Bio


Joshua Salomon is a Professor of Medicine and a core faculty member in the Center for Health Policy and the Center for Primary Care and Outcomes Research. His research focuses on priority-setting in global health, within three main substantive areas: (1) measurement and valuation of health outcomes; (2) modeling patterns and trends in major causes of global mortality and disease burden; and (3) evaluation of health interventions and policies.

Dr. Salomon is an investigator on projects funded by the Centers for Disease Control, 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.

2018-19 Courses


All Publications


  • 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

    View details for PubMedCentralID PMC6202443

  • 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 DOI 10.1177/0272989X18798833

    View details for Web of Science ID 000445463300001

    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 DOI 10.1097/QAI.0000000000001852

    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 DOI 10.1016/S2214-109X(18)30386-3

    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 DOI 10.1016/S0140-6736(18)31668-4

    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 DOI 10.1093/aje/kwy094

    View details for Web of Science ID 000443542000021

    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 DOI 10.1097/QAI.0000000000001765

    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 DOI 10.1093/cid/ciy098

    View details for Web of Science ID 000441000000015

    View details for PubMedID 29420742

    View details for PubMedCentralID PMC6070105

  • 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 DOI 10.1016/S2214-109X(18)30277-8

    View details for Web of Science ID 000438821600020

    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 Web of Science ID 000439864200024

    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 DOI 10.1016/S1473-3099(18)30134-8

    View details for Web of Science ID 000439864200002

    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 DOI 10.1186/s12916-018-1074-y

    View details for Web of Science ID 000437362000001

    View details for PubMedID 29970074

    View details for PubMedCentralID PMC6030776

  • 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 DOI 10.1093/gerona/gly145

    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 DOI 10.1371/journal.pone.0198429

    View details for Web of Science ID 000434384900044

    View details for PubMedID 29879167

    View details for PubMedCentralID PMC5991686

  • 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 DOI 10.1093/ije/dyx247

    View details for Web of Science ID 000438342200005

    View details for PubMedID 29325152

    View details for PubMedCentralID PMC6005147

  • 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 DOI 10.1001/jama.2018.0158

    View details for Web of Science ID 000429590200015

    View details for PubMedID 29634829

    View details for PubMedCentralID PMC5933332

  • 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 DOI 10.1016/S2214-109X(18)30022-6

    View details for Web of Science ID 000427125900023

    View details for PubMedID 29472018

    View details for PubMedCentralID PMC5849574

  • 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 DOI 10.1371/journal.pone.0190688

    View details for Web of Science ID 000427931600002

    View details for PubMedID 29561843

    View details for PubMedCentralID PMC5862405

  • 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 DOI 10.1093/eurpub/ckx090

    View details for Web of Science ID 000424126000022

    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

  • 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 DOI 10.1016/j.jadohealth.2017.08.028

    View details for Web of Science ID 000418488600005

    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 DOI 10.1016/j.jval.2017.07.006

    View details for Web of Science ID 000419246300013

    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 DOI 10.1186/s12877-017-0694-y

    View details for Web of Science ID 000419199700001

    View details for PubMedID 29281995

    View details for PubMedCentralID PMC5745732

  • 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 DOI 10.1377/hlthaff.2017.0684

    View details for Web of Science ID 000417164000016

    View details for PubMedID 29200354

    View details for PubMedCentralID PMC5721349

  • 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 DOI 10.1001/jamaoncol.2017.3055

    View details for Web of Science ID 000418029200017

    View details for PubMedID 28983565

    View details for PubMedCentralID PMC5824275

  • 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 DOI 10.1001/jamainternmed.2017.3941

    View details for Web of Science ID 000417000700014

    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 DOI 10.1097/MLR.0000000000000830

    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 DOI 10.1093/inFdis/jix450

    View details for Web of Science ID 000417338800013

    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 DOI 10.1016/S2214-109X(17)30341-8

    View details for Web of Science ID 000412525400025

    View details for PubMedID 29025634

    View details for PubMedCentralID PMC5640802

  • 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 DOI 10.1161/CIRCOUTCOMES.117.004094

    View details for Web of Science ID 000415956100008

    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 DOI 10.1371/journal.pone.0187347

    View details for Web of Science ID 000413861200059

    View details for PubMedID 29077762

    View details for PubMedCentralID PMC5659770

  • 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 DOI 10.1371/journal.pmed.1002397

    View details for Web of Science ID 000414064100002

    View details for PubMedID 28968399

    View details for PubMedCentralID PMC5624570

  • 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. W., Ghajar, A., Gibney, K. B., Gill, P., Gillum, R. F., Giref, A., Gishu, M., Giussani, G., Godwin, W. W., Gona, P. N., Goodridge, A., Gopalani, S., Goryakin, Y., Goulart, A., Graetz, N., Gugnani, H., Guo, J., Gupta, R., Gupta, T., Gupta, V., Gutierrez, R. A., Hachinski, V., Hafezi-Nejad, N., Hailu, G., Hamadeh, R., Hamidi, S., Hammami, M., Handal, A. J., Hankey, G. J., Harb, H. L., Hareri, H., Hassanvand, M., Havmoeller, R., Hawley, C., Hay, S. I., Hedayati, M. T., Hendrie, D., Beatriz Heredia-Pi, I., Hoek, H. W., Horita, N., Hosgood, H., Hostiuc, S., Hoy, D. G., Hsairi, M., Hu, G., Huang, H., Huang, J. J., Iburg, K., Ikeda, C., Inoue, M., Irvine, C., Jackson, M., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Jauregui, A., Javanbakht, M., Jeemon, P., Johansson, L. K., Johnson, C. O., Jonas, J. B., Jurisson, M., Kabir, Z., Kadel, R., Kahsay, A., Kamal, R., Karch, A., Karema, C., Kasaeian, A., Kassebaum, N. J., Kastor, A., Katikireddi, S., Kawakami, N., Keiyoro, P., Kelbore, S., Kemmer, L., Kengne, A., Kesavachandran, C., Khader, Y., Khalil, I. A., Khan, E., Khang, Y., Khosravi, A., Khubchandani, J., Kieling, C., Kim, D., Kim, J. Y., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kissimova-Skarbek, K. A., Kivimaki, M., Knibbs, L. D., Knudsen, A., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Kravchenko, M., Krohn, K. J., Kromhout, H., Defo, B., Bicer, B., Kumar, G., Kutz, M., Kyu, H. H., Lal, D., Lalloo, R., Lallukka, T., Lan, Q., Lansingh, V. C., Larsson, A., Lee, A., Lee, P. H., Leigh, J., Leung, J., Levi, M., Li, Y., Li, Y., Liang, X., Liben, M., Linn, S., Liu, P., Lodha, R., Logroscino, G., Looker, K. J., Lopez, A. D., Lorkowski, S., Lotufo, P. A., Lozano, R., Lunevicius, R., Macarayan, E., Abd el Razek, H., Abd el Razek, M., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malhotra, R., Malta, D., Mamun, A. A., Manguerra, H., Mantovani, L. G., Mapoma, C. C., Martin, R. V., Martinez-Raga, J., Martins-Melo, F., Mathur, M., Matsushita, K., Matzopoulos, R., Mazidi, M., McAlinden, C., McGrath, J. J., Mehata, S., Mehndiratta, M., Meier, T., Melaku, Y., Memiah, P., Memish, Z. A., Mendoza, W., Mengesha, M., Mensah, G. A., Mensink, G. M., Mereta, S., Meretoja, A., Meretoja, T. J., Mezgebe, H., Micha, R., Millear, A., Miller, T. R., Minnig, S., Mirarefin, M., Mirrakhimov, E. M., Misganaw, A., Mishra, S., Mohammad, K., Mohammed, K., Mohammed, S., Ibrahim, N., Mohan, M. V., Mokdad, A. H., Monasta, L., Montanez Hernandez, J., Montico, M., Moradi-Lakeh, M., Moraga, P., Morawska, L., Morrison, S. D., Mountjoy-Venning, C., Mueller, U. O., Mullany, E. C., Muller, K., Murthy, G., Musa, K., Naghavi, M., Naheed, A., Nangia, V., Natarajan, G., Negoi, I., Negoi, R., Cuong Tat Nguyen, Grant Nguyen, Minh Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Nichols, E., Ningrum, D., Nomura, M., Vuong Minh Nong, Norheim, O. F., Norrving, B., Noubiap, J. N., Obermeyer, C., Ogbo, F., Oh, H., Oladimeji, O., Olagunju, A., Olagunju, T., Olivares, P. R., Olsen, H. E., Olusanya, B., Olusanya, J., Opio, J., Oren, E., Ortiz, A., Ota, E., Owolabi, M. O., Pa, M., Pacella, R. E., Pana, A., Panda, B., Panda-Jonas, S., Pandian, J. D., Papachristou, C., Park, E., Parry, C. D., Patten, S. B., Patton, G. C., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M., Pillay, J., Piradov, M. A., Pishgar, F., Plass, D., Pletcher, M. A., Polinder, S., Popova, S., Poulton, R. G., Pourmalek, F., Prasad, N., Purcell, C., Qorbani, M., Radfar, A., Rafay, A., Rahimi-Movaghar, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, M., Rai, R., Rajsic, S., Ram, U., Rawaf, S., Rehm, C. D., Rehm, J., Reiner, R. C., Reitsma, M. B., Myriam Reynales-Shigematsu, L., Remuzzi, G., Renzaho, A. N., Resnikoff, S., Rezaei, S., Ribeiro, A. L., Rivera, J. A., Roba, K., Rojas-Rueda, D., Roman, Y., Room, R., Roshandel, G., Roth, G. A., Rothenbacher, D., Rubagotti, E., Rushton, L., Sadat, N., Safdarian, M., Safi, S., Safiri, S., Sahathevan, R., Salama, J., Salomon, J. A., Samy, A. M., Sanabria, J., Dolores Sanchez-Nino, M., Sanchez-Pimienta, T. G., Santomauro, D., Santos, I. S., Milicevic, M., Sartorius, B., Satpathy, M., Sawhney, M., Saxena, S., Schaeffner, E., Schmidt, M., Schneider, I. C., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Seedat, S., Sepanlou, S. G., Serdar, B., Servan-Mori, E. E., Shaddick, G., Shaheen, A., Shahraz, S., Shaikh, M., Levy, T., Shamsipour, M., Shamsizadeh, M., Islam, S., Sharma, J., Sharma, R., She, J., Shen, J., Shi, P., Shibuya, K., Shields, C., Shiferaw, M., Shigematsu, M., Shin, M., Shiri, R., Shirkoohi, R., Shishani, K., Shoman, H., Shrime, M. G., Sigfusdottir, I., Santos Silva, D., Silva, J., Alves Silveira, D., Singh, J. A., Singh, V., Sinha, D., Skiadaresi, E., Slepak, E., Smith, D. L., Smith, M., Sobaih, B. A., Sobngwi, E., Soneji, S., Sorensen, R. D., Sposato, L. A., Sreeramareddy, C. T., Srinivasan, V., Steel, N., Stein, D. J., Steiner, C., Steinke, S., Stokes, M., Strub, B., Subart, M., Sufiyan, M., Strub, B., Subart, M., Sufiyan, M., Suliankatchi, R., Sur, P. J., Swaminathan, S., Sykes, B. L., Szoeke, C. I., Tabares-Seisdedos, R., Tadakamadla, S., Takahashi, K., Takala, J. S., Tandon, N., Tanner, M., Tarekegn, Y. L., Tavakkoli, M., Tegegne, T., Tehrani-Banihashemi, A., Terkawi, A., Tesssema, B., Thakur, J. S., Thamsuwan, O., Thankappan, K., Theis, A. M., Thomas, M., Thomson, A. J., Thrift, A. G., Tillmann, T., Tobe-Gai, R., Tobollik, M., Tollanes, M. C., Tonelli, M., Topor-Madry, R., Torre, A., Tortajada, M., Touvier, M., Tran, B., Truelsen, T., Tuem, K., Tuzcu, E., Tyrovolas, S., Ukwaja, K., Uneke, C., Updike, R., Uthman, O. A., van Boven, J. M., van Donkelaar, A., Varughese, S., Vasankari, T., Veerman, L. J., Venkateswaran, V., Venketasubramanian, N., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vollset, S., Vos, T., Wadilo, F., Wakayo, T., Wallin, M. T., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Weiss, D. J., Werdecker, A., Westerman, R., Whiteford, H. A., Wiysonge, C., Woldeyes, B., Wolfe, C. A., Woodbrook, R., Workicho, A., Hanson, S., Xavier, D., Xu, G., Yadgir, S., Yakob, B., Yan, L. L., Yaseri, M., Yimam, H., Yip, P., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Zaidi, Z., Zaki, M., Zavala-Arciniega, L., Zhang, X., Zimsen, S. M., Zipkin, B., Zodpey, S., Lim, S. S., Murray, C. L., GBD Risk Factors Collaborators 2017; 390 (10100): 1345–1422

    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. W., Atey, T., Avila-Burgos, L., Avokpaho, E., Awasthi, A., Paulina, B., Quintanilla, A., Bejot, Y., Babalola, T., Bacha, U., Balakrishnan, K., Barac, A., Barboza, M. A., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Baune, B. T., Bedi, N., Beghi, E., Bekele, B., Bell, M. L., Bennett, J. R., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B., Beuran, M., Bhatt, S., Biadgilign, S., Bienhoff, K., Bikbov, B., Bisanzio, D., Bourne, R. A., Breitborde, N. K., Negesa, L., Bulto, B., Bumgarner, B. R., Butt, Z. A., Cardenas, R., Cahuana-Hurtado, L., Cameron, E., Cesar Campuzano, J., Car, J., Jesus Carrero, J., Carter, A., Casey, D. C., Castaneda-Orjuela, C. A., Catala-Lopez, F., Charlson, F. J., Chibueze, C., Chimed-Ochir, O., Chisumpa, V., Chitheer, A. A., Christopher, D., Ciobanu, L. G., Cirillo, M., Cohen, A. J., Colombara, D., Cooper, C., Cowie, B. C., Criqui, M. H., Dandona, L., Dandona, R., Dargan, P. I., das Neves, J., Davitoiu, D. V., Davletov, K., de Courten, B., Degenhardt, L., Deiparine, S., Deribe, K., Deribew, A., Dey, S., Dicker, D., Ding, E. L., Djalalinia, S., Huyen Phuc Do, Doku, D., Douwes-Schultz, D., Driscoll, T. R., Dubey, M., Duncan, B., Echko, M., El-Khatib, Z., Ellingsen, C., Enayati, A., Erskine, H. E., Eskandarieh, S., Esteghamati, A., Ermakov, S. P., Estep, K., E Sa Farinha, C., Faro, A., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S., Fernandes, J. C., Ferrari, A. J., Feyissa, T., Filip, I., Finegold, S., Fischer, F., Fitzmaurice, C., Flaxman, A. D., Foigt, N., Frank, T., Fraser, M., Fullman, N., Furst, T., Furtado, J. M., Gakidou, E., Garcia-Basteiro, A. L., Gebre, T., Gebregergs, G., Gebrehiwot, T., Gebremichael, D., Geleijnse, J. M., Genova-Maleras, R., Gesesew, H., Gething, P. W., Gillum, R. F., Ginawi, I., Giref, A., Giroud, M., Giussani, G., Godwin, W. W., Gold, A. L., Goldberg, E. M., Gona, P. N., Gopalani, S., Gouda, H. N., Goulart, A., Griswold, M., Gupta, P. C., Gupta, R., Gupta, T., Gupta, V., Haagsma, J. A., Hafezi-Nejad, N., Hailu, A., Hailu, G., Hamadeh, R., Hambisa, M., Hamidi, S., Hammami, M., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Hareri, H., Hassanvand, M., Havmoeller, R., Hay, S. I., He, F., Hedayati, M. T., Henry, N. J., Beatriz Heredia-Pi, I., Herteliu, C., Hoek, H. W., Horino, M., Horita, N., Hosgood, H., Hostiuc, S., Hotez, P. J., Hoy, D. G., Huynh, C., Iburg, K., Ikeda, C., Ileanu, B., Irenso, A., Irvine, C., Irenso, A., Irvine, C., Jurisson, M., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayaraman, S. P., Jeemon, P., Jha, V., John, D., Johnson, C. O., Johnson, S., Jonas, J. B., Kabir, Z., Kadel, R., Kahsay, A., Kamal, R., Karch, A., Karimi, S. M., Karimkhani, C., Kasaeian, A., Kassaw, N., Kassebaum, N. J., Katikireddi, S., Kawakami, N., Keiyoro, P., Kemmer, L., Kesavachandran, C., Khader, Y., Khan, E., Khang, Y., Khoja, A., Khosravi, A., Khosravi, M., Khubchandani, J., Kieling, C., Kievlan, D., Kim, D., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kissoon, N., Kivimaki, M., Knudsen, A., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Defo, B., Kulikoff, X., Kumar, G., Kumar, P., Kutz, M., Kyu, H. H., Lal, D., Lalloo, R., Lallukka, T., Lambert, N., Lan, Q., Lansingh, V. C., Larsson, A., Lee, P. H., Leigh, J., Leung, J., Levi, M., Li, Y., Kappe, D., Liang, X., Liben, M., Lim, S. S., Liu, A., Liu, P. Y., Liu, Y., Lodha, R., Logroscino, G., Lorkowski, S., Lotufo, P. A., Lozano, R., Lucas, T. D., Ma, S., Macarayan, E., Maddison, E. R., Abd el Razek, M., Majdan, M., Majdzadeh, R., Majeed, A., Malekzadeh, R., Malhotra, R., Malta, D., Manguerra, H., Manyazewal, T., Mapoma, C. C., Marczak, L. B., Markos, D., Martinez-Raga, J., Martins-Melo, F., Martopullo, I., McAlinden, C., McGaughey, M., McGrath, J. J., Mehata, S., Meier, T., Meles, K., Memiah, P., Memish, Z. A., Mengesha, M., Mengistu, D., Menota, B., Mensah, G. A., Meretoja, A., Meretoja, T. J., Millear, A., Miller, T. R., Minnig, S., Mirarefin, M., Mirrakhimov, E. M., Misganaw, A., Mishra, S., Mohammad, K., Mohammadi, A., Mohammed, S., Mokdad, A. H., Mola, G. D., Mollenkopf, S. K., Molokhia, M., Monasta, L., Montanez Hernandez, J. C., Montico, M., Mooney, M. D., Moradi-Lakeh, M., Moraga, P., Morawska, L., Morrison, S. D., Morozoff, C., Mountjoy-Venning, C., Mruts, K., Muller, K., Murthy, G., Musa, K., Nachega, J. B., Naheed, A., Naldi, L., Nangia, V., Nascimento, B., Nasher, J. T., Natarajan, G., Negoi, I., Ngunjiri, J., Cuong Tat Nguyen, Grant Nguyen, Minh Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Nichols, E., Ningrum, D., Vuong Minh Nong, Noubiap, J. N., Ogbo, F., Oh, I., Okoro, A., Olagunju, A., Olsen, H. 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 DOI 10.7448/IAS.20.1.21691

    View details for Web of Science ID 000405703200001

    View details for PubMedID 28782333

    View details for PubMedCentralID PMC5577734

  • 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 DOI 10.1016/j.jacc.2017.04.052

    View details for Web of Science ID 000404045700001

    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 DOI 10.1001/jamapediatrics.2017.0250

    View details for Web of Science ID 000402714300018

    View details for PubMedID 28384795

    View details for PubMedCentralID PMC5540012

  • 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 DOI 10.1097/HJH.0000000000001312

    View details for Web of Science ID 000401266500022

    View details for PubMedID 28441697

    View details for PubMedCentralID PMC5505070

  • 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

    View details for PubMedCentralID PMC5528124

  • 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

    View details for PubMedCentralID PMC5439023

  • 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 DOI 10.1097/OLQ.0000000000000598

    View details for Web of Science ID 000399594000005

    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 DOI 10.1016/S2213-8587(17)30015-3

    View details for Web of Science ID 000396338600013

    View details for PubMedID 28126460

    View details for PubMedCentralID PMC5354360

  • 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 DOI 10.2105/AJPH.2016.303562

    View details for Web of Science ID 000397040800038

    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 DOI 10.1097/QAI.0000000000001173

    View details for Web of Science ID 000395994500002

    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 DOI 10.5123/S1679-49742017000100023

    View details for Web of Science ID 000408708900023

    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 DOI 10.1093/ofid/ofw266

    View details for Web of Science ID 000405678200039

    View details for PubMedID 28480259

    View details for PubMedCentralID PMC5414108

  • 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 DOI 10.1371/journal.pone.0168867

    View details for Web of Science ID 000391229300035

    View details for PubMedID 28036357

    View details for PubMedCentralID PMC5201287

  • 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 DOI 10.1016/S0140-6736(16)30388-9

    View details for Web of Science ID 000389631700001

    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

  • 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 DOI 10.1371/journal.pone.0158264

    View details for Web of Science ID 000381768800004

    View details for PubMedID 27552195

    View details for PubMedCentralID PMC4995007

  • 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 DOI 10.1371/journal.pmed.1002056

    View details for Web of Science ID 000379128200008

    View details for PubMedID 27351744

    View details for PubMedCentralID PMC4924581

  • 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 DOI 10.1093/heapol/czv078

    View details for Web of Science ID 000376399500002

    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 DOI 10.1161/JAHA.115.002737

    View details for Web of Science ID 000385312200021

    View details for PubMedID 27025969

    View details for PubMedCentralID PMC4943251

  • 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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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. 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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 DOI 10.1016/S0140-6736(15)00324-4

    View details for Web of Science ID 000365993200035

    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 DOI 10.2471/BLT.14.139105

    View details for Web of Science ID 000366617900011

    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 DOI 10.1186/s12963-015-0064-y

    View details for Web of Science ID 000366082200001

    View details for PubMedID 26582970

    View details for PubMedCentralID PMC4650517

  • 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 DOI 10.1016/S2214-109X(15)00069-8

    View details for Web of Science ID 000363265000022

    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 DOI 10.1377/hlthaff.2014.1435

    View details for Web of Science ID 000361142100016

    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 DOI 10.1037/pas0000094

    View details for Web of Science ID 000360386700025

    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 DOI 10.1038/srep11205

    View details for Web of Science ID 000357262800001

    View details for PubMedID 26135810

    View details for PubMedCentralID PMC5393284

  • 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 DOI 10.1001/jamaoncol.2015.0735

    View details for Web of Science ID 000383672100019

    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 DOI 10.2471/BLT.14.146092

    View details for Web of Science ID 000358888100013

    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 DOI 10.1098/rsif.2015.0146

    View details for Web of Science ID 000353359900030

    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 DOI 10.1016/S2213-8587(15)00081-9

    View details for Web of Science ID 000353413700018

    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 Web of Science ID 000353160400005

    View details for PubMedID 25768060

    View details for PubMedCentralID PMC4396733

  • 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 DOI 10.1186/s12963-015-0042-4

    View details for Web of Science ID 000354921600001

    View details for PubMedID 26778920

    View details for PubMedCentralID PMC4715333

  • 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 DOI 10.1186/1471-2288-15-8

    View details for Web of Science ID 000349713500001

    View details for PubMedID 25656226

    View details for PubMedCentralID PMC4429465

  • 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
  • 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 DOI 10.1097/QAD.0000000000000453

    View details for Web of Science ID 000345900800011

    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 DOI 10.1371/journal.pone.0109311

    View details for Web of Science ID 000343730400050

    View details for PubMedID 25303078

    View details for PubMedCentralID PMC4193776

  • 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

    View details for PubMedCentralID PMC4202387

  • 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 DOI 10.1371/journal.pone.0097317

    View details for Web of Science ID 000340948600023

    View details for PubMedID 24842841

    View details for PubMedCentralID PMC4026319

  • 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 DOI 10.1097/QAD.0000000000000093

    View details for Web of Science ID 000331560500009

    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

  • 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 DOI 10.1097/QAD.0000000000000085

    View details for Web of Science ID 000334160100004

    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 (95% CI, 0.36-0.86), respectively, after adjustment for loss to follow-up. The life-years gained by a patient during the 5-year period after starting ART were estimated at 2.1 (95% CI, 1.6-2.3) in the adjusted model, compared with 1.7 (95% CI, 1.1-2.0) if there was 100% mortality among LTFU patients and with 2.4 (1.7-2.7) if there was 0% mortality among LTFU patients.Accounting for loss to follow-up produces substantial changes in the estimated life-years gained during the first 5 years of ART receipt.

    View details for DOI 10.1093/infdis/jis635

    View details for Web of Science ID 000312604200010

    View details for PubMedID 23100567

  • Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 LANCET Murray, C. J., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., Aboyans, V., Abraham, J., Ackerman, I., Aggarwal, R., Ahn, S. Y., Ali, M. K., Alvarado, M., Anderson, H. R., Anderson, L. M., Andrews, K. G., Atkinson, C., Baddour, L. M., Bahalim, A. N., Barker-Collo, S., Barrero, L. H., Bartels, D. H., Basanez, M., Baxter, A., Bell, M. L., Benjamin, E. J., Bennett, D., Bernabe, E., Bhalla, K., Bhandari, B., Bikbov, B., Bin Abdulhak, A., Birbeck, G., Black, J. A., Blencowe, H., Blore, J. D., Blyth, F., Bolliger, I., Bonaventure, A., Boufous, S. A., Bourne, R., Boussinesq, M., Braithwaite, T., Brayne, C., Bridgett, L., Brooker, S., Brooks, P., Brugha, T. S., Bryan-Hancock, C., Bucello, C., Buchbinder, R., Buckle, G., Budke, C. M., Burch, M., Burney, P., Burstein, R., Calabria, B., Campbell, B., Canter, C. E., Carabin, H., Carapetis, J., Carmona, L., Cella, C., Charlson, F., Chen, H., Cheng, A. T., Chou, D., Chugh, S. S., Coffeng, L. E., Colan, S. D., Colquhoun, S., Colson, K. E., Condon, J., Connor, M. D., Cooper, L. T., Corriere, M., Cortinovis, M., de Vaccaro, K. C., Couser, W., Cowie, B. C., Criqui, M. H., Cross, M., Dabhadkar, K. C., Dahiya, M., Dahodwala, N., Damsere-Derry, J., Danaei, G., Davis, A., De Leo, D., Degenhardt, L., Dellavalle, R., Delossantos, A., Denenberg, J., Derrett, S., Des Jarlais, D. C., Dharmaratne, S. D., Dherani, M., Diaz-Torne, C., Dolk, H., Dorsey, E. R., Driscoll, T., Duber, H., Ebel, B., Edmond, K., Elbaz, A., Ali, S. E., Erskine, H., Erwin, P. J., Espindola, P., Ewoigbokhan, S. E., Farzadfar, F., Feigin, V., Felson, D. T., Ferrari, A., Ferri, C. P., Fevre, E. M., Finucane, M. M., Flaxman, S., Flood, L., Foreman, K., Forouzanfar, M. H., Fowkes, F. G., Fransen, M., Freeman, M. K., Gabbe, B. J., Gabriel, S. E., Gakidou, E., Ganatra, H. A., Garcia, B., Gaspari, F., Gillum, R. F., Gmel, G., Gonzalez-Medina, D., Gosselin, R., Grainger, R., Grant, B., Groeger, J., Guillemin, F., Gunnell, D., Gupta, R., Haagsma, J., Hagan, H., Halasa, Y. A., Hall, W., Haring, D., Maria Haro, J., Harrison, J. E., Havmoeller, R., Hay, R. J., Higashi, H., Hill, C., Hoen, B., Hoffman, H., Hotez, P. J., Hoy, D., Huang, J. J., Ibeanusi, S. E., Jacobsen, K. H., James, S. L., Jarvis, D., Jasrasaria, R., Jayaraman, S., Johns, N., Jonas, J. B., Karthikeyan, G., Kassebaum, N., Kawakami, N., Keren, A., Khoo, J., King, C. H., Knowlton, L. M., Kobusingye, O., Koranteng, A., Krishnamurthi, R., Laden, F., Lalloo, R., Laslett, L. L., Lathlean, T., Leasher, J. L., Lee, Y. Y., Leigh, J., Levinson, D., Lim, S. S., Limb, E., Lin, J. K., Lipnick, M., Lipshultz, S. E., Liu, W., Loane, M., Ohno, S. L., Lyons, R., Mabweijano, J., MacIntyre, M. F., Malekzadeh, R., Mallinger, L., Manivannan, S., Marcenes, W., March, L., Margolis, D. J., Marks, G. B., Marks, R., Matsumori, A., Matzopoulos, R., Mayosi, B. M., McAnulty, J. H., McDermott, M. M., McGill, N., McGrath, J., Elena Medina-Mora, M., Meltzer, M., Mensah, G. A., Merriman, T. R., Meyer, A., Miglioli, V., Miller, M., Miller, T. R., Mitchell, P. B., Mock, C., Mocumbi, A. O., Moffitt, T. E., Mokdad, A. A., Monasta, L., Montico, M., Moradi-Lakeh, M., Moran, A., Morawska, L., Mori, R., Murdoch, M. E., Mwaniki, M. K., Naidoo, K., Nair, M. N., Naldi, L., Narayan, K. M., Nelson, P. K., Nelson, R. G., Nevitt, M. C., Newton, C. R., Nolte, S., Norman, P., Norman, R., O'Donnell, M., O'Hanlon, S., Olives, C., Omer, S. B., Ortblad, K., Osborne, R., Ozgediz, D., Page, A., Pahari, B., Pandian, J. D., Panozo Rivero, A., Patten, S. B., Pearce, N., Perez Padilla, R., Perez-Ruiz, F., Perico, N., Pesudovs, K., Phillips, D., Phillips, M. R., Pierce, K., Pion, S., Polanczyk, G. V., Polinder, S., Pope, C. A., Popova, S., Porrini, E., Pourmalek, F., Prince, M., Pullan, R. L., Ramaiah, K. D., Ranganathan, D., Razavi, H., Regan, M., Rehm, J. T., Rein, D. B., Remuzzi, G., Richardson, K., Rivara, F. P., Roberts, T., Robinson, C., Rodriguez De Leon, F., Ronfani, L., Room, R., Rosenfeld, L. C., Rushton, L., Sacco, R. L., Saha, S., Sampson, U., Sanchez-Riera, L., Sanman, E., Schwebel, D. C., Scott, J. G., Segui-Gomez, M., Shahraz, S., Shepard, D. S., Shin, H., Shivakoti, R., Singh, D., Singh, G. M., Singh, J. A., Singleton, J., Sleet, D. A., Sliwa, K., Smith, E., Smith, J. L., Stapelberg, N. J., Steer, A., Steiner, T., Stolk, W. A., Stovner, L. J., Sudfeld, C., Syed, S., Tamburlini, G., Tavakkoli, M., Taylor, H. R., Taylor, J. A., Taylor, W. J., Thomas, B., Thomson, W. M., Thurston, G. D., Tleyjeh, I. M., Tonelli, M., Towbin, J. R., Truelsen, T., Tsilimbaris, M. K., Ubeda, C., Undurraga, E. A., Van der Werf, M. J., van Os, J., Vavilala, M. S., Venketasubramanian, N., Wang, M., Wang, W., Watt, K., Weatherall, D. J., Weinstock, M. A., Weintraub, R., Weisskopf, M. G., Weissman, M. M., White, R. A., Whiteford, H., Wiebe, N., Wiersma, S. T., Wilkinson, J. D., Williams, H. C., Williams, S. R., Witt, E., Wolfe, F., Woolf, A. D., Wulf, S., Yeh, P., Zaidi, A. K., Zheng, Z., Zonies, D., Lopez, A. D. 2012; 380 (9859): 2197-2223

    Abstract

    Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time.We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights.Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions.Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000312387000016

    View details for PubMedID 23245608

  • Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden Disease Study 2010 LANCET Salomon, J. A., Wang, H., Freeman, M. K., Vos, T., Flaxman, A. D., Lopez, A. D., Murray, C. L. 2012; 380 (9859): 2144–62

    Abstract

    Healthy life expectancy (HALE) summarises mortality and non-fatal outcomes in a single measure of average population health. It has been used to compare health between countries, or to measure changes over time. These comparisons can inform policy questions that depend on how morbidity changes as mortality decreases. We characterise current HALE and changes over the past two decades in 187 countries.Using inputs from the Global Burden of Disease Study (GBD) 2010, we assessed HALE for 1990 and 2010. We calculated HALE with life table methods, incorporating estimates of average health over each age interval. Inputs from GBD 2010 included age-specific information for mortality rates and prevalence of 1160 sequelae, and disability weights associated with 220 distinct health states relating to these sequelae. We computed estimates of average overall health for each age group, adjusting for comorbidity with a Monte Carlo simulation method to capture how multiple morbidities can combine in an individual. We incorporated these estimates in the life table by the Sullivan method to produce HALE estimates for each population defined by sex, country, and year. We estimated the contributions of changes in child mortality, adult mortality, and disability to overall change in population health between 1990 and 2010.In 2010, global male HALE at birth was 58·3 years (uncertainty interval 56·7-59·8) and global female HALE at birth was 61·8 years (60·1-63·4). HALE increased more slowly than did life expectancy over the past 20 years, with each 1-year increase in life expectancy at birth associated with a 0·8-year increase in HALE. Across countries in 2010, male HALE at birth ranged from 27·9 years (17·3-36·5) in Haiti, to 68·8 years (67·0-70·4) in Japan. Female HALE at birth ranged from 37·1 years (26·9-43·7) in Haiti, to 71·7 years (69·7-73·4) in Japan. Between 1990 and 2010, male HALE increased by 5 years or more in 42 countries compared with 37 countries for female HALE, while male HALE decreased in 21 countries and 11 for female HALE. Between countries and over time, life expectancy was strongly and positively related to number of years lost to disability. This relation was consistent between sexes, in cross-sectional and longitudinal analysis, and when assessed at birth, or at age 50 years. Changes in disability had small effects on changes in HALE compared with changes in mortality.HALE differs substantially between countries. As life expectancy has increased, the number of healthy years lost to disability has also increased in most countries, consistent with the expansion of morbidity hypothesis, which has implications for health planning and health-care expenditure. Compared with substantial progress in reduction of mortality over the past two decades, relatively little progress has been made in reduction of the overall effect of non-fatal disease and injury on population health. HALE is an attractive indicator for monitoring health post-2015.The Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(12)61690-0

    View details for Web of Science ID 000312387000014

    View details for PubMedID 23245606

  • Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010 LANCET Salomon, J. A., Vos, T., Hogan, D. R., Gagnon, M., Naghavi, M., Mokdad, A., Begum, N., Shah, R., Karyana, M., Kosen, S., Farje, M., Moncada, G., Dutta, A., Sazawal, S., Dyer, A., Seiler, J., Aboyans, V., Baker, L., Baxter, A., Benjamin, E. J., Bhalla, K., Bin Abdulhak, A., Blyth, F., Bourne, R., Braithwaite, T., Brooks, P., Brugha, T. S., Bryan-Hancock, C., Buchbinder, R., Burney, P., Calabria, B., Chen, H., Chugh, S. S., Cooley, R., Criqui, M. H., Cross, M., Dabhadkar, K. C., Dahodwala, N., Davis, A., Degenhardt, L., Diaz-Torne, C., Dorsey, E., Driscoll, T., Edmond, K., Elbaz, A., Ezzati, M., Feigin, V., Ferri, C. P., Flaxman, A. D., Flood, L., Fransen, M., Fuse, K., Gabbe, B. J., Gillum, R. F., Haagsma, J., Harrison, J. E., Havmoeller, R., Hay, R. J., Hel-Baqui, A., Hoek, H. W., Hoffman, H., Hogeland, E., Hoy, D., Jarvis, D., Karthikeyan, G., Knowlton, L., Lathlean, T., Leasher, J. L., Lim, S. S., Lipshultz, S. E., Lopez, A. D., Lozano, R., Lyons, R., Malekzadeh, R., Marcenes, W., March, L., Margolis, D. J., McGill, N., McGrath, J., Mensah, G. A., Meyer, A., Michaud, C., Moran, A., Mori, R., Murdoch, M. E., Naldi, L., Newton, C. R., Norman, R., Omer, S. B., Osborne, R., Pearce, N., Perez-Ruiz, F., Perico, N., Pesudovs, K., Phillips, D., Pourmalek, F., Prince, M., Rehm, J. T., Remuzzi, G., Richardson, K., Room, R., Saha, S., Sampson, U., Sanchez-Riera, L., Segui-Gomez, M., Shahraz, S., Shibuya, K., Singh, D., Sliwa, K., Smith, E., Soerjomataram, I., Steiner, T., Stolk, W. A., Stovner, L., Sudfeld, C., Taylor, H. R., Tleyjeh, I. M., van der Werf, M. J., Watson, W. L., Weatherall, D. J., Weintraub, R., Weisskopf, M. G., Whiteford, H., Wilkinson, J. D., Woolf, A. D., Zheng, Z., Murray, C. L. 2012; 380 (9859): 2129–43

    Abstract

    Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach.We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004.13,902 individuals participated in household surveys and 16,328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously.This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(12)61680-8

    View details for Web of Science ID 000312387000013

    View details for PubMedID 23245605

  • GBD 2010: design, definitions, and metrics LANCET Murray, C. L., Ezzati, M., Flaxman, A. D., Lim, S., Lozano, R., Michaud, C., Naghavi, M., Salomon, J. A., Shibuya, K., Vos, T., Wikler, D., Lopez, A. D. 2012; 380 (9859): 2063–66
  • GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiology LANCET Murray, C. L., Ezzati, M., Flaxman, A. D., Lim, S., Lozano, R., Michaud, C., Naghavi, M., Salomon, J. A., Shibuya, K., Vos, T., Lopez, A. D. 2012; 380 (9859): 2055–58
  • Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 LANCET Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., Abraham, J., Adair, T., Aggarwal, R., Ahn, S. Y., Alvarado, M., Anderson, H. R., Anderson, L. M., Andrews, K. G., Atkinson, C., Baddour, L. M., Barker-Collo, S., Bartels, D. H., Bell, M. L., Benjamin, E. J., Bennett, D., Bhalla, K., Bikbov, B., Bin Abdulhak, A., Birbeck, G., Blyth, F., Bolliger, I., Boufous, S. A., Bucello, C., Burch, M., Burney, P., Carapetis, J., Chen, H., Chou, D., Chugh, S. S., Coffeng, L. E., Colan, S. D., Colquhoun, S., Colson, K. E., Condon, J., Connor, M. D., Cooper, L. T., Corriere, M., Cortinovis, M., de Vaccaro, K. C., Couser, W., Cowie, B. C., Criqui, M. H., Cross, M., Dabhadkar, K. C., Dahodwala, N., De Leo, D., Degenhardt, L., Delossantos, A., Denenberg, J., Des Jarlais, D. C., Dharmaratne, S. D., Dorsey, E. R., Driscoll, T., Duber, H., Ebel, B., Erwin, P. J., Espindola, P., Ezzati, M., Feigin, V., Flaxman, A. D., Forouzanfar, M. H., Fowkes, F. G., Franklin, R., Fransen, M., Freeman, M. K., Gabriel, S. E., Gakidou, E., Gaspari, F., Gillum, R. F., Gonzalez-Medina, D., Halasa, Y. A., Haring, D., Harrison, J. E., Havmoeller, R., Hay, R. J., Hoen, B., Hotez, P. J., Hoy, D., Jacobsen, K. H., James, S. L., Jasrasaria, R., Jayaraman, S., Johns, N., Karthikeyan, G., Kassebaum, N., Keren, A., Khoo, J., Knowlton, L. M., Kobusingye, O., Koranteng, A., Krishnamurthi, R., Lipnick, M., Lipshultz, S. E., Ohno, S. L., Mabweijano, J., MacIntyre, M. F., Mallinger, L., March, L., Marks, G. B., Marks, R., Matsumori, A., Matzopoulos, R., Mayosi, B. M., McAnulty, J. H., McDermott, M. M., McGrath, J., Mensah, G. A., Merriman, T. R., Michaud, C., Miller, M., Miller, T. R., Mock, C., Mocumbi, A. O., Mokdad, A. A., Moran, A., Mulholland, K., Nair, M. N., Naldi, L., Narayan, K. M., Nasseri, K., Norman, P., O'Donnell, M., Omer, S. B., Ortblad, K., Osborne, R., Ozgediz, D., Pahari, B., Pandian, J. D., Rivero, A. P., Padilla, R. P., Perez-Ruiz, F., Perico, N., Phillips, D., Pierce, K., Pope, C. A., Porrini, E., Pourmalek, F., Raju, M., Ranganathan, D., Rehm, J. T., Rein, D. B., Remuzzi, G., Rivara, F. P., Roberts, T., De Leon, F. R., Rosenfeld, L. C., Rushton, L., Sacco, R. L., Salomon, J. A., Sampson, U., Sanman, E., Schwebel, D. C., Segui-Gomez, M., Shepard, D. S., Singh, D., Singleton, J., Sliwa, K., Smith, E., Steer, A., Taylor, J. A., Thomas, B., Tleyjeh, I. M., Towbin, J. A., Truelsen, T., Undurraga, E. A., Venketasubramanian, N., Vijayakumar, L., Vos, T., Wagner, G. R., Wang, M., Wang, W., Watt, K., Weinstock, M. A., Weintraub, R., Wilkinson, J. D., Woolf, A. D., Wulf, S., Yeh, P., Yip, P., Zabetian, A., Zheng, Z., Lopez, A. D., Murray, C. J. 2012; 380 (9859): 2095-2128

    Abstract

    Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex.We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions.In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted.Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000312387000012

    View details for PubMedID 23245604

  • A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 LANCET Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., Amann, M., Anderson, H. R., Andrews, K. G., Aryee, M., Atkinson, C., Bacchus, L. J., Bahalim, A. N., Balakrishnan, K., Balmes, J., Barker-Collo, S., Baxter, A., Bell, M. L., Blore, J. D., Blyth, F., Bonner, C., Borges, G., Bourne, R., Boussinesq, M., Brauer, M., Brooks, P., Bruce, N. G., Brunekreef, B., Bryan-Hancock, C., Bucello, C., Buchbinder, R., Bull, F., Burnett, R. T., Byers, T. E., Calabria, B., Carapetis, J., Carnahan, E., Chafe, Z., Charlson, F., Chen, H., Chen, J. S., Cheng, A. T., Child, J. C., Cohen, A., Colson, K. E., Cowie, B. C., Darby, S., Darling, S., Davis, A., Degenhardt, L., Dentener, F., Des Jarlais, D. C., Devries, K., Dherani, M., Ding, E. L., Dorsey, E. R., Driscoll, T., Edmond, K., Ali, S. E., Engell, R. E., Erwin, P. J., Fahimi, S., Falder, G., Farzadfar, F., Ferrari, A., Finucane, M. M., Flaxman, S., Fowkes, F. G., Freedman, G., Freeman, M. K., Gakidou, E., Ghosh, S., Giovannucci, E., Gmel, G., Graham, K., Grainger, R., Grant, B., Gunnell, D., Gutierrez, H. R., Hall, W., Hoek, H. W., Hogan, A., Hosgood, H. D., Hoy, D., Hu, H., Hubbell, B. J., Hutchings, S. J., Ibeanusi, S. E., Jacklyn, G. L., Jasrasaria, R., Jonas, J. B., Kan, H., Kanis, J. A., Kassebaum, N., Kawakami, N., Khang, Y., Khatibzadeh, S., Khoo, J., Kok, C., Laden, F., Lalloo, R., Lan, Q., Lathlean, T., Leasher, J. L., Leigh, J., Li, Y., Lin, J. K., Lipshultz, S. E., London, S., Lozano, R., Lu, Y., Mak, J., Malekzadeh, R., Mallinger, L., Marcenes, W., March, L., Marks, R., Martin, R., McGale, P., McGrath, J., Mehta, S., Mensah, G. A., Merriman, T. R., Micha, R., Michaud, C., Mishra, V., Hanafiah, K. M., Mokdad, A. A., Morawska, L., Mozaffarian, D., Murphy, T., Naghavi, M., Neal, B., Nelson, P. K., Miquel Nolla, J., Norman, R., Olives, C., Omer, S. B., Orchard, J., Osborne, R., Ostro, B., Page, A., Pandey, K. D., Parry, C. D., Passmore, E., Patra, J., Pearce, N., Pelizzari, P. M., Petzold, M., Phillips, M. R., Pope, D., Pope, C. A., Powles, J., Rao, M., Razavi, H., Rehfuess, E. A., Rehm, J. T., Ritz, B., Rivara, F. P., Roberts, T., Robinson, C., Rodriguez-Portales, J. A., Romieu, I., Room, R., Rosenfeld, L. C., Roy, A., Rushton, L., Salomon, J. A., Sampson, U., Sanchez-Riera, L., Sanman, E., Sapkota, A., Seedat, S., Shi, P., Shield, K., Shivakoti, R., Singh, G. M., Sleet, D. A., Smith, E., Smith, K. R., Stapelberg, N. J., Steenland, K., Stoeckl, H., Stovner, L. J., Straif, K., Straney, L., Thurston, G. D., Tran, J. H., Van Dingenen, R., van Donkelaar, A., Veerman, J. L., Vijayakumar, L., Weintraub, R., Weissman, M. M., White, R. A., Whiteford, H., Wiersma, S. T., Wilkinson, J. D., Williams, H. C., Williams, W., Wilson, N., Woolf, A. D., Yip, P., Zielinski, J. M., Lopez, A. D., Murray, C. J., Ezzati, M. 2012; 380 (9859): 2224-2260

    Abstract

    Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time.We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden.In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania.Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000312387000017

    View details for PubMedID 23245609

    View details for PubMedCentralID PMC4156511

  • Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 LANCET Vos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., Aboyans, V., Abraham, J., Ackerman, I., Aggarwal, R., Ahn, S. Y., Ali, M. K., Alvarado, M., Anderson, H. R., Anderson, L. M., Andrews, K. G., Atkinson, C., Baddour, L. M., Bahalim, A. N., Barker-Collo, S., Barrero, L. H., Bartels, D. H., Basanez, M., Baxter, A., Bell, M. L., Benjamin, E. J., Bennett, D., Bernabe, E., Bhalla, K., Bhandari, B., Bikbov, B., Bin Abdulhak, A., Birbeck, G., Black, J. A., Blencowe, H., Blore, J. D., Blyth, F., Bolliger, I., Bonaventure, A., Boufous, S. A., Bourne, R., Boussinesq, M., Braithwaite, T., Brayne, C., Bridgett, L., Brooker, S., Brooks, P., Brugha, T. S., Bryan-Hancock, C., Bucello, C., Buchbinder, R., Buckle, G. R., Budke, C. M., Burch, M., Burney, P., Burstein, R., Calabria, B., Campbell, B., Canter, C. E., Carabin, H., Carapetis, J., Carmona, L., Cella, C., Charlson, F., Chen, H., Cheng, A. T., Chou, D., Chugh, S. S., Coffeng, L. E., Colan, S. D., Colquhoun, S., Colson, K. E., Condon, J., Connor, M. D., Cooper, L. T., Corriere, M., Cortinovis, M., de Vaccaro, K. C., Couser, W., Cowie, B. C., Criqui, M. H., Cross, M., Dabhadkar, K. C., Dahiya, M., Dahodwala, N., Damsere-Derry, J., Danaei, G., Davis, A., De Leo, D., Degenhardt, L., Dellavalle, R., Delossantos, A., Denenberg, J., Derrett, S., Des Jarlais, D. C., Dharmaratne, S. D., Dherani, M., Diaz-Torne, C., Dolk, H., Dorsey, E. R., Driscoll, T., Duber, H., Ebel, B., Edmond, K., Elbaz, A., Ali, S. E., Erskine, H., Erwin, P. J., Espindola, P., Ewoigbokhan, S. E., Farzadfar, F., Feigin, V., Felson, D. T., Ferrari, A., Ferri, C. P., Fevre, E. M., Finucane, M. M., Flaxman, S., Flood, L., Foreman, K., Forouzanfar, M. H., Fowkes, F. G., Franklin, R., Fransen, M., Freeman, M. K., Gabbe, B. J., Gabriel, S. E., Gakidou, E., Ganatra, H. A., Garcia, B., Gaspari, F., Gillum, R. F., Gmel, G., Gosselin, R., Grainger, R., Groeger, J., Guillemin, F., Gunnell, D., Gupta, R., Haagsma, J., Hagan, H., Halasa, Y. A., Hall, W., Haring, D., Maria Haro, J., Harrison, J. E., Havmoeller, R., Hay, R. J., Higashi, H., Hill, C., Hoen, B., Hoffman, H., Hotez, P. J., Hoy, D., Huang, J. J., Ibeanusi, S. E., Jacobsen, K. H., James, S. L., Jarvis, D., Jasrasaria, R., Jayaraman, S., Johns, N., Jonas, J. B., Karthikeyan, G., Kassebaum, N., Kawakami, N., Keren, A., Khoo, J., King, C. H., Knowlton, L. M., Kobusingye, O., Koranteng, A., Krishnamurthi, R., Lalloo, R., Laslett, L. L., Lathlean, T., Leasher, J. L., Lee, Y. Y., Leigh, J., Lim, S. S., Limb, E., Lin, J. K., Lipnick, M., Lipshultz, S. E., Liu, W., Loane, M., Ohno, S. L., Lyons, R., Ma, J., Mabweijano, J., MacIntyre, M. F., Malekzadeh, R., Mallinger, L., Manivannan, S., Marcenes, W., March, L., Margolis, D. J., Marks, G. B., Marks, R., Matsumori, A., Matzopoulos, R., Mayosi, B. M., McAnulty, J. H., McDermott, M. M., McGill, N., McGrath, J., Elena Medina-Mora, M., Meltzer, M., Mensah, G. A., Merriman, T. R., Meyer, A., Miglioli, V., Miller, M., Miller, T. R., Mitchell, P. B., Mocumbi, A. O., Moffitt, T. E., Mokdad, A. A., Monasta, L., Montico, M., Moradi-Lakeh, M., Moran, A., Morawska, L., Mori, R., Murdoch, M. E., Mwaniki, M. K., Naidoo, K., Nair, M. N., Naldi, L., Narayan, K. M., Nelson, P. K., Nelson, R. G., Nevitt, M. C., Newton, C. R., Nolte, S., Norman, P., Norman, R., O'Donnell, M., O'Hanlon, S., Olives, C., Omer, S. B., Ortblad, K., Osborne, R., Ozgediz, D., Page, A., Pahari, B., Pandian, J. D., Rivero, A. P., Patten, S. B., Pearce, N., Perez Padilla, R., Perez-Ruiz, F., Perico, N., Pesudovs, K., Phillips, D., Phillips, M. R., Pierce, K., Pion, S., Polanczyk, G. V., Polinder, S., Pope, C. A., Popova, S., Porrini, E., Pourmalek, F., Prince, M., Pullan, R. L., Ramaiah, K. D., Ranganathan, D., Razavi, H., Regan, M., Rehm, J. T., Rein, D. B., Remuzzi, G., Richardson, K., Rivara, F. P., Roberts, T., Robinson, C., De Leon, F. R., Ronfani, L., Room, R., Rosenfeld, L. C., Rushton, L., Sacco, R. L., Saha, S., Sampson, U., Sanchez-Riera, L., Sanman, E., Schwebel, D. C., Scott, J. G., Segui-Gomez, M., Shahraz, S., Shepard, D. S., Shin, H., Shivakoti, R., Singh, D., Singh, G. M., Singh, J. A., Singleton, J., Sleet, D. A., Sliwa, K., Smith, E., Smith, J. L., Stapelberg, N. J., Steer, A., Steiner, T., Stolk, W. A., Stovner, L. J., Sudfeld, C., Syed, S., Tamburlini, G., Tavakkoli, M., Taylor, H. R., Taylor, J. A., Taylor, W. J., Thomas, B., Thomson, W. M., Thurston, G. D., Tleyjeh, I. M., Tonelli, M., Towbin, J. R., Truelsen, T., Tsilimbaris, M. K., Ubeda, C., Undurraga, E. A., Van der Werf, M. J., van Os, J., Vavilala, M. S., Venketasubramanian, N., Wang, M., Wang, W., Watt, K., Weatherall, D. J., Weinstock, M. A., Weintraub, R., Weisskopf, M. G., Weissman, M. M., White, R. A., Whiteford, H., Wiersma, S. T., Wilkinson, J. D., Williams, H. C., Williams, S. R., Witt, E., Wolfe, F., Woolf, A. D., Wulf, S., Yeh, P., Zaidi, A. K., Zheng, Z., Zonies, D., Lopez, A. D., Murray, C. J. 2012; 380 (9859): 2163-2196

    Abstract

    Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs).Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis.Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa.Rates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.Bill & Melinda Gates Foundation.

    View details for Web of Science ID 000312387000015

    View details for PubMedID 23245607

  • Disease burden and mental health system capacity: WHO Atlas study of 117 low- and middle-income countries BRITISH JOURNAL OF PSYCHIATRY McBain, R., Salhi, C., Morris, J. E., Salomon, J. A., Betancourt, T. S. 2012; 201 (6): 444–50

    Abstract

    Treatment coverage for mental disorders ranges from less than 10% to more than 90% across low- and middle-income (LAMI) countries. Studies have yet to examine whether the capacity of mental health systems might be adversely affected by the burdens of unrelated conditions such as HIV/AIDS.To examine whether the magnitude of disease burden from communicable, perinatal, maternal and nutritional conditions - commonly referred to as Group 1 diseases - is inversely associated with mental health system capacity in LAMI countries.Multiple regression analyses were undertaken using data from 117 LAMI countries included in the 2011 World Health Organization (WHO) Mental Health Atlas. Capacity was defined in terms of human resources and infrastructure. Regressions controlled for effects of political stability, government health expenditures, income inequality and neuropsychiatric disease burden.Higher Group 1 disease burden was associated with fewer psychiatrists, psychologists and nurses in the mental health sector, as well as reduced numbers of out-patient facilities and psychiatric beds in mental hospitals and general hospitals (t = -2.06 to -7.68, P<0.05).Evidence suggests that mental health system capacity in LAMI countries may be adversely affected by the magnitude of their Group 1 disease burden.

    View details for DOI 10.1192/bjp.bp.112.112318

    View details for Web of Science ID 000312412100008

    View details for PubMedID 23137730

  • Modelling national HIV/AIDS epidemics: revised approach in the UNAIDS Estimation and Projection Package 2011 SEXUALLY TRANSMITTED INFECTIONS Bao, L., Salomon, J. A., Brown, T., Raftery, A. E., Hogan, D. R. 2012; 88: I3–I10

    Abstract

    United Nations Programme on HIV/AIDS reports regularly on estimated levels and trends in HIV/AIDS epidemics, which are evaluated using an epidemiological model within the Estimation and Projection Package (EPP). The relatively simple four-parameter model of HIV incidence used in EPP through the previous round of estimates has encountered challenges when attempting to fit certain data series on prevalence over time, particularly in settings with long running epidemics where prevalence has increased recently. To address this, the most recent version of the modelling package (EPP 2011) includes a more flexible epidemiological model that allows HIV infection risk to vary over time. This paper describes the technical details of this flexible approach to modelling HIV transmission dynamics within EPP 2011.For the flexible modelling approach, the force of infection parameter, r, is allowed to vary over time through a random walk formulation, and an informative prior distribution is used to improve short-term projections beyond the last year of data. Model parameters are estimated using a Bayesian estimation approach in which models are fit to HIV seroprevalence data from surveillance sites.This flexible model can yield better estimates of HIV prevalence over time in situations where the classic EPP model has difficulties, such as in Uganda, where prevalence is no longer falling. Based on formal out-of-sample projection tests, the flexible modelling approach also improves predictions and CIs for extrapolations beyond the last observed data point.We recommend use of a flexible modelling approach where data are sufficient (eg, where at least 5 years of observations are available), and particularly where an epidemic is beyond its peak.

    View details for DOI 10.1136/sextrans-2012-050637

    View details for Web of Science ID 000311338000002

    View details for PubMedID 23044436

    View details for PubMedCentralID PMC3512428

  • National HIV prevalence estimates for sub-Saharan Africa: controlling selection bias with Heckman-type selection models SEXUALLY TRANSMITTED INFECTIONS Hogan, D. R., Salomon, J. A., Canning, D., Hammitt, J. K., Zaslavsky, A. M., Baernighausen, T. 2012; 88: I17–I23

    Abstract

    Population-based HIV testing surveys have become central to deriving estimates of national HIV prevalence in sub-Saharan Africa. However, limited participation in these surveys can lead to selection bias. We control for selection bias in national HIV prevalence estimates using a novel approach, which unlike conventional imputation can account for selection on unobserved factors.For 12 Demographic and Health Surveys conducted from 2001 to 2009 (N=138 300), we predict HIV status among those missing a valid HIV test with Heckman-type selection models, which allow for correlation between infection status and participation in survey HIV testing. We compare these estimates with conventional ones and introduce a simulation procedure that incorporates regression model parameter uncertainty into confidence intervals.Selection model point estimates of national HIV prevalence were greater than unadjusted estimates for 10 of 12 surveys for men and 11 of 12 surveys for women, and were also greater than the majority of estimates obtained from conventional imputation, with significantly higher HIV prevalence estimates for men in Cote d'Ivoire 2005, Mali 2006 and Zambia 2007. Accounting for selective non-participation yielded 95% confidence intervals around HIV prevalence estimates that are wider than those obtained with conventional imputation by an average factor of 4.5.Our analysis indicates that national HIV prevalence estimates for many countries in sub-Saharan African are more uncertain than previously thought, and may be underestimated in several cases, underscoring the need for increasing participation in HIV surveys. Heckman-type selection models should be included in the set of tools used for routine estimation of HIV prevalence.

    View details for DOI 10.1136/sextrans-2012-050636

    View details for Web of Science ID 000311338000004

    View details for PubMedID 23172342

    View details for PubMedCentralID PMC3512441

  • Spline-based modelling of trends in the force of HIV infection, with application to the UNAIDS Estimation and Projection Package SEXUALLY TRANSMITTED INFECTIONS Hogan, D. R., Salomon, J. A. 2012; 88: I52–I57

    Abstract

    We previously developed a flexible specification of the UNAIDS Estimation and Projection Package (EPP) that relied on splines to generate time-varying values for the force of infection parameter. Here, we test the feasibility of this approach for concentrated HIV/AIDS epidemics with very sparse data and compare two methods for making short-term future projections with the spline-based model.Penalised B-splines are used to model the average infection risk over time within the EPP 2011 modelling framework, which includes antiretroviral treatment effects and CD4 cell count progression, and is fit to sentinel surveillance prevalence data with a Bayesian algorithm. We compare two approaches for future projections: (1) an informative prior related to equilibrium prevalence and (2) a random walk formulation.The spline-based model produced plausible fits across a range of epidemics, which included 87 subpopulations from 14 countries with concentrated epidemics and 75 subpopulations from 33 countries with generalised epidemics. The equilibrium prior and random walk approaches to future projections yielded similar prevalence estimates, and both performed well in tests of out-of-sample predictive validity for prevalence. In contrast, in some cases the two approaches varied substantially in estimates of incidence, with the random walk formulation avoiding extreme changes in incidence.A spline-based approach to allowing the force of infection parameter to vary over time within EPP 2011 is robust across a diverse array of epidemics, including concentrated ones with limited surveillance data. Future work on the EPP model should consider the impact that different modelling approaches have on estimates of HIV incidence.

    View details for DOI 10.1136/sextrans-2012-050652

    View details for Web of Science ID 000311338000008

    View details for PubMedID 23172346

    View details for PubMedCentralID PMC3512430

  • Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluation PLOS MEDICINE Menzies, N. A., Cohen, T., Lin, H., Murray, M., Salomon, J. A. 2012; 9 (11): e1001347

    Abstract

    The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World Health Organization recommends Xpert for initial diagnosis in individuals suspected of having multidrug-resistant TB (MDR-TB) or HIV-associated TB, and many countries are moving quickly toward adopting Xpert. As roll-out proceeds, it is essential to understand the potential health impact and cost-effectiveness of diagnostic strategies based on Xpert.We evaluated potential health and economic consequences of implementing Xpert in five southern African countries--Botswana, Lesotho, Namibia, South Africa, and Swaziland--where drug resistance and TB-HIV coinfection are prevalent. Using a calibrated, dynamic mathematical model, we compared the status quo diagnostic algorithm, emphasizing sputum smear, against an algorithm incorporating Xpert for initial diagnosis. Results were projected over 10- and 20-y time periods starting from 2012. Compared to status quo, implementation of Xpert would avert 132,000 (95% CI: 55,000-284,000) TB cases and 182,000 (97,000-302,000) TB deaths in southern Africa over the 10 y following introduction, and would reduce prevalence by 28% (14%-40%) by 2022, with more modest reductions in incidence. Health system costs are projected to increase substantially with Xpert, by US$460 million (294-699 million) over 10 y. Antiretroviral therapy for HIV represents a substantial fraction of these additional costs, because of improved survival in TB/HIV-infected populations through better TB case-finding and treatment. Costs for treating MDR-TB are also expected to rise significantly with Xpert scale-up. Relative to status quo, Xpert has an estimated cost-effectiveness of US$959 (633-1,485) per disability-adjusted life-year averted over 10 y. Across countries, cost-effectiveness ratios ranged from US$792 (482-1,785) in Swaziland to US$1,257 (767-2,276) in Botswana. Assessing outcomes over a 10-y period focuses on the near-term consequences of Xpert adoption, but the cost-effectiveness results are conservative, with cost-effectiveness ratios assessed over a 20-y time horizon approximately 20% lower than the 10-y values.Introduction of Xpert could substantially change TB morbidity and mortality through improved case-finding and treatment, with more limited impact on long-term transmission dynamics. Despite extant uncertainty about TB natural history and intervention impact in southern Africa, adoption of Xpert evidently offers reasonable value for its cost, based on conventional benchmarks for cost-effectiveness. However, the additional financial burden would be substantial, including significant increases in costs for treating HIV and MDR-TB. Given the fundamental influence of HIV on TB dynamics and intervention costs, care should be taken when interpreting the results of this analysis outside of settings with high HIV prevalence.

    View details for DOI 10.1371/journal.pmed.1001347

    View details for Web of Science ID 000311888800013

    View details for PubMedID 23185139

    View details for PubMedCentralID PMC3502465

  • Assessing the population health impact of market interventions to improve access to antiretroviral treatment HEALTH POLICY AND PLANNING Baernighausen, T., Kyle, M., Salomon, J. A., Waning, B. 2012; 27 (6): 467–76

    Abstract

    Despite extraordinary global progress in increasing coverage of antiretroviral treatment (ART), the majority of people needing ART currently are not receiving treatment. Both the number of people needing ART and the average ART price per patient-year are expected to increase in coming years, which will dramatically raise funding needs for ART. Several international organizations are using interventions in ART markets to decrease ART price or to improve ART quality, delivery and innovation, with the ultimate goal of improving population health. These organizations need to select those market interventions that are most likely to substantially affect population health outcomes (ex ante assessment) and to evaluate whether implemented interventions have improved health outcomes (ex post assessment). We develop a framework to structure ex ante and ex post assessment of the population health impact of market interventions, which is transmitted through effects in markets and health systems. Ex ante assessment should include evaluation of the safety and efficacy of the ART products whose markets will be affected by the intervention; theoretical consideration of the mechanisms through which the intervention will affect population health; and predictive modelling to estimate the potential population health impact of the intervention. For ex post assessment, analysts need to consider which outcomes to estimate empirically and which to model based on empirical findings and understanding of the economic and biological mechanisms along the causal pathway from market intervention to population health. We discuss methods for ex post assessment and analyse assessment issues (unintended intervention effects, interaction effects between different interventions, and assessment impartiality and cost). We offer seven recommendations for ex ante and ex post assessment of population health impact of market interventions.

    View details for DOI 10.1093/heapol/czr058

    View details for Web of Science ID 000308242200003

    View details for PubMedID 21914713

    View details for PubMedCentralID PMC3431498

  • HIV Treatment as Prevention: Systematic Comparison of Mathematical Models of the Potential Impact of Antiretroviral Therapy on HIV Incidence in South Africa PLOS MEDICINE Eaton, J. W., Johnson, L. F., Salomon, J. A., Baernighausen, T., Bendavid, E., Bershteyn, A., Bloom, D. E., Cambiano, V., Fraser, C., Hontelez, J. A., Humair, S., Klein, D. J., Long, E. F., Phillips, A. N., Pretorius, C., Stover, J., Wenger, E. A., Williams, B. G., Hallett, T. B. 2012; 9 (7)

    Abstract

    Many mathematical models have investigated the impact of expanding access to antiretroviral therapy (ART) on new HIV infections. Comparing results and conclusions across models is challenging because models have addressed slightly different questions and have reported different outcome metrics. This study compares the predictions of several mathematical models simulating the same ART intervention programmes to determine the extent to which models agree about the epidemiological impact of expanded ART.Twelve independent mathematical models evaluated a set of standardised ART intervention scenarios in South Africa and reported a common set of outputs. Intervention scenarios systematically varied the CD4 count threshold for treatment eligibility, access to treatment, and programme retention. For a scenario in which 80% of HIV-infected individuals start treatment on average 1 y after their CD4 count drops below 350 cells/µl and 85% remain on treatment after 3 y, the models projected that HIV incidence would be 35% to 54% lower 8 y after the introduction of ART, compared to a counterfactual scenario in which there is no ART. More variation existed in the estimated long-term (38 y) reductions in incidence. The impact of optimistic interventions including immediate ART initiation varied widely across models, maintaining substantial uncertainty about the theoretical prospect for elimination of HIV from the population using ART alone over the next four decades. The number of person-years of ART per infection averted over 8 y ranged between 5.8 and 18.7. Considering the actual scale-up of ART in South Africa, seven models estimated that current HIV incidence is 17% to 32% lower than it would have been in the absence of ART. Differences between model assumptions about CD4 decline and HIV transmissibility over the course of infection explained only a modest amount of the variation in model results.Mathematical models evaluating the impact of ART vary substantially in structure, complexity, and parameter choices, but all suggest that ART, at high levels of access and with high adherence, has the potential to substantially reduce new HIV infections. There was broad agreement regarding the short-term epidemiologic impact of ambitious treatment scale-up, but more variation in longer term projections and in the efficiency with which treatment can reduce new infections. Differences between model predictions could not be explained by differences in model structure or parameterization that were hypothesized to affect intervention impact.

    View details for DOI 10.1371/journal.pmed.1001245

    View details for Web of Science ID 000307106400005

    View details for PubMedCentralID PMC3393664

  • HIV Treatment as Prevention: Issues in Economic Evaluation PLOS MEDICINE Baernighausen, T., Salomon, J. A., Sangrujee, N. 2012; 9 (7): e1001263

    Abstract

    Meyer-Rath and Over assert in another article in the July 2012 PLoS Medicine Collection, "Investigating the Impact of Treatment on New HIV Infections", that economic evaluations of antiretroviral therapy (ART) in currently existing programs and in HIV treatment as prevention (TasP) programs should use cost functions that capture cost dependence on a number of factors, such as scale and scope of delivery, health states, ART regimens, health workers' experience, patients' time on treatment, and the distribution of delivery across public and private sectors. We argue that for particular evaluation purposes (e.g., to establish the social value of TasP) and from particular perspectives (e.g., national health policy makers) less detailed cost functions may be sufficient. We then extend the discussion of economic evaluation of TasP, describing why ART outcomes and costs assessed in currently existing programs are unlikely to be generalizable to TasP programs for several fundamental reasons. First, to achieve frequent, widespread HIV testing and high uptake of ART immediately following an HIV diagnosis, TasP programs will require components that are not present in current ART programs and whose costs are not included in current estimates. Second, the early initiation of ART under TasP will change not only patients' disease courses and treatment experiences--which can affect behaviors that determine clinical treatment success, such as ART adherence and retention--but also quality of life and economic outcomes for HIV-infected individuals. Third, the preventive effects of TasP are likely to alter the composition of the HIV-infected population over time, changing its biological and behavioral characteristics and leading to different costs and outcomes for ART.

    View details for DOI 10.1371/journal.pmed.1001263

    View details for Web of Science ID 000307106400019

    View details for PubMedID 22802743

    View details for PubMedCentralID PMC3393650

  • Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis BRITISH MEDICAL JOURNAL Salomon, J. A., Carvalho, N., Gutierrez-Delgado, C., Orozco, R., Mancuso, A., Hogan, D. R., Lee, D., Murakami, Y., Sridharan, L., Elena Medina-Mora, M., Gonzalez-Pier, E. 2012; 344: e355

    Abstract

    To inform decision making regarding intervention strategies against non-communicable diseases in Mexico, in the context of health reform.Cost effectiveness analysis based on epidemiological modelling.101 intervention strategies relating to nine major clusters of non-communicable disease: depression, heavy alcohol use, tobacco use, cataracts, breast cancer, cervical cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes.Mexican data sources were used for most key input parameters, including administrative registries; disease burden and population estimates; household surveys; and drug price databases. These sources were supplemented as needed with estimates for Mexico from the WHO-CHOICE unit cost database or with estimates extrapolated from the published literature.Population health outcomes, measured in disability adjusted life years (DALYs); costs in 2005 international dollars ($Int); and costs per DALY.Across 101 intervention strategies examined in this study, average yearly costs at the population level would range from around ≤$Int1m (such as for cataract surgeries) to >$Int1bn for certain strategies for primary prevention in cardiovascular disease. Wide variation also appeared in total population health benefits, from <1000 DALYs averted a year (for some components of cancer treatments or aspirin for acute ischaemic stroke) to >300,000 averted DALYs (for aggressive combinations of interventions to deal with alcohol use or cardiovascular risks). Interventions in this study spanned a wide range of average cost effectiveness ratios, differing by more than three orders of magnitude between the lowest and highest ratios. Overall, community and public health interventions such as non-personal interventions for alcohol use, tobacco use, and cardiovascular risks tended to have lower cost effectiveness ratios than many clinical interventions (of varying complexity). Even within the community and public health interventions, however, there was a 200-fold difference between the most and least cost effective strategies examined. Likewise, several clinical interventions appeared among the strategies with the lowest average cost effectiveness ratios-for example, cataract surgeries.Wide variations in costs and effects exist within and across intervention categories. For every major disease area examined, at least some strategies provided excellent value for money, including both population based and personal interventions.

    View details for DOI 10.1136/bmj.e355

    View details for Web of Science ID 000301232600001

    View details for PubMedID 22389335

    View details for PubMedCentralID PMC3292518

  • Vaccine research and development Perspective paper RETHINKHIV: SMARTER WAYS TO INVEST IN ENDING HIV IN SUB-SAHARAN AFRICA Salomon, J. A., Lomborg, B. 2012: 328–34
  • NON-MONOTONICITY IN THE EPISODIC RANDOM UTILITY MODEL HEALTH ECONOMICS Menzies, N. A., Salomon, J. A. 2011; 20 (12): 1523–31

    Abstract

    The time trade-off (TTO) is widely used in population-based surveys to estimate health-state valuations. Typically, respondents may characterize states as being better than or worse than dead. However, worse-than-dead responses can produce strongly negative mean values, so various analytic transformations of these responses have been suggested. The episodic random utility model (eRUM), operationalized using a linear regression estimator, was proposed as an alternative to these transformations, in part because of its theoretical appeal. We analyzed the eRUM estimator's mathematical properties and found that it violates monotonicity under certain patterns of survey responses, such that improvement in some individual valuations would imply a lower overall valuation for a given health state. Consequently, it is possible that orderings of alternative strategies based on eRUM valuations could lead a decision-maker to choose a strictly dominated strategy. Re-analyzing data from a large population-based EQ-5D valuation survey in the United Kingdom, we found 27% of all TTO responses (63% of all worse-than-dead responses) met the conditions for violation of monotonicity, and 74% of all respondents had at least one such response. These results present some challenge to the use of the eRUM estimator in generating health-state valuations for population health measurement and economic evaluation.

    View details for DOI 10.1002/hec.1683

    View details for Web of Science ID 000297510900008

    View details for PubMedID 22025393

    View details for PubMedCentralID PMC3289720

  • Comparability of Patient-reported Health Status Multicountry Analysis of EQ-5D Responses in Patients With Type 2 Diabetes MEDICAL CARE Salomon, J. A., Patel, A., Neal, B., Glasziou, P., Grobbee, D. E., Chalmers, J., Clarke, P. M., Adv Collaborative Grp 2011; 49 (10): 962–69

    Abstract

    Valid and comparable measures of health outcomes are needed for clinical trials, studies on quality of healthcare, and population health monitoring.To examine comparability of patient-reported health status across populations.Logistic regression analysis of health status across regions, controlling for demographics, risk factors, and clinical event history.Multicenter clinical trial in 20 countries, grouped into 3 regions defined by geography and levels of economic development (Asia, Established Market Economies, Eastern Europe).11,140 people with type 2 diabetes.Patient-reported health status in 5 domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) using EQ-5D.Examining unadjusted response probabilities, patients in Eastern Europe were consistently more likely than patients in other regions to report problems in all domains. Compared to Asia, probabilities of reporting problems at baseline in Eastern Europe were more than 3 times higher for mobility or usual activities, and more than 6 times higher for self-care. Patients in Asia were less likely than patients in Established Market Economies to report problems in all domains except anxiety/depression. Substantial regional reporting differences persisted after controlling for demographics, common risk factors, and history of major disease complications. Compared to Established Market Economies, adjusted odds ratios for reporting problems in at least 1 health domain were 1.79 (1.55 to 2.06) in Eastern Europe and 0.76 (0.67 to 0.86) in Asia.There is substantial variation across regions in reporting on functional health problems, which cannot be explained by differences in demographic variables, clinical risk factors, or rates of complications. This suggests that commonly used health status instruments may have important problems in comparability across settings.

    View details for DOI 10.1097/MLR.0b013e3182239489

    View details for Web of Science ID 000294957900013

    View details for PubMedID 21918400

  • Effects of Healthcare Reforms on Coverage, Access, and Disparities Quasi-Experimental Analysis of Evidence from Massachusetts AMERICAN JOURNAL OF PREVENTIVE MEDICINE Pande, A. H., Ross-Degnan, D., Zaslavsky, A. M., Salomon, J. A. 2011; 41 (1): 1–8

    Abstract

    The 2010 Patient Protection and Affordable Care Act (PPACA) has been controversial. The potential impact of national healthcare reform may be considered using a similar set of state-level reforms including exchanges and a mandate, enacted in 2006 in Massachusetts.To evaluate the effects of reforms on healthcare access, affordability, and disparities.Interrupted time series with comparison series.Longitudinal survey data from 2002 to 2009 from the Behavioral Risk Factor Surveillance System including 178,040 nonelderly adults residing in Massachusetts, Vermont, New Hampshire, Rhode Island, and Connecticut. Analysis was conducted from January to August 2010.Massachusetts 2006 healthcare reform, which included an individual health insurance mandate.Being uninsured, having no personal doctor, and forgoing care because of cost, evaluated in Massachusetts and four comparison states before (2002-2005) and after (2007-2009) the healthcare reform. Effects on disparities defined by race, education, income, and employment also were assessed.Living in Massachusetts in 2009 was associated with a 7.6 percentage point (95% CI=3.9, 11.3) higher probability of being insured; 4.8 percentage point (-0.9, 10.6) lower probability of forgoing care because of cost; and a 6.6 percentage point (1.9, 11.3) higher probability of having a personal doctor, compared to expected levels in the absence of reform, defined by trends in control states and adjusting for socioeconomic factors. The effects of the reform on insurance coverage attenuated from 2008 to 2009. In a socioeconomically disadvantaged group, the reforms had a greater effect in improving outcomes on the absolute but not relative scale.Healthcare reforms in Massachusetts, which included a health insurance mandate, were associated with significant increases in insurance coverage and access. The absolute effects of the reform were greater for disadvantaged populations. This is important evidence to consider as debate over national healthcare reform continues.

    View details for DOI 10.1016/j.amepre.2011.03.010

    View details for Web of Science ID 000291468700003

    View details for PubMedID 21665057

  • Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico PLOS MEDICINE Profit, J., Lee, D., Zupancic, J. A., Papile, L., Gutierrez, C., Goldie, S. J., Gonzalez-Pier, E., Salomon, J. A. 2010; 7 (12)

    Abstract

    Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses.Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis of conventional benchmarks for cost-effectiveness analysis. Please see later in the article for the Editors' Summary.

    View details for DOI 10.1371/journal.pmed.1000379

    View details for Web of Science ID 000285499600006

    View details for PubMedID 21179496

    View details for PubMedCentralID PMC3001895

  • New disability weights for the global burden of disease BULLETIN OF THE WORLD HEALTH ORGANIZATION Salomon, J. A. 2010; 88 (12): 879

    View details for DOI 10.2471/BLT.10.084301

    View details for Web of Science ID 000286029500002

    View details for PubMedID 21124707

    View details for PubMedCentralID PMC2995197

  • Modelling HIV epidemics in the antiretroviral era: the UNAIDS Estimation and Projection package 2009 SEXUALLY TRANSMITTED INFECTIONS Brown, T., Bao, L., Raftery, A. E., Salomon, J. A., Baggaley, R. F., Stover, J., Gerland, P. 2010; 86: I3–I10

    Abstract

    The UNAIDS Estimation and Projection Package (EPP) is a tool for country-level estimation and short-term projection of HIV/AIDS epidemics based on fitting observed HIV surveillance data on prevalence. This paper describes the adaptations made in EPP 2009, the latest version of this tool, as new issues have arisen in the global response, in particular the global expansion of antiretroviral therapy (ART).By December 2008 over 4 million people globally were receiving ART, substantially improving their survival. EPP 2009 required modifications to correctly adjust for the effects of ART on incidence and the resulting increases in HIV prevalence in populations with high ART coverage. Because changing incidence is a better indicator of program impact, the 2009 series of UNAIDS tools also focuses on calculating incidence alongside prevalence. Other changes made in EPP 2009 include: an improved procedure, incremental mixture importance sampling, for efficiently generating more accurate uncertainty estimates; provisions to vary the urban/rural population ratios in generalised epidemics over time; introduction of a modified epidemic model that accommodates behaviour change in low incidence settings; and improved procedures for calibrating models. This paper describes these changes in detail, and discusses anticipated future changes in the next version of EPP.

    View details for DOI 10.1136/sti.2010.044784

    View details for Web of Science ID 000284572700006

    View details for PubMedID 20929855

    View details for PubMedCentralID PMC3173807

  • Flexible epidemiological model for estimates and short-term projections in generalised HIV/AIDS epidemics SEXUALLY TRANSMITTED INFECTIONS Hogan, D. R., Zaslavsky, A. M., Hammitt, J. K., Salomon, J. A. 2010; 86: I84–I92

    Abstract

    UNAIDS and country analysts use a simple infectious disease model, embedded in the Estimation and Projection Package (EPP), to generate annual updates on the global HIV/AIDS epidemic. Our objective was to develop modifications to the current model that improve fit to recently observed prevalence trends across countries.Our proposed alternative to the current EPP approach simplifies the model structure and explicitly models changes in average infection risk over time, operationalised using penalised B-splines in a Bayesian framework. We also present an alternative approach to initiating the epidemic that improves standardisation and efficiency, and add an informative prior distribution for changes in infection risk beyond the last data point that enhances the plausibility of short-term extrapolations.The spline-based model produces better fits than the current model to observed prevalence trends in settings that have recently experienced levelling or rising prevalence following a steep decline, such as Uganda and urban Rwanda. The model also predicts a deceleration of the decline in prevalence for countries with recent experience of steady declines, such as Kenya and Zimbabwe. Estimates and projections from our alternative model are comparable to those from the current model where the latter performs well.A more flexible epidemiological model that accommodates changing infection risk over time can provide better estimates and short-term projections of HIV/AIDS incidence, prevalence and mortality than the current EPP model. The alternative model specification can be incorporated easily into existing analytical tools that are used to produce updates on the global HIV/AIDS epidemic.

    View details for DOI 10.1136/sti.2010.045104

    View details for Web of Science ID 000284572700014

    View details for PubMedID 21106520

    View details for PubMedCentralID PMC3173822

  • Quantifying Child Mortality Reductions Related to Measles Vaccination PLOS ONE Goldhaber-Fiebert, J. D., Lipsitch, M., Mahal, A., Zaslavsky, A. M., Salomon, J. A. 2010; 5 (11)

    Abstract

    This study characterizes the historical relationship between coverage of measles containing vaccines (MCV) and mortality in children under 5 years, with a view toward ongoing global efforts to reduce child mortality.Using country-level, longitudinal panel data, from 44 countries over the period 1960-2005, we analyzed the relationship between MCV coverage and measles mortality with (1) logistic regressions for no measles deaths in a country-year, and (2) linear regressions for the logarithm of the measles death rate. All regressions allowed a flexible, non-linear relationship between coverage and mortality. Covariates included birth rate, death rates from other causes, percent living in urban areas, population density, per-capita GDP, use of the two-dose MCV, year, and mortality coding system. Regressions used lagged covariates, country fixed effects, and robust standard errors clustered by country. The likelihood of no measles deaths increased nonlinearly with higher MCV coverage (ORs: 13.8 [1.6-122.7] for 80-89% to 40.7 [3.2-517.6] for ≥95%), compared to pre-vaccination risk levels. Measles death rates declined nonlinearly with higher MCV coverage, with benefits accruing more slowly above 90% coverage. Compared to no coverage, predicted average reductions in death rates were -79% at 70% coverage, -93% at 90%, and -95% at 95%.40 years of experience with MCV vaccination suggests that extremely high levels of vaccination coverage are needed to produce sharp reductions in measles deaths. Achieving sustainable benefits likely requires a combination of extended vaccine programs and supplementary vaccine efforts.

    View details for DOI 10.1371/journal.pone.0013842

    View details for Web of Science ID 000283838600016

    View details for PubMedID 21079809

    View details for PubMedCentralID PMC2973966

  • Exploring Model Uncertainty in Economic Evaluation of Health Interventions: The Example of Rotavirus Vaccination in Vietnam MEDICAL DECISION MAKING Kim, S., Goldie, S. J., Salomon, J. A. 2010; 30 (5): E1–E28

    Abstract

    Motivated by observed discrepancies between 2 published studies on the cost-effectiveness of rotavirus vaccination in Vietnam, the authors' objectives were to illustrate a specific, systematic approach to assessing model (structure and process) uncertainty and to quantify explicitly the contributions of different sources of variation in the outputs of different studies that share the same research question.On the basis of a series of working definitions of key model elements, the authors developed 5 alternative computer simulation (state-transition) models of rotavirus disease. They examined how epidemiological outcomes and cost-effectiveness ratios associated with rotavirus vaccination would change as elements of model structure and modeling process were progressively modified. They also explicitly decomposed the relative contributions of different modeling elements to differences in the cost-effectiveness results between the 2 previous analyses motivating the present study.The findings suggest that within the category of a static, deterministic, aggregate-level model, different choices in model structure and process lead to relatively modest differences in the estimated cost-effectiveness of rotavirus vaccination, but that intermediate epidemiologic outcomes vary more substantially depending on the choice of model structure.The authors caution against generalizing the quantitative results in this study beyond the present example but suggest that the approach presented here may serve as a template for other examinations of model uncertainty. As new research questions arise after the introduction of rotavirus vaccination programs, a reevaluation of model uncertainty is likely to be needed.

    View details for DOI 10.1177/0272989X10375579

    View details for Web of Science ID 000283174800001

    View details for PubMedID 20729510

  • Preferences for health outcomes associated with Group A Streptococcal disease and vaccination HEALTH AND QUALITY OF LIFE OUTCOMES Lee, G. M., Salomon, J. A., Gay, C., Hammitt, J. K. 2010; 8

    Abstract

    A 26-valent Group A Streptococcus (GAS) vaccine candidate has been developed that may provide protection against pharyngitis, invasive disease and rheumatic fever. However, recommendations for the use of a new vaccine must be informed by a range of considerations, including parents' preferences for different relevant health outcomes. Our objectives were to: (1) describe parent preferences for GAS disease and vaccination using willingness-to-pay (WTP) and time trade-off (TTO) methods; and (2) understand how parents' implied WTP for a quality-adjusted life year (QALY) gained might vary depending on the particular health outcome considered (e.g. averted GAS disease vs. vaccine adverse events).Telephone interviews were conducted with parents of children diagnosed with GAS pharyngitis at 2 pediatric practice sites in the Boston metropolitan area. WTP and TTO (trading parental longevity for child's health) questions for 2 vaccine and 4 disease-associated health states were asked using a randomly selected opening bid, followed by a 2nd bid and a final open-ended question about the amount willing to pay or trade. Descriptive analyses included medians and interquartile ranges for WTP and TTO estimates. The Wilcoxon signed-rank test was used to assess differences in WTP/QALY values for vaccine adverse events vs. disease states.Of 119 respondents, 100 (84%) and 96 (81%) provided a complete set of responses for WTP and TTO questions, respectively. The median WTP and discounted (at 3% per year) TTO values to avoid each health state were as follows: local reaction, $30, 0.12 days; systemic reaction, $50, 0.22 days; impetigo, $75, 1.25 days; strep throat, $75, 2.5 days; septic arthritis, $1,000, 6.6 days; and toxic shock syndrome, $3,000, 31.0 days. The median WTP/QALY was significantly higher for vaccine adverse events (approximately $60,000/QALY) compared to disease states ($18,000 to $36,000/QALY).Parents strongly prefer to prevent GAS disease in children compared to vaccine adverse events. However, implied WTP/QALY ratios were higher for the prevention of vaccine adverse events. Regret for errors of commission vs. omission may differ and should be considered by vaccine policymakers.

    View details for DOI 10.1186/1477-7525-8-28

    View details for Web of Science ID 000276380200001

    View details for PubMedID 20226042

    View details for PubMedCentralID PMC2848145

  • Causes of deaths in children younger than 5 years in China in 2008 LANCET Rudan, I., Chan, K., Zhang, J. F., Theodoratou, E., Feng, X., Salomon, J. A., Lawn, J. E., Cousens, S., Black, R. E., Guo, Y., Campbell, H., WHO UNICEF's CHERG 2010; 375 (9720): 1083–89

    Abstract

    Previous estimates of the global burden of disease for children have not included much information from China, leading to a large gap in data. We identified the main causes of deaths in neonates (<1 month), postneonatal infants (1-11 months), and children (<5 years) in China using information that was available to the public.The Child Health Epidemiology Reference Group in collaboration with colleagues from Peking University systematically searched Chinese databases that were available to the public. Information was obtained from the Chinese Ministry of Health and Bureau of Statistics websites, Chinese National Knowledge Infrastructure database, and Chinese Health Statistics yearbooks for 1990-2008. We also obtained information from 206 high-quality community-based longitudinal studies of different causes of deaths in children (<5 years) that were written in the Chinese language. A statistical model was developed to estimate the total number of deaths in children according to provinces, age groups, and main causes.During 1990-2008, the mortality rates in neonates, postneonatal infants, and children were reduced by 70% (from 34.0 to 10.2 per 1000 livebirths), 72% (from 53.5 to 14.9 per 1000 livebirths), and 71% (from 64.6 to 18.5 per 1000 livebirths), respectively, meeting the targets set in the Millennium Development Goal 4. The leading causes of deaths in 2008 were pneumonia, birth asphyxia, and preterm birth complications, each accounting for 15-17% of all deaths. Congenital abnormalities and accidents increased in importance during this period, contributing to 11% and 10% of child deaths, respectively. Sudden infant death syndrome contributed to 5% of deaths in children.Publically available Chinese databases contain much important information that has been underused in the estimation of global and regional burden of disease. On the basis of trends, preterm birth complications are expected to become the leading cause of child mortality in China, whereas deaths from congenital abnormalities, accidents, and sudden infant death syndrome are predicted to continue increasing in importance in the long term.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(10)60060-8

    View details for Web of Science ID 000276334600031

    View details for PubMedID 20346815

  • Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis PLOS MEDICINE Clarke, P. M., Glasziou, P., Patel, A., Chalmers, J., Woodward, M., Harrap, S. B., Salomon, J. A., ADV Collaborative Grp 2010; 7 (2): e1000236

    Abstract

    Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$), which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions) and lowest for nephropathy (15%-26%). The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across region) and heart failure (16-31 d) and lowest for nephropathy (12-23 d). Considering regional differences, probabilities of hospitalization were lowest in Asia and highest in Established Market Economies; on the other hand, lengths of stay were highest in Asia and lowest in Established Market Economies. Overall estimated annual hospital costs for patients with none of the specified events or event histories ranged from Int$76 in Asia to Int$296 in Established Market Economies. All complications included in this analysis led to significant increases in hospital costs; coronary events, cerebrovascular events, and heart failure were the most costly, at more than Int$1,800, Int$3,000, and Int$4,000 in Asia, Eastern Europe, and Established Market Economies, respectively.Major complications of diabetes significantly increase hospital use and costs across various settings and are likely to impose a high economic burden on health care systems.

    View details for DOI 10.1371/journal.pmed.1000236

    View details for Web of Science ID 000275295600012

    View details for PubMedID 20186272

    View details for PubMedCentralID PMC2826379

  • RE: "ARE AMERICANS FEELING LESS HEALTHY? THE PUZZLE OF TRENDS IN SELF-RATED HEALTH" REPLY AMERICAN JOURNAL OF EPIDEMIOLOGY Salomon, J. A. 2009; 170 (12): 1582A–1583

    View details for DOI 10.1093/aje/kwp369

    View details for Web of Science ID 000272463600019

  • Are Americans Feeling Less Healthy? The Puzzle of Trends in Self-rated Health AMERICAN JOURNAL OF EPIDEMIOLOGY Salomon, J. A., Nordhagen, S., Oza, S., Murray, C. L. 2009; 170 (3): 343–51

    Abstract

    Although self-rated health is proposed for use in public health monitoring, previous reports on US levels and trends in self-rated health have shown ambiguous results. This study presents a comprehensive comparative analysis of responses to a common self-rated health question in 4 national surveys from 1971 to 2007: the National Health and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, and Current Population Survey. In addition to variation in the levels of self-rated health across surveys, striking discrepancies in time trends were observed. Whereas data from the Behavioral Risk Factor Surveillance System demonstrate that Americans were increasingly likely to report "fair" or "poor" health over the last decade, those from the Current Population Survey indicate the opposite trend. Subgroup analyses revealed that the greatest inconsistencies were among young respondents, Hispanics, and those without a high school education. Trends in "fair" or "poor" ratings were more inconsistent than trends in "excellent" ratings. The observed discrepancies elude simple explanations but suggest that self-rated health may be unsuitable for monitoring changes in population health over time. Analyses of socioeconomic disparities that use self-rated health may be particularly vulnerable to comparability problems, as inconsistencies are most pronounced among the lowest education group. More work is urgently needed on robust and comparable approaches to tracking population health.

    View details for DOI 10.1093/aje/kwp144

    View details for Web of Science ID 000268330300010

    View details for PubMedID 19564169

    View details for PubMedCentralID PMC2714952

  • Tracking Population Health Based on Self-reported Impairments: Trends in the Prevalence of Hearing Loss in US Adults, 1976-2006 AMERICAN JOURNAL OF EPIDEMIOLOGY Ikeda, N., Murray, C. L., Salomon, J. A. 2009; 170 (1): 80–87

    Abstract

    Trends in the prevalence of hearing loss among US adults remain ambiguous because of variation across surveys in question wording and limited use of audiometric examinations. Pooling samples of participants aged 20-69 years in 4 nationally representative cross-sectional survey series conducted from 1976 to 2006 (N = 990,609), the authors performed logistic regression to quantify self-reporting biases compared with audiometric measurements. Statistically significant underreporting or overreporting of hearing loss was observed, with various patterns of bias across age groups and surveys. Substantial upward reporting biases appeared among young adults in the National Health and Nutrition Examination Survey since 1999 and in the National Health Interview Survey since 1997. Trends in age-standardized prevalence of bilateral hearing loss were estimated with corrections for self-reporting biases. Prevalence in men shifted from 9.6% (95% confidence interval (CI): 7.8, 11.8) in 1978 to 12.2% (95% CI: 10.1, 14.7) in 1993 and declined to 8.1% (95% CI: 7.0, 9.5) in 2000. In women, prevalence was relatively constant at approximately 6%-7% until the early 1990s and decreased from 7.0% (95% CI: 5.5, 9.1) in 1993 to 4.2% (95% CI: 3.4, 5.3) in 2000. Prevalence was stable in both sexes in the early 2000s. This approach to adjust for biases in self-reported impairments by using measured performance may be useful in various health domains.

    View details for DOI 10.1093/aje/kwp097

    View details for Web of Science ID 000267440200010

    View details for PubMedID 19451176

  • Keep it simple: Ranking health states yields values similar to cardinal measurement approaches JOURNAL OF CLINICAL EPIDEMIOLOGY Craig, B. M., Busschbach, J. V., Salomon, J. A. 2009; 62 (3): 296–305

    Abstract

    To examine the relationship between ordinal and cardinal valuation of health states.We analyzed rank, visual analog scale (VAS), and time trade-off (TTO) responses for 52 health states defined using the EQ-5D classification system developed by the EuroQol Group. We analyzed 179,431 responses from 11,483 subjects in eight countries: Slovenia, Argentina, Denmark, Japan, Netherlands, Spain, United Kingdom, and United States. We first compared responses across methods by frequency of ties and values below dead. Ordinal associations between methods were evaluated using Spearman's correlation and Kendall's tau. Next, we estimated numerical values from rank responses using country-specific conditional logit models. After anchoring predicted values on a common scale, we further investigated the cardinal relationships between rank, VAS, and TTO-based values using Pearson's rho and quadratic regression.For each country, rank responses are less likely than TTO responses to be tied and to indicate that states are worse than dead. In all countries, rank responses show a strong linear correlation with both TTO (Pearson's rho=0.88-0.99) and VAS (rho=0.91-0.98) responses. However, rank-based values imply greater decrements in health for mild states than cardinal values.Illiteracy and innumeracy can hinder implementation of complex preference elicitation techniques in diverse settings and populations. These results indicate that ranking exercises may provide an attractive alternative for health-state valuation.

    View details for DOI 10.1016/j.jclinepi.2008.07.002

    View details for Web of Science ID 000263427500009

    View details for PubMedID 18945585

    View details for PubMedCentralID PMC2766172

  • Cost-effectiveness of Rotavirus vaccination in Vietnam BMC PUBLIC HEALTH Kim, S., Goldie, S. J., Salomon, J. A. 2009; 9: 29

    Abstract

    Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. New rotavirus vaccines have recently been approved. Some previous studies have provided broad qualitative insights into the health and economic consequences of introducing the vaccines into low-income countries, representing several features of rotavirus infection, such as varying degrees of severity and age-dependency of clinical manifestation, in their model-based analyses. We extend this work to reflect additional features of rotavirus (e.g., the possibility of reinfection and varying degrees of partial immunity conferred by natural infection), and assess the influence of the features on the cost-effectiveness of rotavirus vaccination.We developed a Markov model that reflects key features of rotavirus infection, using the most recent data available. We applied the model to the 2004 Vietnamese birth cohort and re-evaluated the cost-effectiveness (2004 US dollars per disability-adjusted life year [DALY]) of rotavirus vaccination (Rotarix) compared to no vaccination, from both societal and health care system perspectives. We conducted univariate sensitivity analyses and also performed a probabilistic sensitivity analysis, based on Monte Carlo simulations drawing parameter values from the distributions assigned to key uncertain parameters.Rotavirus vaccination would not completely protect young children against rotavirus infection due to the partial nature of vaccine immunity, but would effectively reduce severe cases of rotavirus gastroenteritis (outpatient visits, hospitalizations, or deaths) by about 67% over the first 5 years of life. Under base-case assumptions (94% coverage and $5 per dose), the incremental cost per DALY averted from vaccination compared to no vaccination would be $540 from the societal perspective and $550 from the health care system perspective.Introducing rotavirus vaccines would be a cost-effective public health intervention in Vietnam. However, given the uncertainty about vaccine efficacy and potential changes in rotavirus epidemiology in local settings, further clinical research and re-evaluation of rotavirus vaccination programs may be necessary as new information emerges.

    View details for DOI 10.1186/1471-2458-9-29

    View details for Web of Science ID 000265063800001

    View details for PubMedID 19159483

    View details for PubMedCentralID PMC2663769

  • Cost Effectiveness of Alternative Surveillance Strategies for Hepatocellular Carcinoma in Patients With Cirrhosis CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Andersson, K. L., Salomon, J. A., Goldie, S. J., Chung, R. T. 2008; 6 (12): 1418–24

    Abstract

    The increasing incidence of hepatocellular carcinoma (HCC) in the United States has significant health and economic consequences. Ultrasound (US) surveillance is recommended for patients with cirrhosis because of their high risk of HCC and improving treatment outcomes for small tumors. We assessed the costs, clinical benefits, and cost effectiveness of US surveillance and alternative strategies for HCC in cirrhosis using a computer-based state transition model with parameters derived from available literature.Our model compared a policy of no surveillance with 6 surveillance strategies in cirrhotic patients ages 50 years and older in the United States: (1) annual US, (2) semiannual US, (3) semiannual US with alpha-fetoprotein, (4) annual computed tomography (CT), (5) semiannual CT, and (6) annual magnetic resonance imaging. The number of screening tests needed to detect one small HCC, cost per treated HCC, lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios were calculated.Semiannual US surveillance for HCC in cirrhosis increased quality-adjusted life expectancy by 8.6 months on average, but extended it nearly 3.5 years in patients with small treated tumors. Semiannual US surveillance had an incremental cost-effectiveness ratio of $30,700 per quality-adjusted life year (QALY) gained, and was more cost effective than the alternative surveillance strategies using a threshold of $50,000 per QALY gained. The incremental cost-effectiveness ratios for the combined alpha-fetoprotein/US and annual CT strategies exceeded $50,000/QALY unless the sensitivity and specificity of US decreased to less than 65% and 60%, respectively.Semiannual US surveillance for HCC in cirrhotic patients improves clinical outcomes at a reasonable cost.

    View details for DOI 10.1016/j.cgh.2008.08.005

    View details for Web of Science ID 000261724300021

    View details for PubMedID 18848905

    View details for PubMedCentralID PMC4340842

  • Evaluating the impact of antiretroviral therapy on HIV transmission AIDS Salomon, J. A., Hogan, D. R. 2008; 22: S149–S159

    Abstract

    As global efforts proceed to scale up the delivery of antiretroviral therapy (ART) to HIV-infected persons in most urgent need, it is essential to understand the potential impact of treatment expansion on the transmission of new HIV infections. In this study, we use a series of simple mathematical models to explore the direction and magnitude of treatment effects on the sexual transmission of HIV. By defining the circumstances under which ART can reduce the number of new infections transmitted by treated patients, we provide critical benchmarks to aid in prioritizing efforts to maximize the population health impact of treatment and in evaluating the performance of different treatment programmes. We find that, based on the best currently available evidence of possible treatment effects on patient infectiousness, survival and behavior, the potential remains for either positive or negative changes in overall transmission. In relation to the total number of expected secondary infections caused by each infected person, however, these net treatment effects are relatively modest, particularly if treatment is initiated at advanced stages of the disease. This finding implies that treatment alone should not be expected to alter the population-level incidence of new infections dramatically, in the absence of changes in other factors including possible behavioral responses among uninfected persons and among infected persons who are not yet treatment candidates.

    View details for DOI 10.1097/01.aids.0000327636.82542.87

    View details for Web of Science ID 000258761700021

    View details for PubMedID 18664947

  • Impact of HIV on novel therapies for tuberculosis control AIDS Sanchez, M. S., Lloyd-Smith, J. O., Porco, T. C., Williams, B. G., Borgdorff, M. W., Mansoer, J., Salomon, J. A., Getz, W. A. 2008; 22 (8): 963–72

    Abstract

    The increased risk for tuberculosis in HIV-infected people has fueled a worldwide resurgence of tuberculosis. A major hindrance to controlling tuberculosis is the long treatment duration, leading to default, jeopardizing cure, and generating drug resistance. We investigated how tuberculosis is impacted by reducing treatment duration alone or combined with enhanced case detection and/or cure under different HIV prevalence levels.Our model includes HIV stages I-IV and was calibrated to long-term tuberculosis and HIV data from Kenya. Benefits were assessed in terms of absolute and relative reductions in new tuberculosis cases and deaths.Compared with present-day strategies, at 3-20% HIV prevalence we attain a 6-20% decrease in incidence and mortality in 25 years when reducing treatment duration alone; benefits exceed 300% when combined with increased detection and cure. Benefits vary substantially according to HIV status and prevalence. Challenges arise because in absolute terms the number of infected people and deaths increases dramatically with increasing HIV prevalence, and because the relative efficacy of tuberculosis control policies displays a nonlinear pattern whereby they become less effective on a per capita basis at HIV prevalence levels greater than 15%. Benefits of reducing treatment duration may even be reversed at extreme HIV prevalence levels. Benefits of increasing cure versus detection increase as HIV prevalence increases.Reducing tuberculosis treatment duration, alone or in combination with other control strategies, can provide enormous benefits at high HIV prevalence. Tuberculosis control policies need to account for HIV levels because the efficacy of different interventions varies substantially with HIV prevalence.

    View details for DOI 10.1097/QAD.0b013e3282f7cb4b

    View details for Web of Science ID 000256358300007

    View details for PubMedID 18453856

  • Cost-effectiveness of cervical cancer screening with human papillomavirus DNA testing and HPV-16,18 vaccination JOURNAL OF THE NATIONAL CANCER INSTITUTE Goldhaber-Fiebert, J. D., Stout, N. K., Salomon, J. A., Kuntz, K. M., Goldie, S. J. 2008; 100 (5): 308-320

    Abstract

    The availability of human papillomavirus (HPV) DNA testing and vaccination against HPV types 16 and 18 (HPV-16,18) motivates questions about the cost-effectiveness of cervical cancer prevention in the United States for unvaccinated older women and for girls eligible for vaccination.An empirically calibrated model was used to assess the quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (2004 US dollars per QALY) of screening, vaccination of preadolescent girls, and vaccination combined with screening. Screening varied by initiation age (18, 21, or 25 years), interval (every 1, 2, 3, or 5 years), and test (HPV DNA testing of cervical specimens or cytologic evaluation of cervical cells with a Pap test). Testing strategies included: 1) cytology followed by HPV DNA testing for equivocal cytologic results (cytology with HPV test triage); 2) HPV DNA testing followed by cytology for positive HPV DNA results (HPV test with cytology triage); and 3) combined HPV DNA testing and cytology. Strategies were permitted to switch once at age 25, 30, or 35 years.For unvaccinated women, triennial cytology with HPV test triage, beginning by age 21 years and switching to HPV testing with cytology triage at age 30 years, cost $78,000 per QALY compared with the next best strategy. For girls vaccinated before age 12 years, this same strategy, beginning at age 25 years and switching at age 35 years, cost $41,000 per QALY with screening every 5 years and $188,000 per QALY screening triennially, each compared with the next best strategy. These strategies were more effective and cost-effective than screening women of all ages with cytology alone or cytology with HPV triage annually or biennially.For both vaccinated and unvaccinated women, age-based screening by use of HPV DNA testing as a triage test for equivocal results in younger women and as a primary screening test in older women is expected to be more cost-effective than current screening recommendations.

    View details for DOI 10.1093/jnci/djn019

    View details for Web of Science ID 000253796800008

    View details for PubMedID 18314477

    View details for PubMedCentralID PMC3099548

  • Evolution of antiretroviral drug costs in Brazil in the context of free and universal access to AIDS treatment PLOS MEDICINE Nunn, A. S., Fonseca, E. M., Bastos, F. I., Gruskin, S., Salomon, J. A. 2007; 4 (11): 1804–17

    Abstract

    Little is known about the long-term drug costs associated with treating AIDS in developing countries. Brazil's AIDS treatment program has been cited widely as the developing world's largest and most successful AIDS treatment program. The program guarantees free access to highly active antiretroviral therapy (HAART) for all people living with HIV/AIDS in need of treatment. Brazil produces non-patented generic antiretroviral drugs (ARVs), procures many patented ARVs with negotiated price reductions, and recently issued a compulsory license to import one patented ARV. In this study, we investigate the drivers of recent ARV cost trends in Brazil through analysis of drug-specific prices and expenditures between 2001 and 2005.We compared Brazil's ARV prices to those in other low- and middle-income countries. We analyzed trends in drug expenditures for HAART in Brazil from 2001 to 2005 on the basis of cost data disaggregated by each ARV purchased by the Brazilian program. We decomposed the overall changes in expenditures to compare the relative impacts of changes in drug prices and drug purchase quantities. We also estimated the excess costs attributable to the difference between prices for generics in Brazil and the lowest global prices for these drugs. Finally, we estimated the savings attributable to Brazil's reduced prices for patented drugs. Negotiated drug prices in Brazil are lowest for patented ARVs for which generic competition is emerging. In recent years, the prices for efavirenz and lopinavir-ritonavir (lopinavir/r) have been lower in Brazil than in other middle-income countries. In contrast, the price of tenofovir is US$200 higher per patient per year than that reported in other middle-income countries. Despite precipitous price declines for four patented ARVs, total Brazilian drug expenditures doubled, to reach US$414 million in 2005. We find that the major driver of cost increases was increased purchase quantities of six specific drugs: patented lopinavir/r, efavirenz, tenofovir, atazanavir, enfuvirtide, and a locally produced generic, fixed-dose combination of zidovudine and lamivudine (AZT/3TC). Because prices declined for many of the patented drugs that constitute the largest share of drug costs, nearly the entire increase in overall drug expenditures between 2001 and 2005 is attributable to increases in drug quantities. Had all drug quantities been held constant from 2001 until 2005 (or for those drugs entering treatment guidelines after 2001, held constant between the year of introduction and 2005), total costs would have increased by only an estimated US$7 million. We estimate that in the absence of price declines for patented drugs, Brazil would have spent a cumulative total of US$2 billion on drugs for HAART between 2001 and 2005, implying a savings of US$1.2 billion from price declines. Finally, in comparing Brazilian prices for locally produced generic ARVs to the lowest international prices meeting global pharmaceutical quality standards, we find that current prices for Brazil's locally produced generics are generally much higher than corresponding global prices, and note that these prices have risen in Brazil while declining globally. We estimate the excess costs of Brazil's locally produced generics totaled US$110 million from 2001 to 2005.Despite Brazil's more costly generic ARVs, the net result of ARV price changes has been a cost savings of approximately US$1 billion since 2001. HAART costs have nevertheless risen steeply as Brazil has scaled up treatment. These trends may foreshadow future AIDS treatment cost trends in other developing countries as more people start treatment, AIDS patients live longer and move from first-line to second and third-line treatment, AIDS treatment becomes more complex, generic competition emerges, and newer patented drugs become available. The specific application of the Brazilian model to other countries will depend, however, on the strength of their health systems, intellectual property regulations, epidemiological profiles, AIDS treatment guidelines, and differing capacities to produce drugs locally.

    View details for DOI 10.1371/journal.pmed.0040305

    View details for Web of Science ID 000251874400017

    View details for PubMedID 18001145

    View details for PubMedCentralID PMC2071936

  • Packaging health services when resources are limited: The example of a cervical cancer screening visit PLOS MEDICINE Kim, J. J., Salomon, J. A., Weinstein, M. C., Goldie, S. J. 2006; 3 (11): 2031–38

    Abstract

    Increasing evidence supporting the value of screening women for cervical cancer once in their lifetime, coupled with mounting interest in scaling up successful screening demonstration projects, present challenges to public health decision makers seeking to take full advantage of the single-visit opportunity to provide additional services. We present an analytic framework for packaging multiple interventions during a single point of contact, explicitly taking into account a budget and scarce human resources, constraints acknowledged as significant obstacles for provision of health services in poor countries.We developed a binary integer programming (IP) model capable of identifying an optimal package of health services to be provided during a single visit for a particular target population. Inputs to the IP model are derived using state-transition models, which compute lifetime costs and health benefits associated with each intervention. In a simplified example of a single lifetime cervical cancer screening visit, we identified packages of interventions among six diseases that maximized disability-adjusted life years (DALYs) averted subject to budget and human resource constraints in four resource-poor regions. Data were obtained from regional reports and surveys from the World Health Organization, international databases, the published literature, and expert opinion. With only a budget constraint, interventions for depression and iron deficiency anemia were packaged with cervical cancer screening, while the more costly breast cancer and cardiovascular disease interventions were not. Including personnel constraints resulted in shifting of interventions included in the package, not only across diseases but also between low- and high-intensity intervention options within diseases.The results of our example suggest several key themes: Packaging other interventions during a one-time visit has the potential to increase health gains; the shortage of personnel represents a real-world constraint that can impact the optimal package of services; and the shortage of different types of personnel may influence the contents of the package of services. Our methods provide a general framework to enhance a decision maker's ability to simultaneously consider costs, benefits, and important nonmonetary constraints. We encourage analysts working on real-world problems to shift from considering costs and benefits of interventions for a single disease to exploring what synergies might be achievable by thinking across disease burdens.

    View details for DOI 10.1371/journal.pmed.0030434

    View details for Web of Science ID 000242374800010

    View details for PubMedID 17105337

    View details for PubMedCentralID PMC1635742

  • Prospects for advancing tuberculosis control efforts through novel therapies PLOS MEDICINE Salomon, J. A., Lloyd-Smith, J. O., Getz, W. M., Resch, S., Sanchez, M. S., Porco, T. C., Borgdorff, M. W. 2006; 3 (8): 1302–9

    Abstract

    Development of new, effective, and affordable tuberculosis (TB) therapies has been identified as a critical priority for global TB control. As new candidates emerge from the global TB drug pipeline, the potential impacts of novel, shorter regimens on TB incidence and mortality have not yet been examined.We used a mathematical model of TB to evaluate the expected benefits of shortening the duration of effective chemotherapy for active pulmonary TB. First, we considered general relationships between treatment duration and TB dynamics. Next, as a specific example, we calibrated the model to reflect the current situation in the South-East Asia region. We found that even with continued and rapid progress in scaling up the World Health Organization's DOTS strategy of directly observed, short-course chemotherapy, the benefits of reducing treatment duration would be substantial. Compared to a baseline of continuing DOTS coverage at current levels, and with currently available tools, a 2-mo regimen introduced by 2012 could prevent around 20% (range 13%-28%) of new cases and 25% (range 19%-29%) of TB deaths in South-East Asia between 2012 and 2030. If effective treatment with existing drugs expands rapidly, overall incremental benefits of shorter regimens would be lower, but would remain considerable (13% [range 8%-19%] and 19% [range 15%-23%] reductions in incidence and mortality, respectively, between 2012 and 2030). A ten-year delay in the introduction of new drugs would erase nearly three-fourths of the total expected benefits in this region through 2030.The introduction of new, shorter treatment regimens could dramatically accelerate the reductions in TB incidence and mortality that are expected under current regimens-with up to 2- or 3-fold increases in rates of decline if shorter regimens are accompanied by enhanced case detection. Continued progress in reducing the global TB burden will require a balanced approach to pursuing new technologies while promoting wider implementation of proven strategies.

    View details for DOI 10.1371/journal.pmed.0030273

    View details for Web of Science ID 000240213200024

    View details for PubMedID 16866578

    View details for PubMedCentralID PMC1523376

  • Cost-effectiveness of treating multidrug-resistant tuberculosis PLOS MEDICINE Resch, S. C., Salomon, J. A., Murray, M., Weinstein, M. C. 2006; 3 (7): 1048–57

    Abstract

    Despite the existence of effective drug treatments, tuberculosis (TB) causes 2 million deaths annually worldwide. Effective treatment is complicated by multidrug-resistant TB (MDR TB) strains that respond only to second-line drugs. We projected the health benefits and cost-effectiveness of using drug susceptibility testing and second-line drugs in a lower-middle-income setting with high levels of MDR TB.We developed a dynamic state-transition model of TB. In a base case analysis, the model was calibrated to approximate the TB epidemic in Peru, a setting with a smear-positive TB incidence of 120 per 100,000 and 4.5% MDR TB among prevalent cases. Secondary analyses considered other settings. The following strategies were evaluated: first-line drugs administered under directly observed therapy (DOTS), locally standardized second-line drugs for previously treated cases (STR1), locally standardized second-line drugs for previously treated cases with test-confirmed MDR TB (STR2), comprehensive drug susceptibility testing and individualized treatment for previously treated cases (ITR1), and comprehensive drug susceptibility testing and individualized treatment for all cases (ITR2). Outcomes were costs per TB death averted and costs per quality-adjusted life year (QALY) gained. We found that strategies incorporating the use of second-line drug regimens following first-line treatment failure were highly cost-effective compared to strategies using first-line drugs only. In our base case, standardized second-line treatment for confirmed MDR TB cases (STR2) had an incremental cost-effectiveness ratio of 720 dollars per QALY (8,700 dollars per averted death) compared to DOTS. Individualized second-line drug treatment for MDR TB following first-line failure (ITR1) provided more benefit at an incremental cost of 990 dollars per QALY (12,000 dollars per averted death) compared to STR2. A more aggressive version of the individualized treatment strategy (ITR2), in which both new and previously treated cases are tested for MDR TB, had an incremental cost-effectiveness ratio of 11,000 dollars per QALY (160,000 dollars per averted death) compared to ITR1. The STR2 and ITR1 strategies remained cost-effective under a wide range of alternative assumptions about treatment costs, effectiveness, MDR TB prevalence, and transmission.Treatment of MDR TB using second-line drugs is highly cost-effective in Peru. In other settings, the attractiveness of strategies using second-line drugs will depend on TB incidence, MDR burden, and the available budget, but simulation results suggest that individualized regimens would be cost-effective in a wide range of situations.

    View details for DOI 10.1371/journal.pmed.0030241

    View details for Web of Science ID 000239493300024

    View details for PubMedID 16796403

    View details for PubMedCentralID PMC1483913

  • Integrating HIV prevention and treatment: From slogans to impact PLOS MEDICINE Salomon, J. A., Hogan, D. R., Stover, J., Stanecki, K. A., Walker, N., Ghys, P. D., Schwartlander, B. 2005; 2 (1): 50–56

    Abstract

    Through major efforts to reduce costs and expand access to antiretroviral therapy worldwide, widespread delivery of effective treatment to people living with HIV/AIDS is now conceivable even in severely resource-constrained settings. However, the potential epidemiologic impact of treatment in the context of a broader strategy for HIV/AIDS control has not yet been examined. In this paper, we quantify the opportunities and potential risks of large-scale treatment roll-out.We used an epidemiologic model of HIV/AIDS, calibrated to sub-Saharan Africa, to investigate a range of possible positive and negative health outcomes under alternative scenarios that reflect varying implementation of prevention and treatment. In baseline projections, reflecting "business as usual," the numbers of new infections and AIDS deaths are expected to continue rising. In two scenarios representing treatment-centered strategies, with different assumptions about the impact of treatment on transmissibility and behavior, the change in the total number of new infections through 2020 ranges from a 10% increase to a 6% reduction, while the number of AIDS deaths through 2020 declines by 9% to 13%. A prevention-centered strategy provides greater reductions in incidence (36%) and mortality reductions similar to those of the treatment-centered scenarios by 2020, but more modest mortality benefits over the next 5 to 10 years. If treatment enhances prevention in a combined response, the expected benefits are substantial-29 million averted infections (55%) and 10 million averted deaths (27%) through the year 2020. However, if a narrow focus on treatment scale-up leads to reduced effectiveness of prevention efforts, the benefits of a combined response are considerably smaller-9 million averted infections (17%) and 6 million averted deaths (16%). Combining treatment with effective prevention efforts could reduce the resource needs for treatment dramatically in the long term. In the various scenarios the numbers of people being treated in 2020 ranges from 9.2 million in a treatment-only scenario with mixed effects, to 4.2 million in a combined response scenario with positive treatment-prevention synergies.These analyses demonstrate the importance of integrating expanded care activities with prevention activities if there are to be long-term reductions in the number of new HIV infections and significant declines in AIDS mortality. Treatment can enable more effective prevention, and prevention makes treatment affordable. Sustained progress in the global fight against HIV/AIDS will be attained only through a comprehensive response.

    View details for DOI 10.1371/journal.pmcd.0020016

    View details for Web of Science ID 000227522100015

    View details for PubMedID 15647780

    View details for PubMedCentralID PMC543462