfel, H., Iannarone, M., Phillips, B., Lofgren, K. T., Sandar, L., Dorrington, R. E., Rakovac, I., Jacobs, T. A., Liang, X., Zhou, M., Zhu, J., Yang, G., Wang, Y., Liu, S., Li, Y., Ozgoren, A. A., Abera, S. F., Abubakar, I., Achoki, T., Adelekan, A., Ademi, Z., Alemu, Z. A., Allen, P. J., AlMazroa, M. A., Alvarez, E., Amankwaa, A. A., Amare, A. T., Ammar, W., Anwari, P., Cunningham, S. A., Asad, M. M., Assadi, R., Banerjee, A., Basu, S., Bedi, N., Bekele, T., Bell, M. L., Bhutta, Z. Q., Blore, J. D., Basara, B. B., Boufous, S., Breitborde, N., Bruce, N. G., Linh Ngoc Bui, L. N., Carapetis, J. R., Cardenas, R., Carpenter, D. O., Caso, V., Estanislao Castro, R., Catala-Lopez, F., Cavlin, A., Che, X., Chiang, P. P., Chowdhury, R., Christophi, C. A., Chuang, T., Cirillo, M., Leite, I. d., Courville, K. J., Dandona, L., Dandona, R., Davis, A., Dayama, A., Deribe, K., Dharmaratne, S. D., Dherani, M. K., Dilmen, U., Ding, E. L., Edmond, K. M., Ermakov, S. P., Farzadfar, F., Fereshtehnejad, S., Fijabi, D. O., Foigt, N., Forouzanfar, M. H., Garcia, A. C., Geleijnse, J. M., Gessner, B. D., Goginashvili, K., Gona, P., Goto, A., Gouda, H. N., Green, M. A., Greenwell, K. F., Gugnani, H. C., Gupta, R., Hamadeh, R. R., Hammami, M., Harb, H. L., Hay, S., Hedayati, M. T., Hosgood, H. D., Hoy, D. G., Idrisov, B. T., Islami, F., Ismayilova, S., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kabagambe, E. K., Kazi, D. S., Kengne, A. P., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khang, Y., Kim, D., Kinfu, Y., Kinge, J. M., Kokubo, Y., Kosen, S., Defo, B. K., Kumar, G. A., Kumar, K., Kumar, R. B., Lai, T., Lan, Q., Larsson, A., Lee, J., Leinsalu, M., Lim, S. S., Lipshultz, S. E., Logroscino, G., Lotufo, P. A., Lunevicius, R., Lyons, R. A., Ma, S., Mahdi, A. A., Marzan, M. B., Mashal, M. T., Mazorodze, T. T., McGrath, J. J., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Miller, T. R., Mills, E. J., Mohammad, K. A., Mokdad, A. H., Monasta, L., Montico, M., Moore, A. R., Moschandreas, J., Msemburi, W. T., Mueller, U. O., Muszynska, M. M., Naghavi, M., Naidoo, K. S., Narayan, K. M., Nejjari, C., Ng, M., de Dieu Ngirabega, J., Nieuwenhuijsen, M. J., Nyakarahuka, L., Ohkubo, T., Omer, S. B., Paternina Caicedo, A. J., Pillay-Van Wyk, V., Pope, D., Pourmalek, F., Prabhakaran, D., Rahman, S. u., Rana, S. M., Reilly, R. Q., Rojas-Rueda, D., Ronfani, L., Rushton, L., Saeedi, M. Y., Salomon, J. A., Sampson, U., Santos, I. S., Sawhney, M., Schmidt, J. C., Shakh-Nazarova, M., She, J., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shishani, K., Shiue, I., Sigfusdottir, I. D., Singh, J. A., Skirbekk, V., Sliwa, K., Soshnikov, S. S., Sposato, L. A., Stathopoulou, V. K., Stroumpoulis, K., Tabb, K. M., Talongwa, R. T., Teixeira, C. M., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Toyoshima, H., Dimbuene, Z. T., Uwaliraye, P., Uzun, S. B., Vasankari, T. J., Nogales Vasconcelos, A. M., Vlassov, V. V., Vollset, S. E., Waller, S., Wan, X., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., Wilkinson, J. D., Williams, H. C., Yang, Y. C., Yentur, G. K., Yip, P., Yonemoto, N., Younis, M., Yu, C., Jin, K. Y., Zaki, M. E., Zhu, S., Vos, T., Lopez, A. D., Murray, C. J. 2014; 384 (9947): 957-979

    Abstract

    Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.Bill & Melinda Gates Foundation, US Agency for International Development.

    View details for DOI 10.1016/S0140-6736(14)60497-9

    View details for Web of Science ID 000341679700030

    View details for PubMedCentralID PMC4165626

  • Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Murray, C. J., Ortblad, K. F., Guinovart, C., Lim, S. S., Wolock, T. M., Roberts, D. A., Dansereau, E. A., Graetz, N., Barber, R. M., Brown, J. C., Wang, H., Duber, H. C., Naghavi, M., Dicker, D., Dandona, L., Salomon, J. A., Heuton, K. R., Foreman, K., Phillips, D. E., Fleming, T. D., Flaxman, A. D., Phillips, B. K., Johnson, E. K., Coggeshall, M. S., Abd-Allah, F., Abera, S. F., Abraham, J. P., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Adeyemo, A. O., Adou, A. K., Adsuar, J. C., Agardh, E. E., Akena, D., Al Kahbouri, M. J., Alasfoor, D., Albittar, M. I., Alcala-Cerra, G., Angel Alegretti, M., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allen, P. J., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Amini, H., Ammar, W., Anderson, B. O., Antonio, C. A., Anwari, P., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Badawi, A., Balakrishnan, K., Banerjee, A., Basu, S., Beardsley, J., Bekele, T., Bell, M. L., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Bin Abdulhak, A., Binagwaho, A., Blore, J. D., Basara, B. B., Bose, D., Brainin, M., Breitborde, N., Castaneda-Orjuela, C. A., Catala-Lopez, F., Chadha, V. K., Chang, J., Chiang, P. P., Chuang, T., Colomar, M., Cooper, L. T., Cooper, C., Courville, K. J., Cowie, B. C., Criqui, M. H., Dandona, R., Dayama, A., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Deribe, K., Des Jarlais, D. C., Dessalegn, M., Dharmaratne, S. D., Dilmen, U., Ding, E. L., Driscoll, T. R., Durrani, A. M., Ellenbogen, R. G., Ermakov, S. P., Esteghamati, A., Faraon, E. J., Farzadfar, F., Fereshtehnejad, S., Fijabi, D. O., Forouzanfar, M. H., Paleo, U. F., Gaffikin, L., Gamkrelidze, A., Gankpe, F. G., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Ginawi, I. A., Glaser, E. L., Gona, P., Goto, A., Gouda, H. N., Gugnani, H. C., Gupta, R., Gupta, R., Hafezi-Nejad, N., Hamadeh, R. R., Hammami, M., Hankey, G. J., Harb, H. L., Maria Haro, J., Havmoeller, R., Hay, S. I., Hedayati, M. T., Heredia Pi, I. B., Hoek, H. W., Hornberger, J. C., Hosgood, H. D., Hotez, P. J., Hoy, D. G., Huang, J. J., Iburg, K. M., Idrisov, B. T., Innos, K., Jacobsen, K. H., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kan, H., Kankindi, I., Karam, N. E., Karch, A., Karema, C. K., Kaul, A., Kawakami, N., Kazi, D. S., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Khonelidze, I., Kinfu, Y., Kinge, J. M., Knibbs, L., Kokubo, Y., Kosen, S., Defo, B. K., Kulkarni, V. S., Kulkarni, C., Kumar, K., Kumar, R. B., Kumar, G. A., Kwan, G. F., Lai, T., Balaji, A. L., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Li, Y., Li, Y., Ferreira De Lima, G. M., Lin, H., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lotufo, P. A., Pedro Machado, V. M., Maclachlan, J. H., Magis-Rodriguez, C., Majdan, M., Mapoma, C. C., Marcenes, W., Barrieotos Marzan, M., Masci, J. R., Mashal, M. T., Mason-Jones, A. J., Mayosi, B. M., Mazorodze, T. T., Mckay, A. C., Meaney, P. A., Mehndiratta, M. M., Mejia-Rodriguez, F., Melaku, Y. A., Memish, Z. A., Mendoza, W., Miller, T. R., Mills, E. J., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Montico, M., Moore, A. R., Mori, R., Moturi, W. N., Mukaigawara, M., Murthy, K. S., Naheed, A., Naidoo, K. S., Naldi, L., Nangia, V., Narayan, K. M., Nash, D., Nejjari, C., Nelson, R. G., Neupane, S. P., Newton, C. R., Ng, M., Nisar, M. I., Nolte, S., Norheim, O. F., Nowaseb, V., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Pandian, J. D., Papachristou, C., Paternina Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Pervaiz, A., Pesudovs, K., Petzold, M., Pourmalek, F., Qato, D., Quezada, A. D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rana, S. M., Razavi, H., Reilly, R. Q., Remuzzi, G., Richardus, J. H., Ronfani, L., Roy, N., Sabin, N., Saeedi, M. Y., Sahraian, M. A., Samonte, G. M., Sawhney, M., Schneider, I. J., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shiue, I., Shivakoti, R., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Simard, E. P., Singh, J. A., Skirbekk, V., Sliwa, K., Soneji, S., Soshnikov, S. S., Sreeramareddy, C. T., Stathopoulou, V. K., Stroumpoulis, K., Swaminathan, S., Sykes, B. L., Tabb, K. M., Talongwa, R. T., Tenkorang, E. Y., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Towbin, J. A., Traebert, J., Tran, B. X., Dimbuene, Z. T., Tsilimbaris, M., Uchendu, U. S., Ukwaja, K. N., Uzun, S. B., Vallely, A. J., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Waller, S., Wallin, M. T., Wang, L., Wang, X., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., White, R. A., Wilkinson, J. D., Williams, T. N., Woldeyohannes, S. M., Wong, J. Q., Xu, G., Yang, Y. C., Yano, Y., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M., Yu, C., Jin, K. Y., Zaki, M. E., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zou, X. N., Lopez, A. D., Vos, T. 2014; 384 (9947): 1005-1070

    Abstract

    The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration.To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets.Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)60844-8

    View details for Web of Science ID 000341679700032

    View details for PubMedCentralID PMC4202387

  • Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., Gonzalez-Medina, D., Barber, R., Huynh, C., Dicker, D., Templin, T., Wolock, T. M., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Abubakar, I., Achoki, T., Adelekan, A., Ademi, Z., Adou, A. K., Adsuar, J. C., Agardh, E. E., Akena, D., Alasfoor, D., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Al Kahbouri, M. J., Alla, F., Allen, P. J., AlMazroa, M. A., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Amini, H., Ammar, W., Antonio, C. A., Anwari, P., Arnlov, J., Arsic Arsenijevic, V. S., Artaman, A., Asad, M. M., Asghar, R. J., Assadi, R., Atkins, L. S., Badawi, A., Balakrishnan, K., Basu, A., Basu, S., Beardsley, J., Bedi, N., Bekele, T., Bell, M. L., Bernabe, E., Beyene, T. J., Bhutta, Z., Bin Abdulhak, A., Blore, J. D., Basara, B. B., Bose, D., Breitborde, N., Cardenas, R., Castaneda-Orjuela, C. A., Castro, R. E., Catala-Lopez, F., Cavlin, A., Chang, J., Che, X., Christophi, C. A., Chugh, S. S., Cirillo, M., Colquhoun, S. M., Cooper, L. T., Cooper, C., Leite, I. d., Dandona, L., Dandona, R., Davis, A., Dayama, A., Degenhardt, L., De Leo, D., Del Pozo-Cruz, B., Deribe, K., Dessalegn, M., deVeber, G. A., Dharmaratne, S. D., Dilmen, U., Ding, E. L., Dorrington, R. E., Driscoll, T. R., Ermakov, S. P., Esteghamati, A., Faraon, E. J., Farzadfar, F., Felicio, M. M., Fereshtehnejad, S., Ferreira De Lima, G. M., Forouzanfar, M. H., Franca, E. B., Gaffikin, L., Gambashidze, K., Gankpe, F. G., Garcia, A. C., Geleijnse, J. M., Gibney, K. B., Giroud, M., Glaser, E. L., Goginashvili, K., Gona, P., Gonzalez-Castell, D., Goto, A., Gouda, H. N., Gugnani, H. C., Gupta, R., Gupta, R., Hafezi-Nejad, N., Hamadeh, R. R., Hammami, M., Hankey, G. J., Harb, H. L., Havmoeller, R., Hay, S. I., Heredia Pi, I. B., Hoek, H. W., Hosgood, H. D., Hoy, D. G., Husseini, A., Idrisov, B. T., Innos, K., Inoue, M., Jacobsen, K. H., Jahangir, E., Jee, S. H., Jensen, P. N., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kabagambe, E. K., Kan, H., Karam, N. E., Karch, A., Karema, C. K., Kaul, A., Kawakami, N., Kazanjan, K., Kazi, D. S., Kemp, A. H., Kengne, A. P., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Knibbs, L., Kokubo, Y., Kosen, S., Defo, B. K., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kumar, K., Kumar, R. B., Kwan, G., Lai, T., Lalloo, R., Lam, H., Lansingh, V. C., Larsson, A., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Li, X., Li, Y., Li, Y., Liang, J., Liang, X., Lim, S. S., Lin, H., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., London, S. J., Lotufo, P. A., Ma, J., Ma, S., Pedro Machado, V. M., Mainoo, N. K., Majdan, M., Mapoma, C. C., Marcenes, W., Barrientos Marzan, M., Mason-Jones, A. J., Mehndiratta, M. M., Mejia-Rodriguez, F., Memish, Z. A., Mendoza, W., Miller, T. R., Mills, E. J., Mokdad, A. H., Mola, G. L., Monasta, L., de la Cruz Monis, J., Montanez Hernandez, J. C., Moore, A. R., Moradi-Lakeh, M., Mori, R., Mueller, U. O., Mukaigawara, M., Naheed, A., Naidoo, K. S., Nand, D., Nangia, V., Nash, D., Nejjari, C., Nelson, R. G., Neupane, S. P., Newton, C. R., Ng, M., Nieuwenhuijsen, M. J., Nisar, M. I., Nolte, S., Norheim, O. F., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Pandian, J. D., Papachristou, C., Park, J., Paternina Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Pesudovs, K., Petzold, M., Poenaru, D., Polanczyk, G. V., Polinder, S., Pope, D., Pourmalek, F., Qato, D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., ur Rahman, S., Raju, M., Rana, S. M., Refaat, A., Ronfani, L., Roy, N., Sanchez Pimienta, T. G., Sahraian, M. A., Salomon, J. A., Sampson, U., Santos, I. S., Sawhney, M., Sayinzoga, F., Schneider, I. J., Schumacher, A., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shakh-Nazarova, M., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shiue, I., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Singh, J. A., Skirbekk, V., Sliwa, K., Soshnikov, S. S., Sposato, L. A., Sreeramareddy, C. T., Stroumpoulis, K., Sturua, L., Sykes, B. L., Tabb, K. M., Talongwa, R. T., Tan, F., Teixeira, C. M., Tenkorang, E. Y., Terkawi, A. S., Thorne-Lyman, A. L., Tirschwell, D. L., Towbin, J. A., Tran, B. X., Tsilimbaris, M., Uchendu, U. S., Ukwaja, K. N., Undurraga, E. A., Uzun, S. B., Vallely, A. J., van Gool, C. H., Vasankari, T. J., Vavilala, M. S., Venketasubramanian, N., Villalpando, S., Violante, F. S., Vlassov, V. V., Vos, T., Waller, S., Wang, H., Wang, L., Wang, X., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., Wilkinson, J. D., Woldeyohannes, S. M., Wong, J. Q., Wordofa, M. A., Xu, G., Yang, Y. C., Yano, Y., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Jin, K. Y., Zaki, M. E., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zou, X. N., Lopez, A. D., Naghavi, M., Murray, C. J., Lozano, R. 2014; 384 (9947): 980-1004

    Abstract

    The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)60696-6

    View details for Web of Science ID 000341679700031

  • Population Health Impact and Cost-Effectiveness of Monitoring Inactive Chronic Hepatitis B and Treating Eligible Patients in Shanghai, China HEPATOLOGY Toy, M., Salomon, J. A., Jiang, H., Gui, H., Wang, H., Wang, J., Richardus, J. H., Xie, Q. 2014; 60 (1): 46-55

    Abstract

    Inactive chronic hepatitis B (CHB) carriers make up the largest group of hepatitis B virus-infected patients, and China bears the largest total CHB burden of any country. We therefore assessed the population health impact and cost-effectiveness of a strategy of lifelong monitoring for inactive CHB and treatment of eligible patients in Shanghai, China. We used a computer simulation model to project health outcomes among a population cohort of CHB based on age-specific prevalence of hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and cirrhosis. Using a Markov model we simulated patients' progression through a discrete series of health states, and compared current practice to a monitor and treat (M&T) strategy. We measured lifetime costs and quality-adjusted life years (QALYs) (both discounted at 3% per year), incremental cost-effectiveness ratios (ICERs), and clinical outcomes such as development of hepatocellular carcinoma (HCC). We estimated that there are 1.5 million CHB-infected persons in Shanghai. The M&T strategy costs US$20,730 per patient and yields a discounted QALY of 15.45, which represents incremental costs and health benefits of US$275 and 0.10 QALYs compared to current practice, and an ICER of US$2,996 per QALY gained. In the base case, we estimated that the M&T strategy will reduce HCC and CHB-related mortality by only around 1%. If variables such as adherence to monitoring and treatment could be substantially improved the M&T strategy could reduce HCC by 70% and CHB-related mortality by 83%.Lifelong monitoring of inactive CHB carriers is cost-effective in Shanghai according to typical benchmarks for value for money, but achieving substantial population-level health gains depends on identifying more CHB-infected cases in the population, and increasing rates of treatment, monitoring, and treatment adherence.

    View details for DOI 10.1002/hep.26934

    View details for Web of Science ID 000337969000010

    View details for PubMedID 24990105

  • The Hepatitis C Cascade of Care: Identifying Priorities to Improve Clinical Outcomes PLOS ONE Linas, B. P., Barter, D. M., Leff, J. A., Assoumou, S. A., Salomon, J. A., Weinstein, M. C., Kim, A. Y., Schackman, B. R. 2014; 9 (5): e97317

    Abstract

    As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them.We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation.Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs).We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals.We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost-effective. Priority should be given to developing and evaluating interventions addressing multiple points along the cascade rather than options focusing solely on single points.

    View details for PubMedID 24842841

  • The cost-effectiveness of improved hepatitis C virus therapies in HIV/hepatitis C virus coinfected patients AIDS Linas, B. P., Barter, D. M., Leff, J. A., DiLorenzo, M., Schackman, B. R., Horsburgh, C. R., Assoumou, S. A., Salomon, J. A., Weinstein, M. C., Kim, A. Y., Freedberg, K. A. 2014; 28 (3): 365–76

    Abstract

    To evaluate the effectiveness and cost-effectiveness of strategies to treat hepatitis C virus (HCV) in HIV/HCV coinfected patients in the United States.Simulated cohort of HIV/HCV genotype 1 coinfected, noncirrhotic, HCV treatment-naive individuals enrolled in US HIV guideline-concordant care.Monte Carlo simulation comparing five strategies: no treatment; dual therapy with pegylated-interferon (PEG) and ribavirin (RBV); 'PEG/RBV trial' in which all patients initiate dual therapy and switch to triple therapy upon failure; 'IL28B triage' in which patients initiate either dual therapy or triple therapy based on their IL28B allele type; and PEG/RBV and telaprevir (TPV) triple therapy. Sensitivity analyses varied efficacies and costs and included a scenario with interferon (IFN)-free therapy.Sustained virologic response (SVR), life expectancy, discounted quality-adjusted life expectancy (QALE), lifetime medical costs, and incremental cost-effectiveness ratios (ICERs) in $/quality-adjusted life years (QALY) gained.'PEG/RBV trial,' 'IL28B triage,' and 'triple therapy' each provided 72% SVR and extended QALE compared with 'dual therapy' by 1.12, 1.14, and 1.15 QALY, respectively. The ICER of 'PEG/RBV trial' compared with 'dual therapy' was $37 500/QALY. 'IL28B triage' and 'triple therapy' provided little benefit compared with 'PEG/RBV trial,' and both had ICERs exceeding $300 000/QALY. In sensitivity analyses, IFN-free treatment attaining 90% SVR had an ICER less than $100 000/QALY compared with 'PEG/RBV trial' when its cost was $109 000 or less (125% of the cost of PEG/RBV/TVR).HCV protease inhibitors are most efficiently used in HIV/HCV coinfection after a trial of PEG/RBV, sparing protease inhibitors for those who attain rapid virologic response and SVR. The cost-effectiveness of IFN-free regimens for HIV/HCV coinfection will depend on the cost of these therapies.

    View details for PubMedID 24670522

    View details for PubMedCentralID PMC4045405

  • Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models LANCET GLOBAL HEALTH Eaton, J. W., Menzies, N. A., Stover, J., Cambiano, V., Chindelevitch, L., Cori, A., Hontelez, J. A., Humair, S., Kerr, C. C., Klein, D. J., Mishra, S., Mitchell, K. M., Nichols, B. E., Vickerman, P., Bakker, R., Baernighausen, T., Bershteyn, A., Bloom, D. E., Boily, M., Chang, S. T., Cohen, T., Dodd, P. J., Fraser, C., Gopalappa, C., Lundgren, J., Martin, N. K., Mikkelsen, E., Mountain, E., Pham, Q. D., Pickles, M., Phillips, A., Platt, L., Pretorius, C., Prudden, H. J., Salomon, J. A., Van De Vijver, D. A., De Vlas, S. J., Wagner, B. G., White, R. G., Wilson, D. P., Zhang, L., Blandford, J., Meyer-Rath, G., Remme, M., Revill, P., Sangrujee, N., Terris-Prestholt, F., Doherty, M., Shaffer, N., Easterbrook, P. J., Hirnschall, G., Hallett, T. B. 2014; 2 (1): E23-E34

    Abstract

    New WHO guidelines recommend initiation of antiretroviral therapy for HIV-positive adults with CD4 counts of 500 cells per μL or less, a higher threshold than was previously recommended. Country decision makers have to decide whether to further expand eligibility for antiretroviral therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage.We used several independent mathematical models in four settings-South Africa (generalised epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)-to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μL or less, or all HIV-positive adults, compared with the previous (2010) recommendation of initiation with CD4 counts of 350 cells per μL or less. We assessed costs from a health-system perspective, and calculated the incremental cost (in US$) per disability-adjusted life-year (DALY) averted to compare competing strategies. Strategies were regarded very cost effective if the cost per DALY averted was less than the country's 2012 per-head gross domestic product (GDP; South Africa: $8040; Zambia: $1425; India: $1489; Vietnam: $1407) and cost effective if the cost per DALY averted was less than three times the per-head GDP.In South Africa, the cost per DALY averted of extending eligibility for antiretroviral therapy to adult patients with CD4 counts of 500 cells per μL or less ranged from $237 to $1691 per DALY averted compared with 2010 guidelines. In Zambia, expansion of eligibility to adults with a CD4 count threshold of 500 cells per μL ranged from improving health outcomes while reducing costs (ie, dominating the previous guidelines) to $749 per DALY averted. In both countries results were similar for expansion of eligibility to all HIV-positive adults, and when substantially expanded treatment coverage was assumed. Expansion of treatment coverage in the general population was also cost effective. In India, the cost for extending eligibility to all HIV-positive adults ranged from $131 to $241 per DALY averted, and in Vietnam extending eligibility to patients with CD4 counts of 500 cells per μL or less cost $290 per DALY averted. In concentrated epidemics, expanded access for key populations was also cost effective.Our estimates suggest that earlier eligibility for antiretroviral therapy is very cost effective in low-income and middle-income settings, although these estimates should be revisited when more data become available. Scaling up antiretroviral therapy through earlier eligibility and expanded coverage should be considered alongside other high-priority health interventions competing for health budgets.Bill & Melinda Gates Foundation, WHO.

    View details for DOI 10.1016/S2214-109X(13)70172-4

    View details for Web of Science ID 000336423900015

    View details for PubMedID 25104632

  • Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England) Wang, H. n., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., Apfel, H. n., Iannarone, M. n., Phillips, B. n., Lofgren, K. T., Sandar, L. n., Dorrington, R. E., Rakovac, I. n., Jacobs, T. A., Liang, X. n., Zhou, M. n., Zhu, J. n., Yang, G. n., Wang, Y. n., Liu, S. n., Li, Y. n., Ozgoren, A. A., Abera, S. F., Abubakar, I. n., Achoki, T. n., Adelekan, A. n., Ademi, Z. n., Alemu, Z. A., Allen, P. J., AlMazroa, M. A., Alvarez, E. n., Amankwaa, A. A., Amare, A. T., Ammar, W. n., Anwari, P. n., Cunningham, S. A., Asad, M. M., Assadi, R. n., Banerjee, A. n., Basu, S. n., Bedi, N. n., Bekele, T. n., Bell, M. L., Bhutta, Z. n., Blore, J. D., Basara, B. B., Boufous, S. n., Breitborde, N. n., Bruce, N. G., Bui, L. N., Carapetis, J. R., Cárdenas, R. n., Carpenter, D. O., Caso, V. n., Castro, R. E., Catalá-Lopéz, F. n., Cavlin, A. n., Che, X. n., Chiang, P. P., Chowdhury, R. n., Christophi, C. A., Chuang, T. W., Cirillo, M. n., da Costa Leite, I. n., Courville, K. J., Dandona, L. n., Dandona, R. n., Davis, A. n., Dayama, A. n., Deribe, K. n., Dharmaratne, S. D., Dherani, M. K., Dilmen, U. n., Ding, E. L., Edmond, K. M., Ermakov, S. P., Farzadfar, F. n., Fereshtehnejad, S. M., Fijabi, D. O., Foigt, N. n., Forouzanfar, M. H., Garcia, A. C., Geleijnse, J. M., Gessner, B. D., Goginashvili, K. n., Gona, P. n., Goto, A. n., Gouda, H. N., Green, M. A., Greenwell, K. F., Gugnani, H. C., Gupta, R. n., Hamadeh, R. R., Hammami, M. n., Harb, H. L., Hay, S. n., Hedayati, M. T., Hosgood, H. D., Hoy, D. G., Idrisov, B. T., Islami, F. n., Ismayilova, S. n., Jha, V. n., Jiang, G. n., Jonas, J. B., Juel, K. n., Kabagambe, E. K., Kazi, D. S., Kengne, A. P., Kereselidze, M. n., Khader, Y. S., Khalifa, S. E., Khang, Y. H., Kim, D. n., Kinfu, Y. n., Kinge, J. M., Kokubo, Y. n., Kosen, S. n., Defo, B. K., Kumar, G. A., Kumar, K. n., Kumar, R. B., Lai, T. n., Lan, Q. n., Larsson, A. n., Lee, J. T., Leinsalu, M. n., Lim, S. S., Lipshultz, S. E., Logroscino, G. n., Lotufo, P. A., Lunevicius, R. n., Lyons, R. A., Ma, S. n., Mahdi, A. A., Marzan, M. B., Mashal, M. T., Mazorodze, T. T., McGrath, J. J., Memish, Z. A., Mendoza, W. n., Mensah, G. A., Meretoja, A. n., Miller, T. R., Mills, E. J., Mohammad, K. A., Mokdad, A. H., Monasta, L. n., Montico, M. n., Moore, A. R., Moschandreas, J. n., Msemburi, W. T., Mueller, U. O., Muszynska, M. M., Naghavi, M. n., Naidoo, K. S., Narayan, K. M., Nejjari, C. n., Ng, M. n., de Dieu Ngirabega, J. n., Nieuwenhuijsen, M. J., Nyakarahuka, L. n., Ohkubo, T. n., Omer, S. B., Caicedo, A. J., Pillay-van Wyk, V. n., Pope, D. n., Pourmalek, F. n., Prabhakaran, D. n., Rahman, S. U., Rana, S. M., Reilly, R. Q., Rojas-Rueda, D. n., Ronfani, L. n., Rushton, L. n., Saeedi, M. Y., Salomon, J. A., Sampson, U. n., Santos, I. S., Sawhney, M. n., Schmidt, J. C., Shakh-Nazarova, M. n., She, J. n., Sheikhbahaei, S. n., Shibuya, K. n., Shin, H. H., Shishani, K. n., Shiue, I. n., Sigfusdottir, I. D., Singh, J. A., Skirbekk, V. n., Sliwa, K. n., Soshnikov, S. S., Sposato, L. A., Stathopoulou, V. K., Stroumpoulis, K. n., Tabb, K. M., Talongwa, R. T., Teixeira, C. M., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Toyoshima, H. n., Dimbuene, Z. T., Uwaliraye, P. n., Uzun, S. B., Vasankari, T. J., Vasconcelos, A. M., Vlassov, V. V., Vollset, S. E., Waller, S. n., Wan, X. n., Weichenthal, S. n., Weiderpass, E. n., Weintraub, R. G., Westerman, R. n., Wilkinson, J. D., Williams, H. C., Yang, Y. C., Yentur, G. K., Yip, P. n., Yonemoto, N. n., Younis, M. n., Yu, C. n., Jin, K. Y., El Sayed Zaki, M. n., Zhu, S. n., Vos, T. n., Lopez, A. D., Murray, C. J. 2014; 384 (9947): 957–79

    Abstract

    Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.Bill & Melinda Gates Foundation, US Agency for International Development.

    View details for PubMedID 24797572

  • Who Needs Laboratories and Who Needs Statins? Comparative and Cost-Effectiveness Analyses of Non-Laboratory-Based, Laboratory-Based, and Staged Primary Cardiovascular Disease Screening Guidelines CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES Pandya, A., Weinstein, M. C., Salomon, J. A., Cutler, D., Gaziano, T. A. 2014; 7 (1): 25–32

    Abstract

    Early detection and treatment of cardiovascular disease (CVD) risk factors produces significant clinical benefits, but no consensus exists on optimal screening algorithms. This study aimed to evaluate the comparative and cost-effectiveness of staged laboratory-based and non-laboratory-based total CVD risk assessment.We used receiver operating characteristic curve and cost-effectiveness modeling methods to compare strategies with and without laboratory components and used single-stage and multistage algorithms, including approaches based on Framingham risk scores (laboratory-based assessments for all individuals). Analyses were conducted using data from 5998 adults in the Third National Health and Nutrition Examination Survey without history of CVD using 10-year CVD death as the main outcome. A microsimulation model projected lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios for 60 Framingham-based, non-laboratory-based, and staged screening approaches. Across strategies, the area under the receiver operating characteristic curve was 0.774 to 0.780 in men and 0.812 to 0.834 in women. There were no statistically significant differences in area under the receiver operating characteristic curve between multistage and Framingham-based approaches. In cost-effectiveness analyses, multistage strategies had incremental cost-effectiveness ratios of $52,000/QALY and $83,000/QALY for men and women, respectively. Single-stage/Framingham-based strategies were dominated (higher cost and lower QALYs) or had unattractive incremental cost-effectiveness ratios (>$300,000/QALY) compared with single-stage/non-laboratory-based and multistage approaches.Non-laboratory-based CVD risk assessment can be useful in primary CVD prevention as a substitute for laboratory-based assessments or as the initial component of a multistage approach. Cost-effective multistage screening strategies could avoid 25% to 75% of laboratory testing used in CVD risk screening with predictive power comparable with Framingham risks.

    View details for DOI 10.1161/CIRCOUTCOMES.113.000397

    View details for Web of Science ID 000331071200007

    View details for PubMedID 24425701

    View details for PubMedCentralID PMC3971865

  • The potential effects of changing HIV treatment policy on tuberculosis outcomes in South Africa: results from three tuberculosis-HIV transmission models AIDS Pretorius, C., Menzies, N. A., Chindelevitch, L., Cohen, T., Cori, A., Eaton, J. W., Fraser, C., Gopalappa, C., Hallett, T. B., Salomon, J. A., Stover, J., White, R. G., Dodd, P. J. 2014; 28: S25–S34

    Abstract

    Many countries are considering expanding HIV treatment following recent findings emphasizing the effects of antiretroviral therapy (ART) on reducing HIV transmission in addition to already established survival benefits. Given the close interaction of tuberculosis (TB) and HIV epidemics, ART expansion could have important ramifications for TB burden. Previous studies suggest a wide range of possible TB impacts following ART expansion. We used three independently developed TB-HIV models to estimate the TB-related impact of expanding ART in South Africa.We considered two dimensions of ART expansion--improving coverage of pre-ART and ART services, and expanding CD4-based ART eligibility criteria (from CD4 <350 to CD4 <500 or all HIV-positive).Three independent mathematical models were calibrated to the same data pertaining to the South African HIV-TB epidemic, and used to assess standardized ART policy changes. Key TB impact indicators were projected from 2014 to 2033.Compared with current eligibility and coverage, cumulative TB incidence was projected to decline by 6-30% over the period 2014-2033 if ART eligibility were expanded to all HIV positive individuals, and by 28-37% if effective ART coverage were additionally increased to 80%. Overall, expanding ART was estimated to avert one TB case for each 10-13 additional person-years of ART. All models showed that TB incidence and mortality reductions would grow over time, but would stabilize towards the end of the projection period.ART expansion could substantially reduce TB incidence and mortality in South Africa and could provide a platform for collaborative HIV-TB programs to effectively halt HIV-associated TB.

    View details for PubMedID 24468944

  • Cost-effectiveness of monitoring inactive chronic hepatitis B and treating eligible patients in Shanghai, China Toy, M., Salomon, J. WILEY-BLACKWELL. 2013: 641–42
  • The State of US Health, 1990-2010 Burden of Diseases, Injuries, and Risk Factors JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Murray, C. J., Abraham, J., Ali, M. K., Alvarado, M., Atkinson, C., Baddour, L. M., Bartels, D. H., Benjamin, E. J., Bhalla, K., Birbeck, G., Bolliger, I., Burstein, R., Carnahan, E., Chen, H., Chou, D., Chugh, S. S., Cohen, A., Colson, K. E., Cooper, L. T., Couser, W., Criqui, M. H., Dabhadkar, K. C., Dahodwala, N., Danaei, G., Dellavalle, R. P., Des Jarlais, D. C., Dicker, D., Ding, E. L., Dorsey, R., Duber, H., Ebel, B. E., Engell, R. E., Ezzati, M., Felson, D. T., Finucane, M. M., Flaxman, S., Flaxman, A. D., Fleming, T., Forouzanfar, M. H., Freedman, G., Freeman, M. K., Gabriel, S. E., Gakidou, E., Gillum, R. F., Gonzalez-Medina, D., Gosselin, R., Grant, B., Gutierrez, H. R., Hagan, H., Havmoeller, R., Hoffman, H., Jacobsen, K. H., James, S. L., Jasrasaria, R., Jayaraman, S., Johns, N., Kassebaum, N., Khatibzadeh, S., Knowlton, L. M., Lan, Q., Leasher, J. L., Lim, S., Lin, J. K., Lipshultz, S. E., London, S., Lozano, R., Lu, Y., MacIntyre, M. F., Mallinger, L., McDermott, M. M., Meltzer, M., Mensah, G. A., Michaud, C., Miller, T. R., Mock, C., Moffitt, T. E., Mokdad, A. A., Mokdad, A. H., Moran, A. E., Mozaffarian, D., Murphy, T., Naghavi, M., Narayan, K. M., Nelson, R. G., Olives, C., Omer, S. B., Ortblad, K., Ostro, B., Pelizzari, P. M., Phillips, D., Pope, C. A., Raju, M., Ranganathan, D., Razavi, H., Ritz, B., Rivara, F. P., Roberts, T., Sacco, R. L., Salomon, J. A., Sampson, U., Sanman, E., Sapkota, A., Schwebel, D. C., Shahraz, S., Shibuya, K., Shivakoti, R., Silberberg, D., Singh, G. M., Singh, D., Singh, J. A., Sleet, D. A., Steenland, K., Tavakkoli, M., Taylor, J. A., Thurston, G. D., Towbin, J. A., Vavilala, M. S., Vos, T., Wagner, G. R., Weinstock, M. A., Weisskopf, M. G., Wilkinson, J. D., Wulf, S., Zabetian, A., Lopez, A. D. 2013; 310 (6): 591-608

    Abstract

    Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy.To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries.We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages.US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th.From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.

    View details for DOI 10.1001/jama.2013.13805

    View details for Web of Science ID 000323058400015

    View details for PubMedID 23842577

    View details for PubMedCentralID PMC5436627

  • Life expectancy in Seychelles Reply LANCET Wang, H., Salomon, J. A., Murray, C. L. 2013; 382 (9886): 23–24
  • UK health performance: findings of the Global Burden of Disease Study 2010 LANCET Murray, C. L., Richards, M. A., Newton, J. N., Fenton, K. A., Anderson, H., Atkinson, C., Bennett, D., Bernab, E., Blencowe, H., Bourne, R., Braithwaite, T., Brayne, C., Bruce, N. G., Brugha, T. S., Burney, P., Dherani, M., Dolk, H., Edmond, K., Ezzati, M., Flaxman, A. D., Fleming, T. D., Freedman, G., Gunnell, D., Hay, R. J., Hutchings, S. J., Ohno, S., Lozano, R., Lyons, R. A., Marcenes, W., Naghavi, M., Newton, C. R., Pearce, N., Pope, D., Rushton, L., Salomon, J. A., Shibuya, K., Vos, T., Wang, H., Williams, H. C., Woolf, A. D., Lopez, A. D., Davis, A. 2013; 381 (9871): 997–1020

    Abstract

    The UK has had universal free health care and public health programmes for more than six decades. Several policy initiatives and structural reforms of the health system have been undertaken. Health expenditure has increased substantially since 1990, albeit from relatively low levels compared with other countries. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to examine the patterns of health loss in the UK, the leading preventable risks that explain some of these patterns, and how UK outcomes compare with a set of comparable countries in the European Union and elsewhere in 1990 and 2010.We used results of GBD 2010 for 1990 and 2010 for the UK and 18 other comparator nations (the original 15 members of the European Union, Australia, Canada, Norway, and the USA; henceforth EU15+). We present analyses of trends and relative performance for mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 259 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to the UK. We assessed the UK's rank for age-standardised YLLs and DALYs for their leading causes compared with EU15+ in 1990 and 2010. We estimated 95% uncertainty intervals (UIs) for all measures.For both mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010. Life expectancy in the UK increased by 4·2 years (95% UI 4·2-4·3) from 1990 to 2010. However, the UK performed significantly worse than the EU15+ for age-standardised death rates, age-standardised YLL rates, and life expectancy in 1990, and its relative position had worsened by 2010. Although in most age groups, there have been reductions in age-specific mortality, for men aged 30-34 years, mortality rates have hardly changed (reduction of 3·7%, 95% UI 2·7-4·9). In terms of premature mortality, worsening ranks are most notable for men and women aged 20-54 years. For all age groups, the contributions of Alzheimer's disease (increase of 137%, 16-277), cirrhosis (65%, ?15 to 107), and drug use disorders (577%, 71-942) to premature mortality rose from 1990 to 2010. In 2010, compared with EU15+, the UK had significantly lower rates of age-standardised YLLs for road injury, diabetes, liver cancer, and chronic kidney disease, but significantly greater rates for ischaemic heart disease, chronic obstructive pulmonary disease, lower respiratory infections, breast cancer, other cardiovascular and circulatory disorders, oesophageal cancer, preterm birth complications, congenital anomalies, and aortic aneurysm. Because YLDs per person by age and sex have not changed substantially from 1990 to 2010 but age-specific mortality has been falling, the importance of chronic disability is rising. The major causes of YLDs in 2010 were mental and behavioural disorders (including substance abuse; 21·5% [95 UI 17·2-26·3] of YLDs), and musculoskeletal disorders (30·5% [25·5-35·7]). The leading risk factor in the UK was tobacco (11·8% [10·5-13·3] of DALYs), followed by increased blood pressure (9·0 % [7·5-10·5]), and high body-mass index (8·6% [7·4-9·8]). Diet and physical inactivity accounted for 14·3% (95% UI 12·8-15·9) of UK DALYs in 2010.The performance of the UK in terms of premature mortality is persistently and significantly below the mean of EU15+ and requires additional concerted action. Further progress in premature mortality from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities. The growing burden of disability, particularly from mental disorders, substance use, musculoskeletal disorders, and falls deserves an integrated and strategic response.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(13)60355-4

    View details for Web of Science ID 000316936800030

    View details for PubMedID 23668584

  • Disability weights for vision disorders in Global Burden of Disease study reply LANCET Salomon, J. A., Vos, T., Murray, C. L. 2013; 381 (9860): 23–24
  • Incorporating Loss to Follow-up in Estimates of Survival Among HIV-Infected Individuals in Sub-Saharan Africa Enrolled in Antiretroviral Therapy Programs JOURNAL OF INFECTIOUS DISEASES Verguet, S., Lim, S. S., Murray, C. L., Gakidou, E., Salomon, J. A. 2013; 207 (1): 72–79

    Abstract

    Measuring the survival of human immunodeficiency virus-infected adult patients enrolled in antiretroviral therapy (ART) programs is complicated by short observation periods and loss to follow-up. We synthesized data from treatment cohorts in sub-Saharan Africa to estimate survival over 5 years after initiation of ART.We used data on retention, mortality, and loss to follow-up from 34 cohorts, including a total of 102,306 adult patients from 18 sub-Saharan African countries. These data were augmented by data from 13 sub-Saharan African studies tracking death rates among adult patients who were lost to follow-up (LTFU). We used a Poisson regression model to estimate survival over time, incorporating predicted mortality among LTFU patients.Across studies, the median CD4(+) cell count at ART initiation was 104 cells/mm(3), 65% of patients were female, and the median age was 37 years. Survival at 1 year and 5 years were estimated to be 0.87 (95% confidence interval [CI], 0.72-0.94) and 0.70 (