Joshua Salomon

All Publications

• Estimated Health and Economic Outcomes of Racial and Ethnic Tuberculosis Disparities in US-Born Persons. JAMA network open Swartwood, N. A., Li, Y., Regan, M., Marks, S. M., Barham, T., Beeler Asay, G. R., Cohen, T., Hill, A. N., Horsburgh, C. R., Khan, A. D., McCree, D. H., Myles, R. L., Salomon, J. A., Self, J. L., Menzies, N. A. 2024; 7 (9): e2431988

  Abstract

  Importance: Despite significant progress made toward tuberculosis (TB) elimination, racial and ethnic disparities persist in TB incidence and case-fatality rates in the US.Objective: To estimate the health outcomes and economic cost of TB disparities among US-born persons from 2023 to 2035.Design, Setting, and Participants: Generalized additive regression models projecting trends in TB incidence and case-fatality rates from 2023 to 2035 were fit based on national TB surveillance data for 2010 to 2019 in the 50 US states and the District of Columbia among US-born persons. This baseline scenario was compared with alternative scenarios in which racial and ethnic disparities in age- and sex-adjusted incidence and case-fatality rates were eliminated by setting rates for each race and ethnicity to goal values. Additional scenarios were created examining the potential outcomes of delayed reduction of racial and ethnic disparities. The potential benefits of eliminating disparities from differences between baseline and alternative scenario outcomes were quantified. Data were analyzed from January 2010 to December 2019.Exposures: Non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Black, Hispanic, non-Hispanic Native Hawaiian or Other Pacific Islander, or non-Hispanic White race and ethnicity.Main outcomes and measures: TB cases and deaths averted, quality-adjusted life years gained, and associated costs from a societal perspective.Results: The study included 31 811 persons with reported TB from 2010 to 2019 (mean [SD] age, 47 [24] years; 20 504 [64%] male; 1179 [4%] American Indian or Alaska Native persons; 1332 [4%] Asian persons; 12 152 [38%] Black persons; 6595 [21%] Hispanic persons; 299 [1%] Native Hawaiian or Other Pacific Islander persons; and 10 254 [32%] White persons). There were 3722 persons with a reported TB death. Persistent racial and ethnic disparities were associated with an estimated 11 901 of 26 203 TB cases among US-born persons (45%; 95% uncertainty interval [UI], 44%-47%), 1421 of 3264 TB deaths among US-born persons (44%; 95% UI, 39%-48%), and an economic cost of $914 (95% UI, $675-$1147) million from 2023 to 2035. Delayed goal attainment reduced the estimated avertable TB outcomes by 505 (95% UI, 495-518) TB cases, 55 (95% UI, 51-59) TB deaths, and $32 (95% UI, $24-$40) million in societal costs annually.Conclusions and relevance: In this modeling study of racial and ethnic disparities of TB, these disparities were associated with substantial future health and economic outcomes of TB among US-born persons without interventions beyond current efforts. Actions to eliminate disparities may reduce the excess TB burden among these persons and may contribute to accelerating TB elimination within the US.

  View details for DOI 10.1001/jamanetworkopen.2024.31988

  View details for PubMedID 39254977

• Risk factors underlying racial and ethnic disparities in tuberculosis diagnosis and treatment outcomes, 2011-19: a multiple mediation analysis of national surveillance data. The Lancet. Public health Regan, M., Barham, T., Li, Y., Swartwood, N. A., Beeler Asay, G. R., Cohen, T., Horsburgh, C. R., Khan, A., Marks, S. M., Myles, R. L., Salomon, J. A., Self, J. L., Winston, C. A., Menzies, N. A. 2024; 9 (8): e564-e572

  Abstract

  BACKGROUND: Despite an overall decline in tuberculosis incidence and mortality in the USA in the past two decades, racial and ethnic disparities in tuberculosis outcomes persist. We aimed to examine the extent to which inequalities in health and neighbourhood-level social vulnerability mediate these disparities.METHODS: We extracted data from the US National Tuberculosis Surveillance System on individuals with tuberculosis during 2011-19. Individuals with multidrug-resistant tuberculosis or missing data on race and ethnicity were excluded. We examined potential disparities in tuberculosis outcomes among US-born and non-US-born individuals and conducted a mediation analysis for groups with a higher risk of treatment incompletion (a summary outcome comprising diagnosis after death, treatment discontinuation, or death during treatment). We used sequential multiple mediation to evaluate eight potential mediators: three comorbid conditions (HIV, end-stage renal disease, and diabetes), homelessness, and four census tract-level measures (poverty, unemployment, insurance coverage, and racialised economic segregation [measured by Index of Concentration at the ExtremesRace-Income]). We estimated the marginal contribution of each mediator using Shapley values.FINDINGS: During 2011-19, 27 788 US-born individuals and 57 225 non-US-born individuals were diagnosed with active tuberculosis, of whom 27 605 and 56 253 individuals, respectively, met eligibility criteria for our analyses. We did not observe evidence of disparities in tuberculosis outcomes for non-US-born individuals by race and ethnicity. Therefore, subsequent analyses were restricted to US-born individuals. Relative to White individuals, Black and Hispanic individuals had a higher risk of not completing tuberculosis treatment (adjusted relative risk 1·27, 95% CI 1·19-1·35; 1·22, 1·11-1·33, respectively). In multiple mediator analysis, the eight measured mediators explained 67% of the disparity for Black individuals and 65% for Hispanic individuals. The biggest contributors to these disparities for Black individuals and Hispanic individuals were concomitant end-stage renal disease, concomitant HIV, census tract-level racialised economic segregation, and census tract-level poverty.INTERPRETATION: Our findings underscore the need for initiatives to reduce disparities in tuberculosis outcomes among US-born individuals, particularly in highly racially and economically polarised neighbourhoods. Mitigating the structural and environmental factors that lead to disparities in the prevalence of comorbidities and their case management should be a priority.FUNDING: US Centers for Disease Control and Prevention National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention Epidemiologic and Economic Modeling Agreement.

  View details for DOI 10.1016/S2468-2667(24)00151-8

  View details for PubMedID 39095133

• The long-term effects of domestic and international tuberculosis service improvements on tuberculosis trends within the USA: a mathematical modelling study. The Lancet. Public health Menzies, N. A., Swartwood, N. A., Cohen, T., Marks, S. M., Maloney, S. A., Chappelle, C., Miller, J. W., Beeler Asay, G. R., Date, A. A., Horsburgh, C. R., Salomon, J. A. 2024; 9 (8): e573-e582

  Abstract

  BACKGROUND: For settings with low tuberculosis incidence, disease elimination is a long-term goal. We investigated pathways to tuberculosis pre-elimination (incidence <1·0 cases per 100 000 people) and elimination (incidence <0·1 cases per 100 000 people) in the USA, where incidence was estimated at 2·9 per 100 000 people in 2023.METHODS: Using a mathematical modelling framework, we simulated how US tuberculosis incidence could be affected by changes in tuberculosis services in the countries of origin for future migrants to the USA, as well as changes in tuberculosis services inside the USA. To do so, we used a linked set of transmission dynamic models, calibrated to demographic and epidemiological data for each setting. We constructed intervention scenarios representing improvements in tuberculosis services internationally and within the USA, individually and in combination, plus a base-case scenario representing continuation of current services. We simulated health and economic outcomes until 2100, using a Bayesian approach to quantify uncertainty in these outcomes.FINDINGS: Under the base-case scenario, US tuberculosis incidence was projected to decline to 1·8 cases per 100 000 (95% uncertainty interval [UI] 1·5-2·1) in the total population by 2050. Intervention scenarios produced substantial reductions in tuberculosis incidence, with the combination of all domestic and international interventions projected to achieve pre-elimination by 2033 (95% UI 2031-2037). Compared with the base-case scenario, this combination of interventions could avert 101 000 tuberculosis cases (95% UI 84 000-120 000) and 13 300 tuberculosis deaths (95% UI 10 500-16 300) in the USA from 2025 to 2050. Tuberculosis elimination was not projected before 2100.INTERPRETATION: Strengthening tuberculosis services domestically, promoting the development of more effective technologies and interventions, and supporting tuberculosis programmes in countries with a high tuberculosis burden are key strategies for accelerating progress towards tuberculosis elimination in the USA.FUNDING: US Centers for Disease Control and Prevention.

  View details for DOI 10.1016/S2468-2667(24)00150-6

  View details for PubMedID 39095134

• Modelling the potential impact of global hepatitis B vaccination on the burden of chronic hepatitis B in the United States. Journal of viral hepatitis Hutton, D. W., Toy, M., Yang, D., Zhang, H., Handanagic, S., Armstrong, P. A., Wasley, A., Menzies, N. A., Pham, H., Salomon, J. A., So, S. K. 2024

  Abstract

  About 80% of persons with chronic hepatitis B virus (HBV) infection in the United States are non-US-born. Despite improvements in infant hepatitis B vaccination globally since 2000, work remains to attain the World Health Organization's (WHO) global 2030 goal of 90% vaccination. We explore the impacts on the United States of global progress in hepatitis B vaccination since 2000 and of achieving WHO hepatitis B vaccination goals. We simulated immigrants with HBV infection arriving to the United States from 2000 to 2070 using models of the 10 countries from which the largest numbers of individuals with HBV infection were born. We estimated costs in the United States among these cohorts using a disease simulation model. We simulated three scenarios: a scenario with no progress in infant vaccination for hepatitis B since 2000 (baseline), current (2020) progress and achieving WHO 2030 goals for hepatitis B vaccination. We estimate current hepatitis B vaccination progress since the 2000 baseline in these 10 countries will lead to 468,686 fewer HBV infections, avoid 35,582 hepatitis B-related deaths and save $4.2billion in the United States through 2070. Achieving the WHO 2030 90% hepatitis B infant vaccination targets could lead to an additional 16,762 fewer HBV infections, 989 fewer hepatitis B-related deaths and save $143million through 2070. Global hepatitis B vaccination since 2000 reduced prevalence of HBV infection in the United States. Achieving the WHO 2030 infant vaccination goals globally could lead to over one hundred million dollars in additional savings.

  View details for DOI 10.1111/jvh.13982

  View details for PubMedID 39037155

• Potential impact of curative and preventive interventions toward hepatitis C elimination in people who inject drugs-A network modeling study. The International journal on drug policy Zhu, L., Thompson, W. W., Hagan, L., Randall, L. M., Rudolph, A. E., Young, A. M., Havens, J. R., Salomon, J. A., Linas, B. P. 2024; 130: 104539

  Abstract

  BACKGROUND: Injection-equipment-sharing networks play an important role in hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Direct-acting antiviral (DAA) treatments for HCV infection and interventions to prevent HCV transmission are critical components of an overall hepatitis C elimination strategy, but how they contribute to the elimination outcomes in different PWID network settings are unclear.METHODS: We developed an agent-based network model of HCV transmission through the sharing of injection equipment among PWID and parameterized and calibrated the model with rural PWID data in the United States. We modeled curative and preventive interventions at annual coverage levels of 12.5 %, 25 %, or 37.5 % (cumulative percentage of eligible individuals engaged), and two allocation approaches: random vs targeting PWID with more injection partners (hereafter 'degree-based'). We compared the impact of these intervention strategies on prevalence and incidence of HCV infections. We conducted sensitivity analysis on key parameters governing the effects of curative and preventive interventions and PWID network characteristics.RESULTS: Combining curative and preventive interventions at 37.5 % annual coverage with degree-based allocation decreased prevalence and incidence of HCV infection by 67 % and 70 % over two years, respectively. Curative interventions decreased prevalence by six to 12 times more than preventive interventions, while curative and preventive interventions had comparable effectiveness on reducing incidence. Intervention impact increased with coverage almost linearly across all intervention strategies, and degree-based allocation was always more effective than random allocation, especially for preventive interventions. Results were sensitive to parameter values defining intervention effects and network mean degree.CONCLUSION: DAA treatments are effective in reducing both prevalence and incidence of HCV infection in PWID, but preventive interventions play a significant role in reducing incidence when intervention coverage is low. Increasing coverage, including efforts in reaching individuals with the most injection partners, preventing reinfection, and improving compliance and retention in preventive services can substantially improve the outcomes. PWID network characteristics should be considered when designing hepatitis C elimination programs.

  View details for DOI 10.1016/j.drugpo.2024.104539

  View details for PubMedID 39033645

• Assessing thresholds of resistance prevalence at which empiric treatment of gonorrhea should change among men who have sex with men in the US: A cost-effectiveness analysis. PLoS medicine Yin, X., Li, Y., Rönn, M. M., Li, S., Yuan, Y., Gift, T. L., Hsu, K., Salomon, J. A., Grad, Y. H., Yaesoubi, R. 2024; 21 (7): e1004424

  Abstract

  Since common diagnostic tests for gonorrhea do not provide information about susceptibility to antibiotics, treatment of gonorrhea remains empiric. Antibiotics used for empiric therapy are usually changed once resistance prevalence exceeds a certain threshold (e.g., 5%). A low switch threshold is intended to increase the probability that an infection is successfully treated with the first-line antibiotic, but it could also increase the pace at which recommendations are switched to newer antibiotics. Little is known about the impact of changing the switch threshold on the incidence of gonorrhea, the rate of treatment failure, and the overall cost and quality-adjusted life-years (QALYs) associated with gonorrhea.We developed a transmission model of gonococcal infection with multiple resistant strains to project gonorrhea-associated costs and loss in QALYs under different switch thresholds among men who have sex with men (MSM) in the United States. We accounted for the costs and disutilities associated with symptoms, diagnosis, treatment, and sequelae, and combined costs and QALYs in a measure of net health benefit (NHB). Our results suggest that under a scenario where 3 antibiotics are available over the next 50 years (2 suitable for the first-line therapy of gonorrhea and 1 suitable only for the retreatment of resistant infections), changing the switch threshold between 1% and 10% does not meaningfully impact the annual number of gonorrhea cases, total costs, or total QALY losses associated with gonorrhea. However, if a new antibiotic is to become available in the future, choosing a lower switch threshold could improve the population NHB. If in addition, drug-susceptibility testing (DST) is available to inform retreatment regimens after unsuccessful first-line therapy, setting the switch threshold at 1% to 2% is expected to maximize the population NHB. A limitation of our study is that our analysis only focuses on the MSM population and does not consider the influence of interventions such as vaccine and common use of rapid drugs susceptibility tests to inform first-line therapy.Changing the switch threshold for first-line antibiotics may not substantially change the health and financial outcomes associated with gonorrhea. However, the switch threshold could be reduced when newer antibiotics are expected to become available soon or when in addition to future novel antibiotics, DST is also available to inform retreatment regimens.

  View details for DOI 10.1371/journal.pmed.1004424

  View details for PubMedID 38976754

• Combining genomic data and infection estimates to characterize the complex dynamics of SARS-CoV-2 Omicron variants in the US. Cell reports Lopes, R., Pham, K., Klaassen, F., Chitwood, M. H., Hahn, A. M., Redmond, S., Swartwood, N. A., Salomon, J. A., Menzies, N. A., Cohen, T., Grubaugh, N. D. 2024; 43 (7): 114451

  Abstract

  Omicron surged as a variant of concern in late 2021. Several distinct Omicron variants appeared and overtook each other. We combined variant frequencies and infection estimates from a nowcasting model for each US state to estimate variant-specific infections, attack rates, and effective reproduction numbers (Rt). BA.1 rapidly emerged, and we estimate that it infected 47.7% of the US population before it was replaced by BA.2. We estimate that BA.5 infected 35.7% of the US population, persisting in circulation for nearly 6months. Other variants-BA.2, BA.4, and XBB-together infected 30.7% of the US population. We found a positive correlation between the state-level BA.1 attack rate and social vulnerability and a negative correlation between the BA.1 and BA.2 attack rates. Our findings illustrate the complex interplay between viral evolution, population susceptibility, and social factors during the Omicron emergence in the US.

  View details for DOI 10.1016/j.celrep.2024.114451

  View details for PubMedID 38970788

• State-level population estimates of sexual minority adolescents in the United States: A predictive modeling study. PloS one Ferstad, J. O., Aslam, M., Wang, L. Y., Henaghan, K., Zhao, J., Li, J., Salomon, J. A. 2024; 19 (6): e0304175

  Abstract

  The Youth Risk Behavior Survey (YRBS) among high school students includes standard questions about sexual identity and sex of sexual contacts, but these questions are not consistently included in every state that conducts the survey. This study aimed to develop and apply a method to predict state-level proportions of high school students identifying as lesbian, gay, or bisexual (LGB) or reporting any same-sex sexual contacts in those states that did not include these questions in their 2017 YRBS.We used state-level high school YRBS data from 2013, 2015, and 2017. We defined two primary outcomes relating to self-reported LGB identity and reported same-sex sexual contacts. We developed machine learning models to predict the two outcomes based on other YRBS variables, and comparing different modeling approaches. We used a leave-one-out cross-validation approach and report results from best-performing models.Modern ensemble models outperformed traditional linear models at predicting state-level proportions for the two outcomes, and we identified prediction methods that performed well across different years and prediction tasks. Predicted proportions of respondents reporting LGB identity in states that did not include direct measurement ranged between 9.4% and 12.9%. Predicted proportions of respondents reporting any same-sex contacts, where not directly observed, ranged between 7.0% and 10.4%.Comparable population estimates of sexual minority adolescents can raise awareness among state policy makers and the public about what proportion of youth may be exposed to disparate health risks and outcomes associated with sexual minority status. This information can help decision makers in public health and education agencies design, implement and evaluate community and school interventions to improve the health of LGB youth.

  View details for DOI 10.1371/journal.pone.0304175

  View details for PubMedID 38935807

• Disparities in Tuberculosis Incidence by Race and Ethnicity Among the U.S.-Born Population in the United States, 2011 to 2021 : An Analysis of National Disease Registry Data. Annals of internal medicine Li, Y., Regan, M., Swartwood, N. A., Barham, T., Beeler Asay, G. R., Cohen, T., Hill, A. N., Horsburgh, C. R., Khan, A., Marks, S. M., Myles, R. L., Salomon, J. A., Self, J. L., Menzies, N. A. 2024

  Abstract

  Elevated tuberculosis (TB) incidence rates have recently been reported for racial/ethnic minority populations in the United States. Tracking such disparities is important for assessing progress toward national health equity goals and implementing change.To quantify trends in racial/ethnic disparities in TB incidence among U.S.-born persons.Time-series analysis of national TB registry data for 2011 to 2021.United States.U.S.-born persons stratified by race/ethnicity.TB incidence rates, incidence rate differences, and incidence rate ratios compared with non-Hispanic White persons; excess TB cases (calculated from incidence rate differences); and the index of disparity. Analyses were stratified by sex and by attribution of TB disease to recent transmission and were adjusted for age, year, and state of residence.In analyses of TB incidence rates for each racial/ethnic population compared with non-Hispanic White persons, incidence rate ratios were as high as 14.2 (95% CI, 13.0 to 15.5) among American Indian or Alaska Native (AI/AN) females. Relative disparities were greater for females, younger persons, and TB attributed to recent transmission. Absolute disparities were greater for males. Excess TB cases in 2011 to 2021 represented 69% (CI, 66% to 71%) and 62% (CI, 60% to 64%) of total cases for females and males, respectively. No evidence was found to indicate that incidence rate ratios decreased over time, and most relative disparity measures showed small, statistically nonsignificant increases.Analyses assumed complete TB case diagnosis and self-report of race/ethnicity and were not adjusted for medical comorbidities or social determinants of health.There are persistent disparities in TB incidence by race/ethnicity. Relative disparities were greater for AI/AN persons, females, and younger persons, and absolute disparities were greater for males. Eliminating these disparities could reduce overall TB incidence by more than 60% among the U.S.-born population.Centers for Disease Control and Prevention.

  View details for DOI 10.7326/M23-2975

  View details for PubMedID 38560914

• Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. Infectious diseases 2024

  Abstract

  Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020.We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990-2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data.We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5-14 years, 6·29% (5·05 to 7·70) in those aged 15-49 years, 5·72% (4·02 to 7·39) in those aged 50-69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5-14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15-49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50-69 years, and a 3·29% (-5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (-713 to 2180) fewer deaths.Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups.Bill & Melinda Gates Foundation.

  View details for DOI 10.1016/S1473-3099(24)00007-0

  View details for PubMedID 38518787

• Estimated rates of progression to tuberculosis disease for persons infected with Mycobacterium tuberculosis in the United States. Epidemiology (Cambridge, Mass.) Ekramnia, M., Li, Y., Haddad, M. B., Marks, S. M., Kammerer, J. S., Swartwood, N. A., Cohen, T., Miller, J. W., Horsburgh, C. R., Salomon, J. A., Menzies, N. A. 2024; 35 (2): 164-173

  Abstract

  In the United States, over 80% of tuberculosis (TB) disease cases are estimated to result from reactivation of latent TB infection (LTBI) acquired more than 2 years previously ("reactivation TB"). We estimated reactivation TB rates for the US population with LTBI, overall, by age, sex, race-ethnicity, and US-born status, and for selected comorbidities (diabetes, end-stage renal disease, and HIV).We collated nationally representative data for 2011-2012. Reactivation TB incidence was based on TB cases reported to the National TB Surveillance System that were attributed to LTBI reactivation. Person-years at risk of reactivation TB were calculated using interferon-gamma release assay (IGRA) positivity from the National Health and Nutrition Examination Survey, published values for interferon-gamma release assay sensitivity and specificity, and population estimates from the American Community Survey.For persons aged ≥6 years with LTBI, the overall reactivation rate was estimated as 0.072 (95% uncertainty interval: 0.047, 0.12) per 100 person-years. Estimated reactivation rates declined with age. Compared to the overall population, estimated reactivation rates were higher for persons with diabetes (adjusted rate ratio [aRR] = 1.6 [1.5, 1.7]), end-stage renal disease (aRR = 9.8 [5.4, 19]), and HIV (aRR = 12 [10, 13]).In our study, individuals with LTBI faced small, non-negligible risks of reactivation TB. Risks were elevated for individuals with medical comorbidities that weaken immune function.

  View details for DOI 10.1097/EDE.0000000000001707

  View details for PubMedID 38290139

• Resource Utilization and Costs Associated with Approaches to Identify Infants with Early-Onset Sepsis. MDM policy & practice Guan, G., Joshi, N. S., Frymoyer, A., Achepohl, G. D., Dang, R., Taylor, N. K., Salomon, J. A., Goldhaber-Fiebert, J. D., Owens, D. K. 2024; 9 (1): 23814683231226129

  Abstract

  Objective. To compare resource utilization and costs associated with 3 alternative screening approaches to identify early-onset sepsis (EOS) in infants born at ≥35 wk of gestational age, as recommended by the American Academy of Pediatrics (AAP) in 2018. Study Design. Decision tree-based cost analysis of the 3 AAP-recommended approaches: 1) categorical risk assessment (categorization by chorioamnionitis exposure status), 2) neonatal sepsis calculator (a multivariate prediction model based on perinatal risk factors), and 3) enhanced clinical observation (assessment based on serial clinical examinations). We evaluated resource utilization and direct costs (2022 US dollars) to the health system. Results. Categorical risk assessment led to the greatest neonatal intensive care unit usage (210 d per 1,000 live births) and antibiotic exposure (6.8%) compared with the neonatal sepsis calculator (112 d per 1,000 live births and 3.6%) and enhanced clinical observation (99 d per 1,000 live births and 3.1%). While the per-live birth hospital costs of the 3 approaches were similar-categorical risk assessment cost $1,360, the neonatal sepsis calculator cost $1,317, and enhanced clinical observation cost $1,310-the cost of infants receiving intervention under categorical risk assessment was approximately twice that of the other 2 strategies. Results were robust to variations in data parameters. Conclusion. The neonatal sepsis calculator and enhanced clinical observation approaches may be preferred to categorical risk assessment as they reduce the number of infants receiving intervention and thus antibiotic exposure and associated costs. All 3 approaches have similar costs over all live births, and prior literature has indicated similar health outcomes. Inclusion of downstream effects of antibiotic exposure in the neonatal period should be evaluated within a cost-effectiveness analysis.Of the 3 approaches recommended by the American Academy of Pediatrics in 2018 to identify early-onset sepsis in infants born at ≥35 weeks, the categorical risk assessment approach leads to about twice as many infants receiving evaluation to rule out early-onset sepsis compared with the neonatal sepsis calculator and enhanced clinical observation approaches.While the hospital costs of the 3 approaches were similar over the entire population of live births, the neonatal sepsis calculator and enhanced clinical observation approaches reduce antibiotic exposure, neonatal intensive care unit admission, and hospital costs associated with interventions as part of the screening approach compared with the categorical risk assessment approach.

  View details for DOI 10.1177/23814683231226129

  View details for PubMedID 38293656

  View details for PubMedCentralID PMC10826394

• Racial and ethnic disparities in diagnosis and treatment outcomes among US-born people diagnosed with tuberculosis, 2003-19: an analysis of national surveillance data. The Lancet. Public health Regan, M., Li, Y., Swartwood, N. A., Barham, T., Asay, G. R., Cohen, T., Hill, A. N., Horsburgh, C. R., Khan, A., Marks, S. M., Myles, R. L., Salomon, J. A., Self, J. L., Menzies, N. A. 2024; 9 (1): e47-e56

  Abstract

  Persistent racial and ethnic disparities in tuberculosis incidence exist in the USA, however, less is known about disparities along the tuberculosis continuum of care. This study aimed to describe how race and ethnicity are associated with tuberculosis diagnosis and treatment outcomes.In this analysis of national surveillance data, we extracted data from the US National Tuberculosis Surveillance System on US-born patients with tuberculosis during 2003-19. To estimate the association between race and ethnicity and tuberculosis diagnosis (diagnosis after death, cavitation, and sputum smear positivity) and treatment outcomes (treatment for more than 12 months, treatment discontinuation, and death during treatment), we fitted log-binomial regression models adjusting for calendar year, sex, age category, and regional division. Race and ethnicity were defined based on US Census Bureau classification as White, Black, Hispanic, Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and people of other ethnicities. We quantified racial and ethnic disparities as adjusted relative risks (aRRs) using non-Hispanic White people as the reference group. We also calculated the Index of Disparity as a summary measure that quantifies the dispersion in a given outcome across all racial and ethnic groups, relative to the population mean. We estimated time trends in each outcome to evaluate whether disparities were closing or widening.From 2003 to 2019, there were 72 809 US-born individuals diagnosed with tuberculosis disease of whom 72 369 (35·7% women and 64·3% men) could be included in analyses. We observed an overall higher risk of any adverse outcome (defined as diagnosis after death, treatment discontinuation, or death during treatment) for non-Hispanic Black people (aRR 1·27, 95% CI 1·22-1·32), Hispanic people (1·20, 1·14-1·27), and American Indian or Alaska Native people (1·24, 1·12-1·37), relative to non-Hispanic White people. The Index of Disparity for this summary outcome remained unchanged over the study period.This study, based on national surveillance data, indicates racial and ethnic disparaties among US-born tuberculosis patients along the tuberculosis continuum of care. Initiatives are needed to reduce diagnostic delays and improve treatment outcomes for US-born racially marginalised people in the USA.US Centers for Disease Control and Prevention.

  View details for DOI 10.1016/S2468-2667(23)00276-1

  View details for PubMedID 38176842

• Bias-Adjusted Predictions of County-Level Vaccination Coverage from the COVID-19 Trends and Impact Survey. Medical decision making : an international journal of the Society for Medical Decision Making Reitsma, M. B., Rose, S., Reinhart, A., Goldhaber-Fiebert, J. D., Salomon, J. A. 2023: 272989X231218024

  Abstract

  BACKGROUND: The potential for selection bias in nonrepresentative, large-scale, low-cost survey data can limit their utility for population health measurement and public health decision making. We developed an approach to bias adjust county-level COVID-19 vaccination coverage predictions from the large-scale US COVID-19 Trends and Impact Survey.DESIGN: We developed a multistep regression framework to adjust for selection bias in predicted county-level vaccination coverage plateaus. Our approach included poststratification to the American Community Survey, adjusting for differences in observed covariates, and secondary normalization to an unbiased reference indicator. As a case study, we prospectively applied this framework to predict county-level long-run vaccination coverage among children ages 5 to 11y. We evaluated our approach against an interim observed measure of 3-mo coverage for children ages 5 to 11y and used long-term coverage estimates to monitor equity in the pace of vaccination scale up.RESULTS: Our predictions suggested a low ceiling on long-term national vaccination coverage (46%), detected substantial geographic heterogeneity (ranging from 11% to 91% across counties in the United States), and highlighted widespread disparities in the pace of scale up in the 3 mo following Emergency Use Authorization of COVID-19 vaccination for 5- to 11-y-olds.LIMITATIONS: We relied on historical relationships between vaccination hesitancy and observed coverage, which may not capture rapid changes in the COVID-19 policy and epidemiologic landscape.CONCLUSIONS: Our analysis demonstrates an approach to leverage differing strengths of multiple sources of information to produce estimates on the time scale and geographic scale necessary for proactive decision making.IMPLICATIONS: Designing integrated health measurement systems that combine sources with different advantages across the spectrum of timeliness, spatial resolution, and representativeness can maximize the benefits of data collection relative to costs.HIGHLIGHTS: The COVID-19 pandemic catalyzed massive survey data collection efforts that prioritized timeliness and sample size over population representativeness.The potential for selection bias in these large-scale, low-cost, nonrepresentative data has led to questions about their utility for population health measurement.We developed a multistep regression framework to bias adjust county-level vaccination coverage predictions from the largest public health survey conducted in the United States to date: the US COVID-19 Trends and Impact Survey.Our study demonstrates the value of leveraging differing strengths of multiple data sources to generate estimates on the time scale and geographic scale necessary for proactive public health decision making.

  View details for DOI 10.1177/0272989X231218024

  View details for PubMedID 38159263

• Tabby2: a user-friendly web tool for forecasting state-level TB outcomes in the United States. BMC medicine Swartwood, N. A., Testa, C., Cohen, T., Marks, S. M., Hill, A. N., Beeler Asay, G., Cochran, J., Cranston, K., Randall, L. M., Tibbs, A., Horsburgh, C. R., Salomon, J. A., Menzies, N. A. 2023; 21 (1): 331

  Abstract

  In the United States, the tuberculosis (TB) disease burden and associated factors vary substantially across states. While public health agencies must choose how to deploy resources to combat TB and latent tuberculosis infection (LTBI), state-level modeling analyses to inform policy decisions have not been widely available.We developed a mathematical model of TB epidemiology linked to a web-based user interface - Tabby2. The model is calibrated to epidemiological and demographic data for the United States, each U.S. state, and the District of Columbia. Users can simulate pre-defined scenarios describing approaches to TB prevention and treatment or create their own intervention scenarios. Location-specific results for epidemiological outcomes, service utilization, costs, and cost-effectiveness are reported as downloadable tables and customizable visualizations. To demonstrate the tool's functionality, we projected trends in TB outcomes without additional intervention for all 50 states and the District of Columbia. We further undertook a case study of expanded treatment of LTBI among non-U.S.-born individuals in Massachusetts, covering 10% of the target population annually over 2025-2029.Between 2022 and 2050, TB incidence rates were projected to decline in all states and the District of Columbia. Incidence projections for the year 2050 ranged from 0.03 to 3.8 cases (median 0.95) per 100,000 persons. By 2050, we project that majority (> 50%) of TB will be diagnosed among non-U.S.-born persons in 46 states and the District of Columbia; per state percentages range from 17.4% to 96.7% (median 83.0%). In Massachusetts, expanded testing and treatment for LTBI in this population was projected to reduce cumulative TB cases between 2025 and 2050 by 6.3% and TB-related deaths by 8.4%, relative to base case projections. This intervention had an incremental cost-effectiveness ratio of $180,951 (2020 USD) per quality-adjusted life year gained from the societal perspective.Tabby2 allows users to estimate the costs, impact, and cost-effectiveness of different TB prevention approaches for multiple geographic areas in the United States. Expanded testing and treatment for LTBI could accelerate declines in TB incidence in the United States, as demonstrated in the Massachusetts case study.

  View details for DOI 10.1186/s12916-023-02785-y

  View details for PubMedID 37649031

  View details for PubMedCentralID PMC10469407

• The Impact of Rapid Drug Susceptibility Tests on Gonorrhea Burden and Lifespan of Antibiotic Treatments: A Modeling Study Among Men Who Have Sex With Men in the United States. American journal of epidemiology Yaesoubi, R., Xi, Q., Hsu, K., Gift, T. L., St Cyr, S. B., Rönn, M. M., Salomon, J. A., Grad, Y. H. 2023

  Abstract

  Rapid point-of-care tests that diagnose gonococcal infections and identify susceptibility to antibiotics enable individualized treatment. This could improve patient outcomes and slow the emergence and spread of resistance. However, little is known about the long-term impact of such diagnostics on the burden of gonorrhea and the effective lifespan of antibiotics. We used a mathematical model of gonorrhea transmission among men who have sex with men in the US to project the annual rate of reported gonorrhea cases and the effective lifespan of ceftriaxone, the recommended antibiotic for the first-line treatment of gonorrhea, as well as two previously recommended antibiotics, ciprofloxacin and tetracycline, when a rapid drug susceptibility test (DST) that reports susceptibility to ciprofloxacin and tetracycline is available. The use of a rapid DST with ≥50% sensitivity and ≥95% specificity, defined in terms of correct ascertainment of drug susceptibility and non-susceptibility status, could increase the combined effective lifespan of ciprofloxacin, tetracycline, and ceftriaxone by at least 2 years over 25 years of simulation. If test specificity is imperfect, however, the increase in the effective lifespan of antibiotics is accompanied by an increase in the rate of reported gonorrhea cases even under perfect sensitivity.

  View details for DOI 10.1093/aje/kwad175

  View details for PubMedID 37625444

• Resistance-minimising strategies for introducing a novel antibiotic for gonorrhoea treatment: a mathematical modelling study. The Lancet. Microbe Reichert, E., Yaesoubi, R., Rönn, M. M., Gift, T. L., Salomon, J. A., Grad, Y. H. 2023

  Abstract

  Gonorrhoea is a highly prevalent sexually transmitted infection and an urgent public health concern because of increasing antibiotic resistance in Neisseria gonorrhoeae. Only ceftriaxone remains as the recommended treatment in the USA. With the prospect of new anti-gonococcal antibiotics being approved, we aimed to evaluate how to deploy a new drug to maximise its clinically useful lifespan.We used a compartmental model of gonorrhoea transmission in a US population of men who have sex with men (MSM) to compare strategies for introducing a new antibiotic for gonorrhoea treatment. The MSM population was stratified into three sexual activity groups (low, intermediate, and high) characterised by annual rates of partner change. The four introduction strategies tested were: (1) random 50-50 allocation, where each treatment-seeking infected individual had a 50% probability of receiving either drug A (current drug; a ceftriaxone-like antibiotic) or drug B (a new antibiotic), effective at time 0; (2) combination therapy of both the current drug and the new antibiotic; (3) reserve strategy, by which the new antibiotic was held in reserve until the current therapy reached a 5% threshold prevalence of resistance; and (4) gradual switch, or the gradual introduction of the new drug until random 50-50 allocation was reached. The primary outcome of interest was the time until 5% prevalence of resistance to each of the drugs (the new drug and the current ceftriaxone-like antibiotic); sensitivity of the primary outcome to the properties of the new antibiotic, specifically the probability of resistance emergence after treatment and the fitness costs of resistance, was explored. Secondary outcomes included the time to a 1% resistance threshold for each drug, as well as population-level prevalence, mean and range annual incidence, and the cumulative number of incident gonococcal infections.Under baseline model conditions, a 5% prevalence of resistance to each of drugs A and B was reached within 13·9 years with the reserve strategy, 18·2 years with the gradual switch strategy, 19·2 years with the random 50-50 allocation strategy, and 19·9 years with the combination therapy strategy. The reserve strategy was consistently inferior for mitigating antibiotic resistance under the parameter space explored and was increasingly outperformed by the other strategies as the probability of de novo resistance emergence decreased and as the fitness costs associated with resistance increased. Combination therapy tended to prolong the development of antibiotic resistance and minimise the number of annual gonococcal infections (under baseline model conditions, mean number of incident infections per year 178 641 [range 177 998-181 731] with combination therapy, 180 084 [178 011-184 405] with the reserve strategy).Our study argues for rapid introduction of new anti-gonococcal antibiotics, recognising that the feasibility of each strategy must incorporate cost, safety, and other practical concerns. The analyses should be revisited once robust estimates of key parameters-ie, the likelihood of emergence of resistance and fitness costs of resistance for the new antibiotic-are available.US Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases.

  View details for DOI 10.1016/S2666-5247(23)00145-3

  View details for PubMedID 37619582

• First Do No Harm? Modeling Risks and Benefits of Challenge Trials for Hepatitis C Vaccine Development. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Bilinski, A., Slimovitch, R., Mendlowitz, A., Feld, J. J., Salomon, J. A. 2023; 77 (Supplement_3): S231-S237

  Abstract

  BACKGROUND: In 2019, about 58 million individuals were chronically infected with hepatitis C virus. Some experts have proposed challenge trials for hepatitis C virus vaccine development.METHODS: We modeled incremental infections averted through a challenge approach, under varying assumptions regarding trial duration, number of candidates, and vaccine uptake. We computed the benefit-risk ratio of incremental benefits to risks for challenge versus traditional approaches. We also benchmarked against monetary costs of achieving incremental benefits through treatment.RESULTS: Our base case assumes 3 vaccine candidates, each with an 11% chance of success, corresponding to a 30% probability of successfully developing a vaccine. Given this probability, and assuming a 5-year difference in duration between challenge and traditional trials, a challenge approach would avert an expected 185 000 incremental infections with 20% steady-state uptake compared to a traditional approach and 832 000 with 90% uptake (quality-adjusted life-year benefit-risk ratio, 72 000 & 323 000). It would cost at least $92 million and $416 million, respectively, to obtain equivalent benefits through treatment. BRRs vary considerably across scenarios, depending on input assumptions.CONCLUSIONS: Benefits of a challenge approach increase with more vaccine candidates, faster challenge trials, and greater uptake.

  View details for DOI 10.1093/cid/ciad379

  View details for PubMedID 37579207

• Adaptive metrics for an evolving pandemic: A dynamic approach to area-level COVID-19 risk designations. Proceedings of the National Academy of Sciences of the United States of America Bilinski, A. M., Salomon, J. A., Hatfield, L. A. 2023; 120 (32): e2302528120

  Abstract

  Throughout the COVID-19 pandemic, policymakers have proposed risk metrics, such as the CDC Community Levels, to guide local and state decision-making. However, risk metrics have not reliably predicted key outcomes and have often lacked transparency in terms of prioritization of false-positive versus false-negative signals. They have also struggled to maintain relevance over time due to slow and infrequent updates addressing new variants and shifts in vaccine- and infection-induced immunity. We make two contributions to address these weaknesses. We first present a framework to evaluate predictive accuracy based on policy targets related to severe disease and mortality, allowing for explicit preferences toward false-negative versus false-positive signals. This approach allows policymakers to optimize metrics for specific preferences and interventions. Second, we propose a method to update risk thresholds in real time. We show that this adaptive approach to designating areas as "high risk" improves performance over static metrics in predicting 3-wk-ahead mortality and intensive care usage at both state and county levels. We also demonstrate that with our approach, using only new hospital admissions to predict 3-wk-ahead mortality and intensive care usage has performed consistently as well as metrics that also include cases and inpatient bed usage. Our results highlight that a key challenge for COVID-19 risk prediction is the changing relationship between indicators and outcomes of policy interest. Adaptive metrics therefore have a unique advantage in a rapidly evolving pandemic context.

  View details for DOI 10.1073/pnas.2302528120

  View details for PubMedID 37527346

• Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021 LANCET Ong, K., Stafford, L. K., Mclaughlin, S. A., Boyko, E. J., Vollset, S., Smith, A. E., Dalton, B. E., Duprey, J., Cruz, J. A., Hagins, H., Lindstedt, P. A., Aali, A., Abate, Y., Abate, M., Abbasian, M., Abbasi-Kangevari, Z., Abbasi-Kangevari, M., Abd ElHafeez, S., Abd-Rabu, R., Abdulah, D., Abdullah, A., Abedi, V., Abidi, H., Aboagye, R., Abolhassani, H., Abu-Gharbieh, E., Abu-Zaid, A., Adane, T., Adane, D., Addo, I., Adegboye, O. A., Adekanmbi, V., Adepoju, A., Adnani, Q., Afolabi, R., Agarwal, G., Aghdam, Z., Agudelo-Botero, M., Arriagada, C., Agyemang-Duah, W., Ahinkorah, B., Ahmad, D., Ahmad, R., Ahmad, S., Ahmad, A., Ahmadi, A., Ahmadi, K., Ahmed, A., Ahmed, A., Ahmed, L. A., Ahmed, S., Ajami, M., Akinyemi, R., Al Hamad, H., Hasan, S., AL-Ahdal, T., Alalwan, T. A., Al-Aly, Z., Albataineh, M., Alcalde-Rabanal, J., Alemi, S., Ali, H., Alinia, T., Aljunid, S., Almustanyir, S., Al-Raddadi, R. M., Alvis-Guzman, N., Amare, F., Ameyaw, E., Amiri, S., Amusa, G., Andrei, C., Anjana, R., Ansar, A., Ansari, G., Ansari-Moghaddam, A., Anyasodor, A., Arabloo, J., Aravkin, A. Y., Areda, D., Arifin, H., Arkew, M., Armocida, B., Aernloev, J., Artamonov, A. A., Arulappan, J., Aruleba, R., Arumugam, A., Aryan, Z., Asemu, M., Asghari-Jafarabadi, M., Askari, E., Asmelash, D., Astell-Burt, T., Athar, M., Athari, S., Atout, M., Avila-Burgos, L., Awaisu, A., Azadnajafabad, S., Babamohamadi, H., Badar, M., Badawi, A., Badiye, A., Baghcheghi, N., Bagheri, N., Bagherieh, S., Bah, S., Bahadory, S., Bai, R., Baig, A., Baltatu, O., Baradaran, H., Barchitta, M., Bardhan, M., Barengo, N. C., Baernighausen, T., Barone, M., Barone-Adesi, F., Barrow, A., Bashiri, H., Basiru, A., Basu, S., Basu, S., Batiha, A., Batra, K., Bayih, M., Bayileyegn, N., Behnoush, A., Bekele, A., Belete, M., Belgaumi, U., Belo, L., Bennett, D. A., Bensenor, I. M., Berhe, K., Berhie, A., Bhaskar, S., Bhat, A., Bhatti, J., Bikbov, B., Bilal, F., Bintoro, B., Bitaraf, S., Bitra, V. R., Bjegovic-Mikanovic, V., Bodolica, V., Boloor, A., Brauer, M., Brazo-Sayavera, J., Brenner, H., Butt, Z. A., Calina, D., Campos, L., Campos-Nonato, I. R., Cao, Y., Cao, C., Car, J., Carvalho, M., Castaneda-Orjuela, C. A., Catala-Lopez, F., Cerin, E., Chadwick, J., Chandrasekar, E. K., Chanie, G., Charan, J., Chattu, V., Chauhan, K., Cheema, H., Abebe, E., Chen, S., Cherbuin, N., Chichagi, F., Chidambaram, S., Cho, W. S., Choudhari, S., Chowdhury, R., Chowdhury, E., Chu, D., Chukwu, I., Chung, S., Coberly, K., Columbus, A., Contreras, D., Cousin, E., Criqui, M. H., Cruz-Martins, N., Cuschieri, S., Dabo, B., Dadras, O., Dai, X., Damasceno, A., Dandona, R., Dandona, L., Das, S., Dascalu, A., Dash, N., Dashti, M., Davila-Cervantes, C., Cruz-Gongora, V., Debele, G., Delpasand, K., Demisse, F., Demissie, G., Deng, X., Denova-Gutierrez, E., Deo, S., Dervisevic, E., Desai, H., Desale, A., Dessie, A., Desta, F., Dewan, S., Dey, S., Dhama, K., Dhimal, M., Diao, N., Diaz, D., Dinu, M., Diress, M., Djalalinia, S., Doan, L., Dongarwar, D., Figueiredo, F., Duncan, B. B., Dutta, S., Dziedzic, A., Edinur, H., Ekholuenetale, M., Ekundayo, T., Elgendy, I. Y., Elhadi, M., El-Huneidi, W., Elmeligy, O., Elmonem, M. A., Endeshaw, D., Esayas, H., Eshetu, H., Etaee, F., Fadhil, I., Fagbamigbe, A., Fahim, A., Falahi, S., Faris, M., Farrokhpour, H., Farzadfar, F., Fatehizadeh, A., Fazli, G., Feng, X., Ferede, T. Y., Fischer, F., Flood, D., Forouhari, A., Foroumadi, R., Koudehi, M., Gaidhane, A., Gaihre, S., Gaipov, A., Galali, Y., Ganesan, B., Garcia-Gordillo, M. A., Gautam, R. K., Gebrehiwot, M., Gebrekidan, K., Gebremeskel, T., Getacher, L., Ghadirian, F., Ghamari, S., Nour, M., Ghassemi, F., Golechha, M., Goleij, P., Golinelli, D., Gopalani, S., Guadie, H., Guan, S., Gudayu, T., Guimaraes, R., Guled, R., Gupta, R., Gupta, K., Gupta, V., Gupta, V., Gyawali, B., Haddadi, R., Hadi, N. R., Haile, T., Hajibeygi, R., Haj-Mirzaian, A., Halwani, R., Hamidi, S., Hankey, G. J., Hannan, M., Haque, S., Harandi, H., Harlianto, N., Hasan, S., Hasan, S., Hasani, H., Hassanipour, S., Hassen, M., Haubold, J., Hayat, K., Heidari, G., Heidari, M., Hessami, K., Hiraike, Y., Holla, R., Hossain, S., Hossain, M., Hosseini, M., Hosseinzadeh, M., Hosseinzadeh, H., Huang, J., Huda, N., Hussain, S., Huynh, H., Hwang, B., Ibitoye, S., Ikeda, N., Ilic, I. M., Ilic, M., Inbaraj, L., Iqbal, A., Islam, S., Islam, R. M., Ismail, N., Iso, H., Isola, G., Itumalla, R., Iwagami, M., Iwu, C. D., Iyamu, I., Iyasu, A. N., Jacob, L., Jafarzadeh, A., Jahrami, H., Jain, R., Jaja, C., Jamalpoor, Z., Jamshidi, E., Janakiraman, B., Jayanna, K., Jayapal, S., Jayaram, S., Jayawardena, R., Jebai, R., Jeong, W., Jin, Y., Jokar, M., Jonas, J. B., Joseph, N., Joseph, A., Joshua, C., Joukar, F., Jozwiak, J., Kaambwa, B., Kabir, A., Kabthymer, R., Kadashetti, V., Kahe, F., Kalhor, R., Kandel, H., Karanth, S., Karaye, I. M., Karkhah, S., Katoto, P. C., Kaur, N., Kazemian, S., Kebede, S., Khader, Y., Khajuria, H., Khalaji, A., AB Khan, M., Khan, M., Khan, A., Khanal, S., Khatatbeh, M., Khater, A. M., Khateri, S., Khorashadizadeh, F., Khubchandani, J., Kibret, B., Kim, M., Kimokoti, R. W., Kisa, A., Kivimaki, M., Kolahi, A., Komaki, S., Kompani, F., Koohestani, H., Korzh, O., Kostev, K., Kothari, N., Koyanagi, A., Krishan, K., Krishnamoorthy, Y., Defo, B., Kuddus, M., Kuddus, M., Kumar, R., Kumar, H., Kundu, S., Kurniasari, M., Kuttikkattu, A., La Vecchia, C., Lallukka, T., Larijani, B., Larsson, A. O., Latief, K., Lawal, B., Thao Thi Thu Le, Trang Thi Bich Le, Lee, S., Lee, M., Lee, W., Lee, P. H., Lee, S., Lee, S., Legesse, S., Lenzi, J., Li, Y., Li, M., Lim, S. S., Lim, L., Liu, X., Liu, C., Lo, C., Lopes, G., Lorkowski, S., Lozano, R., Lucchetti, G., Maghazachi, A. A., Mahasha, P., Mahjoub, S., Mahmoud, M., Mahmoudi, R., Mahmoudimanesh, M., Anh Tuan Mai, Majeed, A., Sanaye, P., Makris, K., Malhotra, K., Malik, A., Malik, I., Mallhi, T., Malta, D., Mamun, A. A., Mansouri, B., Marateb, H., Mardi, P., Martini, S., Martorell, M., Marzo, R., Masoudi, R., Masoudi, S., Mathews, E., Maugeri, A., Mazzaglia, G., Mekonnen, T., Meshkat, M., Mestrovic, T., Jonasson, J., Miazgowski, T., Michalek, I., Le Huu Nhat Minh, Mini, G. K., Miranda, J., Mirfakhraie, R., Mirrakhimov, E. M., Mirza-Aghazadeh-Attari, M., Misganaw, A., Misgina, K., Mishra, M., Moazen, B., Mohamed, N., Mohammadi, E., Mohammadi, M., Mohammadian-Hafshejani, A., Mohammadshahi, M., Mohseni, A., Mojiri-Forushani, H., Mokdad, A. H., Momtazmanesh, S., Monasta, L., Moniruzzaman, M., Mons, U., Montazeri, F., Ghalibaf, A., Moradi, Y., Moradi, M., Sarabi, M., Morovatdar, N., Morrison, S., Morze, J., Mossialos, E., Mostafavi, E., Mueller, U., Mulita, F., Mulita, A., Murillo-Zamora, E., Musa, K., Mwita, J. C., Nagaraju, S., Naghavi, M., Nainu, F., Nair, T., Najmuldeen, H., Nangia, V., Nargus, S., Naser, A. Y., Nassereldine, H., Natto, Z. S., Nauman, J., Nayak, B., Ndejjo, R., Negash, H., Negoi, R., Hau Thi Hien Nguyen, Nguyen, D. H., Phat Tuan Nguyen, Van Thanh Nguyen, Hien Quang Nguyen, Niazi, R., Nigatu, Y. T., Ningrum, D., Nizam, M. A., Nnyanzi, L., Noreen, M., Noubiap, J., Nzoputam, O., Nzoputam, C., Oancea, B., Odogwu, N., Odukoya, O., Ojha, V., Okati-Aliabad, H., Okekunle, A., Okonji, O., Okwute, P., Olufadewa, I., Onwujekwe, O. E., Ordak, M., Ortiz, A., Osuagwu, U., Oulhaj, A., Owolabi, M. O., Padron-Monedero, A., Padubidri, J., Palladino, R., Panagiotakos, D., Panda-Jonas, S., Pandey, A., Pandey, A., Pandi-Perumal, S. R., Stoian, A., Pardhan, S., Parekh, T., Parekh, U., Pasovic, M., Patel, J., Patel, J. R., Paudel, U., Pepito, V., Pereira, M., Perico, N., Perna, S., Petcu, I., Petermann-Rocha, F., Podder, V., Postma, M. J., Pourali, G., Pourtaheri, N., Prates, E., Qadir, M., Qattea, I., Raee, P., Rafique, I., Rahimi, M., Rahimifard, M., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahman, M., Rahman, M., Rahman, M., Rahmani, M., Rahmani, S., Rahmanian, V., Rahmawaty, S., Rahnavard, N., Rajbhandari, B., Ram, P., Ramazanu, S., Rana, J., Rancic, N., Ranjha, M., Rao, C. R., Rapaka, D., Rasali, D., Rashedi, S., Rashedi, V., Rashid, A., Rashidi, M., Ratan, Z., Rawaf, S., Rawal, L., Redwan, E., Remuzzi, G., Rengasamy, K. R., Renzaho, A. N., Reyes, L., Rezaei, N., Rezaei, N., Rezaeian, M., Rezazadeh, H., Riahi, S., Rias, Y., Riaz, M., Ribeiro, D., Rodrigues, M., Rodriguez, J., Roever, L., Rohloff, P., Roshandel, G., Roustazadeh, A., Rwegerera, G. M., Saad, A. A., Saber-Ayad, M., Sabour, S., Sabzmakan, L., Saddik, B., Sadeghi, E., Saeed, U., Moghaddam, S., Safi, S., Safi, S., Saghazadeh, A., Sharif-Askari, N., Sharif-Askari, F., Sahebkar, A., Sahoo, S., Sahoo, H., Saif-Ur-Rahman, K. M., Sajid, M., Salahi, S., Salahi, S., Saleh, M. A., Salehi, M., Salomon, J. A., Sanabria, J., Sanjeev, R., Sanmarchi, F., Santric-Milicevic, M. M., Sarasmita, M., Sargazi, S., Sathian, B., Sathish, T., Sawhney, M., Schlaich, M. P., Schmidt, M., Schuermans, A., Seidu, A., Kumar, N., Sepanlou, S. G., Sethi, Y., Seylani, A., Shabany, M., Shafaghat, T., Shafeghat, M., Shafie, M., Shah, N. S., Shahid, S., Shaikh, M., Shanawaz, M., Shannawaz, M., Sharfaei, S., Shashamo, B., Shiri, R., Shittu, A., Shivakumar, K. M., Shivalli, S., Shobeiri, P., Shokri, F., Shuval, K., Sibhat, M., Silva, L., Simpson, C. R., Singh, J. A., Singh, P., Singh, S., Siraj, M., Skryabina, A., Sohag, A., Soleimani, H., Solikhah, S., Soltani-Zangbar, M., Somayaji, R., Sorensen, R. D., Starodubova, A. V., Sujata, S., Suleman, M., Sun, J., Sundstrom, J., Tabares-Seisdedos, R., Tabatabaei, S., Tabatabaeizadeh, S., Tabish, M., Taheri, M., Taheri, E., Taki, E., Tamuzi, J., Tan, K., Tat, N. Y., Taye, B., Temesgen, W., Temsah, M., Tesler, R., Thangaraju, P., Thankappan, K., Thapa, R., Tharwat, S., Thomas, N., Ticoalu, J., Tiyuri, A., Tonelli, M., Tovani-Palone, M., Trico, D., Trihandini, I., Tripathy, J., Tromans, S., Tsegay, G., Tualeka, A., Tufa, D., Tyrovolas, S., Ullah, S., Upadhyay, E., Vahabi, S., Vaithinathan, A., Valizadeh, R., van Daalen, K., Vart, P., Varthya, S., Vasankari, T., Vaziri, S., Verma, M., Verras, G., Danh Cao Vo, Wagaye, B., Waheed, Y., Wang, Z., Wang, Y., Wang, C., Wang, F., Wassie, G., Wei, M., Weldemariam, A., Westerman, R., Wickramasinghe, N., Wu, Y., Wulandari, R. I., Xia, J., Xiao, H., Xu, S., Xu, X., Yada, D. Y., Yang, L., Yatsuya, H., Yesiltepe, M., Yi, S., Yohannis, H., Yonemoto, N., You, Y., Bin Zaman, S., Zamora, N., Zare, I., Zarea, K., Zarrintan, A., Zastrozhin, M., Zeru, N., Zhang, Z., Zhong, C., Zhou, J., Zielinska, M., Zikarg, Y., Zodpey, S., Zoladl, M., Zou, Z., Zumla, A., Zuniga, Y. H., Magliano, D. J., Murray, C. L., Hay, S. I., Vos, T., GBD 2021 Diabet Collaborators 2023; 402 (10397): 203-234

  Abstract

  Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050.Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively.In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%.Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.Bill & Melinda Gates Foundation.

  View details for DOI 10.1016/S0140-6736(23)01301-6

  View details for Web of Science ID 001084390700001

  View details for PubMedID 37356446

  View details for PubMedCentralID PMC10364581

• Use of Wastewater Metrics to Track COVID-19 in the US. JAMA network open Varkila, M. R., Montez-Rath, M. E., Salomon, J. A., Yu, X., Block, G. A., Owens, D. K., Chertow, G. M., Parsonnet, J., Anand, S. 2023; 6 (7): e2325591

  Abstract

  Importance: Widespread use of at-home COVID-19 tests hampers determination of community COVID-19 incidence.Objective: To examine the association of county-level wastewater metrics with high case and hospitalization rates nationwide both before and after widespread use of at-home tests.Design, Setting, and Participants: This observational cohort study with a time series analysis was conducted from January to September 2022 in 268 US counties in 22 states participating in the US Centers for Disease Control and Prevention's National Wastewater Surveillance System. Participants included the populations of those US counties.Exposures: County level of circulating SARS-CoV-2 as determined by metrics based on viral wastewater concentration relative to the county maximum (ie, wastewater percentile) and 15-day percentage change in SARS-CoV-2 (ie, percentage change).Main Outcomes and Measures: High county incidence of COVID-19 as evidenced by dichotomized reported cases (current cases ≥200 per 100 000 population) and hospitalization (≥10 per 100 000 population lagged by 2 weeks) rates, stratified by calendar quarter.Results: In the first quarter of 2022, use of the wastewater percentile detected high reported case (area under the curve [AUC], 0.95; 95% CI, 0.94-0.96) and hospitalization (AUC, 0.86; 95% CI, 0.84-0.88) rates. The percentage change metric performed poorly, with AUCs ranging from 0.51 (95% CI, 0.50-0.53) to 0.57 (95% CI, 0.55-0.59) for reported new cases, and from 0.50 (95% CI, 0.48-0.52) to 0.55 (95% CI, 0.53-0.57) for hospitalizations across the first 3 quarters of 2022. The Youden index for detecting high case rates was wastewater percentile of 51% (sensitivity, 0.82; 95% CI, 0.80-0.84; specificity, 0.93; 95% CI, 0.92-0.95). A model inclusive of both metrics performed no better than using wastewater percentile alone. The performance of wastewater percentile declined over time for cases in the second quarter (AUC, 0.84; 95% CI, 0.82-0.86) and third quarter (AUC, 0.72; 95% CI, 0.70-0.75) of 2022.Conclusions and Relevance: In this study, nationwide, county wastewater levels relative to the county maximum were associated with high COVID-19 case and hospitalization rates in the first quarter of 2022, but there was increasing dissociation between wastewater and clinical metrics in subsequent quarters, which may reflect increasing underreporting of cases, reduced testing, and possibly lower virulence of infection due to vaccines and treatments. This study offers a strategy to operationalize county wastewater percentile to improve the accurate assessment of community SARS-CoV-2 infection prevalence when reliability of conventional surveillance data is declining.

  View details for DOI 10.1001/jamanetworkopen.2023.25591

  View details for PubMedID 37494040

• Costs, Health Benefits, and Cost-Effectiveness of Chlamydia Screening and Partner Notification in the United States, 2000-2019: A Mathematical Modeling Analysis. Sexually transmitted diseases Rönn, M. M., Li, Y., Gift, T. L., Chesson, H. W., Menzies, N. A., Hsu, K., Salomon, J. A. 2023; 50 (6): 351-358

  Abstract

  Chlamydia remains a significant public health problem that contributes to adverse reproductive health outcomes. In the United States, sexually active women 24 years and younger are recommended to receive annual screening for chlamydia. In this study, we evaluated the impact of estimated current levels of screening and partner notification (PN), and the impact of screening based on guidelines on chlamydia associated sequelae, quality adjusted life years (QALYs) lost and costs.We conducted a cost-effectiveness analysis of chlamydia screening, using a published calibrated pair formation transmission model that estimated trends in chlamydia screening coverage in the United States from 2000 to 2015 consistent with epidemiological data. We used probability trees to translate chlamydial infection outcomes into estimated numbers of chlamydia-associated sequelae, QALYs lost, and health care services costs (in 2020 US dollars). We evaluated the costs and population health benefits of screening and PN in the United States for 2000 to 2015, as compared with no screening and no PN. We also estimated the additional benefits that could be achieved by increasing screening coverage to the levels indicated by the policy recommendations for 2016 to 2019, compared with screening coverage achieved by 2015.Screening and PN from 2000 to 2015 were estimated to have averted 1.3 million (95% uncertainty interval [UI] 490,000-2.3 million) cases of pelvic inflammatory disease, 430,000 (95% UI, 160,000-760,000) cases of chronic pelvic pain, 300,000 (95% UI, 104,000-570,000) cases of tubal factor infertility, and 140,000 (95% UI, 47,000-260,000) cases of ectopic pregnancy in women. We estimated that chlamydia screening and PN cost $9700 per QALY gained compared with no screening and no PN. We estimated the full realization of chlamydia screening guidelines for 2016 to 2019 to cost $30,000 per QALY gained, compared with a scenario in which chlamydia screening coverage was maintained at 2015 levels.Chlamydia screening and PN as implemented in the United States from 2000 through 2015 has substantially improved population health and provided good value for money when considering associated health care services costs. Further population health gains are attainable by increasing screening further, at reasonable cost per QALY gained.

  View details for DOI 10.1097/OLQ.0000000000001786

  View details for PubMedID 36804917

• Changes in population immunity against infection and severe disease from SARS-CoV-2 Omicron variants in the United States between December 2021 and November 2022. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Klaassen, F., Chitwood, M. H., Cohen, T., Pitzer, V. E., Russi, M., Swartwood, N. A., Salomon, J. A., Menzies, N. A. 2023

  Abstract

  BACKGROUND: While a substantial fraction of the US population was infected with SARS-CoV-2 during December 2021 - February 2022, the subsequent evolution of population immunity reflects the competing influences of waning protection over time and acquisition or restoration of immunity through additional infections and vaccinations.METHODS: Using a Bayesian evidence synthesis model of reported COVID-19 data (diagnoses, hospitalizations), vaccinations, and waning patterns for vaccine- and infection-acquired immunity, we estimate population immunity against infection and severe disease from SARS-CoV-2 Omicron variants in the United States, by location (national, state, county) and week.RESULTS: By November 9, 2022, 97% (95%-99%) of the US population were estimated to have prior immunological exposure to SARS-CoV-2. Between December 1, 2021 and November 9, 2022, protection against a new Omicron infection rose from 22% (21%-23%) to 63% (51%-75%) nationally, and protection against an Omicron infection leading to severe disease increased from 61% (59%-64%) to 89% (83%-92%). Increasing first booster uptake to 55% in all states (current US coverage: 34%) and second booster uptake to 22% (current US coverage: 11%) would increase protection against infection by 4.5 percentage points (2.4-7.2) and protection against severe disease by 1.1 percentage points (1.0-1.5).CONCLUSIONS: Effective protection against SARS-CoV-2 infection and severe disease in November 2022 was substantially higher than in December 2021. Despite this high level of protection, a more transmissible or immune evading (sub)variant, changes in behavior, or ongoing waning of immunity could lead to a new SARS-CoV-2 wave.

  View details for DOI 10.1093/cid/ciad210

  View details for PubMedID 37074868

• Gaps and Disparities in Chronic Hepatitis B Monitoring and Treatment in the United States, 2016-2019. Medical care Pham, T. T., Toy, M., Hutton, D., Thompson, W., Conners, E. E., Nelson, N. P., Salomon, J. A., So, S. 2023; 61 (4): 247-253

  Abstract

  BACKGROUND: Chronic hepatitis B (CHB) carries an increased risk of death from cirrhosis and hepatocellular carcinoma (HCC). The American Association for the Study of Liver Diseases recommends patients with CHB receive monitoring of disease activity, including ALT, hepatitis B virus (HBV) DNA, hepatitis B e-antigen (HBeAg), and liver imaging for patients who experience an increased risk for HCC. HBV antiviral therapy is recommended for patients with active hepatitis and cirrhosis.METHODS: Monitoring and treatment of adults with new CHB diagnoses were analyzed using Optum Clinformatics Data Mart Database claims data from January 1, 2016, to December 31, 2019.RESULTS: Among 5978 patients with new CHB diagnosis, only 56% with cirrhosis and 50% without cirrhosis had claims for≥1 ALT and either HBV DNA or HBeAg test, and among patients recommended for HCC surveillance, 82% with cirrhosis and 57% without cirrhosis had claims for≥1 liver imaging within 12 months of diagnosis. Although antiviral treatment is recommended for patients with cirrhosis, only 29% of patients with cirrhosis had≥1 claim for HBV antiviral therapy within 12 months of CHB diagnosis. Multivariable analysis showed patients who were male, Asian, privately insured, or had cirrhosis were more likely (P<0.05) to receive ALT and either HBV DNA or HBeAg tests and HBV antiviral therapy within 12 months of diagnosis.CONCLUSION: Many patients diagnosed with CHB are not receiving the clinical assessment and treatment recommended. A comprehensive initiative is needed to address the patient, provider, and system-related barriers to improve the clinical management of CHB.

  View details for DOI 10.1097/MLR.0000000000001825

  View details for PubMedID 36893410

• Gaps in Prenatal Hepatitis B Screening and Management of HBsAg Positive Pregnant Persons in the U.S., 2015-2020. American journal of preventive medicine Pham, T. T., Maria, N., Cheng, V., Nguyen, B., Toy, M., Hutton, D., Conners, E. E., Nelson, N. P., Salomon, J. A., So, S. 2023

  Abstract

  The Advisory Committee for Immunization Practices (ACIP) recommends testing all pregnant women for hepatitis B surface antigen (HBsAg) and testing HBsAg-positive pregnant women for hepatitis B virus deoxyribonucleic acid (HBV DNA). HBsAg-positive pregnant persons are recommended by the American Association for the Study of Liver Diseases to receive regular monitoring, including alanine transaminase (ALT) and HBV DNA and antiviral therapy for active hepatitis and to prevent perinatal HBV transmission if HBV DNA level is >200,000 IU/mL.Using Optum Clinformatics Data Mart Database claims data, pregnant women who received HBsAg testing and HBsAg-positive pregnant persons who received HBV DNA and alt testing and antiviral therapy during pregnancy and after delivery during January 1, 2015-December 31, 2020 were analyzed.Among 506,794 pregnancies, 14.6% did not receive HBsAg testing. Pregnant women more likely to receive testing for HBsAg (p<0.01) were persons aged ≥20 years, were Asian, had >1 child, or received education beyond high school. Among the 0.28% (1,437) pregnant women who tested positive for hepatitis B surface antigen, 46% were Asian. The proportion of HBsAg-positive pregnant women who received HBV DNA testing during pregnancy and in the 12 months after delivery was 44.3% and 28.6%, respectively; the proportion that received HBsAg was 31.6% and 12.7%, respectively; the proportion that received ALT testing was 67.4% and 47%, respectively; and the proportion that received HBV antiviral therapy was 7% and 6.2%, respectively.This study suggests that as many as half a million (∼14%) pregnant persons who gave birth each year were not tested for HBsAg to prevent perinatal transmission. More than 50% of HBsAg-positive persons did not receive the recommended HBV-directed monitoring tests during pregnancy and after delivery.

  View details for DOI 10.1016/j.amepre.2023.01.041

  View details for PubMedID 36906494

• Vaccination and voting patterns in the United States: analysis of COVID-19 and flu surveys from 2010 to 2022. American journal of preventive medicine Ronn, M. M., Menzies, N. A., Salomon, J. A. 2023

  Abstract

  INTRODUCTION: The study assessed the relationship between COVID-19 and influenza (flu) vaccination and voting patterns during the pandemic, and time trends between flu vaccination and voting patterns.METHODS: Flu and COVID-19 vaccination coverage were analyzed using National Immunization Surveys for flu (NIS-FLU; years 2010-2022) and for COVID-19 (NIS-ACM; 2021-2022), CDC surveillance of COVID-19 vaccination coverage (2021-2022) and US COVID-19 Trends and Impact Survey (CTIS; 2021-2022). The study described the correlations between state-level COVID-19 and flu vaccination coverage, examined individual-level characteristics of vaccination for COVID-19 and for flu using logistic regression (CTIS May-June 2022), and analyzed flu vaccination coverage by age (NIS-FLU 2010-2022), and its relationship with voting patterns.RESULTS: There was a strong correlation between state-level COVID-19 vaccination coverage and voting share for the Democratic candidate in the 2020 presidential elections. COVID-19 vaccination coverage in June 2022 was higher than flu vaccination coverage and it had a stronger correlation with voting patterns (R=0.90 vs. R=0.60 in CTIS). Vaccinated people were more likely to be living in a county where the majority voted for the Democratic candidate in 2020 elections both for COVID-19 (aOR 1.77, 95%CI 1.71-1.84) and for flu (aOR 1.27, 95%CI 1.23-1.31). There is a longstanding correlation between voting patterns and flu vaccination coverage, which varies by age with the strongest correlation in the youngest ages.CONCLUSIONS: There are existing pre-pandemic patterns between vaccination coverage and voting patterns. The findings align with research that has identified an association between adverse health outcomes and the political environment in the United States.

  View details for DOI 10.1016/j.amepre.2023.03.001

  View details for PubMedID 36893952

• Projected COVID-19 Mortality Reduction From Paxlovid Rollout. JAMA health forum Khunte, M., Kumar, S., Salomon, J. A., Bilinski, A. 2023; 4 (3): e230046

  View details for DOI 10.1001/jamahealthforum.2023.0046

  View details for PubMedID 36930169

• Lifetime quality-adjusted life years lost due to genital herpes acquired in the United States in 2018: a mathematical modeling study. Lancet regional health. Americas You, S., Yaesoubi, R., Lee, K., Li, Y., Eppink, S. T., Hsu, K. K., Chesson, H. W., Gift, T. L., Berruti, A. A., Salomon, J. A., Rönn, M. M. 2023; 19: 100427

  Abstract

  Genital herpes (GH), caused by herpes simplex virus type 1 and type 2 (HSV-1, HSV-2), is a common sexually transmitted disease associated with adverse health outcomes. Symptoms associated with GH outbreaks can be reduced by antiviral medications, but the infection is incurable and lifelong. In this study, we estimate the long-term health impacts of GH in the United States using quality-adjusted life years (QALYs) lost.We used probability trees to model the natural history of GH secondary to infection with HSV-1 and HSV-2 among people aged 18-49 years. We modelled the following outcomes to quantify the major causes of health losses following infection: symptomatic herpes outbreaks, psychosocial impacts associated with diagnosis and recurrences, urinary retention caused by sacral radiculitis, aseptic meningitis, Mollaret's meningitis, and neonatal herpes. The model was parameterized based on published literature on the natural history of GH. We summarized losses of health by computing the lifetime number of QALYs lost per genital HSV-1 and HSV-2 infection, and we combined this information with incidence estimates to compute the total lifetime number of QALYs lost due to infections acquired in 2018 in the United States.We estimated 0.05 (95% uncertainty interval (UI) 0.02-0.08) lifetime QALYs lost per incident GH infection acquired in 2018, equivalent to losing 0.05 years or about 18 days of life for one person with perfect health. The average number of QALYs lost per GH infection due to genital HSV-1 and HSV-2 was 0.01 (95% UI 0.01-0.02) and 0.05 (95% UI 0.02-0.09), respectively. The burden of genital HSV-1 is higher among women, while the burden of HSV-2 is higher among men. QALYs lost per neonatal herpes infection was estimated to be 7.93 (95% UI 6.63-9.19). At the population level, the total estimated lifetime QALYs lost as a result of GH infections acquired in 2018 was 33,100 (95% UI 12,600-67,900) due to GH in adults and 3,140 (95% UI 2,260-4,140) due to neonatal herpes. Results were most sensitive to assumptions on the magnitude of the disutility associated with post-diagnosis psychosocial distress and symptomatic recurrences.GH is associated with substantial health losses in the United States. Results from this study can be used to compare the burden of GH to other diseases, and it provides inputs that may be used in studies on the health impact and cost-effectiveness of interventions that aim to reduce the burden of GH.The Center for Disease Control and Prevention.

  View details for DOI 10.1016/j.lana.2023.100427

  View details for PubMedID 36950038

  View details for PubMedCentralID PMC10025423

• The estimated lifetime quality-adjusted life-years lost due to chlamydia, gonorrhea, and trichomoniasis in the United States in 2018. The Journal of infectious diseases Li, Y., You, S., Lee, K., Yaesoubi, R., Hsu, K., Gift, T. L., Chesson, H. W., Berruti, A. A., Salomon, J. A., Rönn, M. M. 2023

  Abstract

  We quantified the quality-adjusted life-years (QALYs) lost attributable to chlamydia, gonorrhea, and trichomoniasis in the US, by sex and age group.We adapted a previous probability-tree model to estimate the average number of lifetime QALYs lost due to genital chlamydia, gonorrhea, and trichomoniasis, per incident infection and at the population level, by sex and age group. We conducted multivariate sensitivity analyses to address uncertainty around key parameter values.The estimated total discounted lifetime QALYs lost for men and women, respectively, due to infections acquired in 2018, were 1,541 (95% uncertainty interval: 186, 6,358) and 111,872 (29,777, 267,404) for chlamydia, 989 (127, 3,720) and 12,112 (2,410, 33,895) for gonorrhea, and 386 (30, 1,851) and 4,576 (13, 30,355) for trichomoniasis. Total QALYs lost were highest among women ages 15-24 years with chlamydia. QALYs lost estimates were highly sensitive to disutilities (health losses) of infections and sequelae, and to duration of infections and chronic sequelae for chlamydia and gonorrhea in women.The three sexually transmitted infections cause substantial health losses in the US, particularly gonorrhea and chlamydia among women. The estimates of lifetime QALYs lost per infection help to prioritize prevention policies and inform cost-effectiveness analyses of STI interventions.

  View details for DOI 10.1093/infdis/jiad047

  View details for PubMedID 36806950

• Generating simple classification rules to predict local surges in COVID-19 hospitalizations. Health care management science Yaesoubi, R., You, S., Xi, Q., Menzies, N. A., Tuite, A., Grad, Y. H., Salomon, J. A. 2023

  Abstract

  Low rates of vaccination, emergence of novel variants of SARS-CoV-2, and increasing transmission relating to seasonal changes and relaxation of mitigation measures leave many US communities at risk for surges of COVID-19 that might strain hospital capacity, as in previous waves. The trajectories of COVID-19 hospitalizations differ across communities depending on their age distributions, vaccination coverage, cumulative incidence, and adoption of risk mitigating behaviors. Yet, existing predictive models of COVID-19 hospitalizations are almost exclusively focused on national- and state-level predictions. This leaves local policymakers in urgent need of tools that can provide early warnings about the possibility that COVID-19 hospitalizations may rise to levels that exceed local capacity. In this work, we develop a framework to generate simple classification rules to predict whether COVID-19 hospitalization will exceed the local hospitalization capacity within a 4- or 8-week period if no additional mitigating strategies are implemented during this time. This framework uses a simulation model of SARS-CoV-2 transmission and COVID-19 hospitalizations in the US to train classification decision trees that are robust to changes in the data-generating process and future uncertainties. These generated classification rules use real-time data related to hospital occupancy and new hospitalizations associated with COVID-19, and when available, genomic surveillance of SARS-CoV-2. We show that these classification rules present reasonable accuracy, sensitivity, and specificity (all≥80%) in predicting local surges in hospitalizations under numerous simulated scenarios, which capture substantial uncertainties over the future trajectories of COVID-19. Our proposed classification rules are simple, visual, and straightforward to use in practice by local decision makers without the need to perform numerical computations.

  View details for DOI 10.1007/s10729-023-09629-4

  View details for PubMedID 36692583

• Estimated costs and quality-adjusted life-years lost due to N. gonorrhoeae infections acquired in 2015 in the United States: A modelling study of overall burden and disparities by age, race/ethnicity, and other factors. Lancet regional health. Americas Li, Y., Rönn, M. M., Tuite, A. R., Chesson, H. W., Gift, T. L., Trikalinos, T. A., Testa, C., Bellerose, M., Hsu, K., Berruti, A. A., Malyuta, Y., Menzies, N. A., Salomon, J. A. 2022; 16: 100364

  Abstract

  Disparities in the health and economic burden of gonorrhoea have not been systematically quantified. We estimated population-level health losses and costs associated with gonococcal infection and sequelae in the United States.We used probability-tree models to capture gonorrhoea sequelae and to estimate attributable disease burden in terms of the discounted lifetime costs and quality-adjusted life-years (QALYs) lost due to incident infections acquired during 2015 from the healthcare system perspective. Numbers of infections in 2015 were obtained from a published gonorrhoea transmission model. We evaluated population-level disease burden, disaggregated by sex, age, race/ethnicity, and for men who have sex with men (MSM). We conducted a multivariate sensitivity analysis for key parameters.Discounted lifetime QALYs lost per incident gonococcal infection were estimated as 0.093 (95% uncertainty interval [UI] 0.022-0.22) for women, 0.0020 (0.0015-0.0024) for heterosexual men, and 0.0015 (0.00070-0.0021) for MSM. Discounted lifetime costs per incident infection were USD 261 (109-480), 169 (88-263), and 133 (50-239), respectively. At the population level, total discounted lifetime QALYs lost due to infections acquired during 2015 were 53,293 (12,326-125,366) for women, 621 (430-872) for heterosexual men, and 1,078 (427-1,870) for MSM. Total discounted lifetime costs were USD 150 million (64-277 million), 54 million (25-92 million), and 97 million (34-197 million), respectively. The highest total burden of both QALYs and costs at the population-level was observed in Non-Hispanic Black women, and highest burden per 1,000 person-years was identified in MSM among men and American Indian/Alaska Native among women.Gonorrhoea causes substantial health losses and costs in the United States. These results can inform planning and prioritization of prevention services.Centers for Disease Control and Prevention, Charles A. King Trust.

  View details for DOI 10.1016/j.lana.2022.100364

  View details for PubMedID 36777156

  View details for PubMedCentralID PMC9904145

• Changes in population immunity against infection and severe disease from SARS-CoV-2 Omicron variants in the United States between December 2021 and November 2022. medRxiv : the preprint server for health sciences Klaassen, F., Chitwood, M. H., Cohen, T., Pitzer, V. E., Russi, M., Swartwood, N. A., Salomon, J. A., Menzies, N. A. 2022

  Abstract

  While a substantial fraction of the US population was infected with SARS-CoV-2 during December 2021 - February 2022, the subsequent evolution of population immunity against SARS-CoV-2 Omicron variants reflects the competing influences of waning protection over time and acquisition or restoration of immunity through additional infections and vaccinations.To estimate changes in population immunity against infection and severe disease due to circulating SARS-CoV-2 Omicron variants in the United States from December 2021 to November 2022, and to quantify the protection against a potential 2022-2023 winter SARS-CoV-2 wave.Bayesian evidence synthesis of reported COVID-19 data (diagnoses, hospitalizations), vaccinations, and waning patterns for vaccine- and infection-acquired immunity, using a mathematical model of COVID-19 natural history.Population immunity against infection and severe disease from SARS-CoV-2 Omicron variants in the United States, by location (national, state, county) and week.By November 9, 2022, 94% (95% CrI, 79%-99%) of the US population were estimated to have been infected by SARS-CoV-2 at least once. Combined with vaccination, 97% (95%-99%) were estimated to have some prior immunological exposure to SARS-CoV-2. Between December 1, 2021 and November 9, 2022, protection against a new Omicron infection rose from 22% (21%-23%) to 63% (51%-75%) nationally, and protection against an Omicron infection leading to severe disease increased from 61% (59%-64%) to 89% (83%-92%). Increasing first booster uptake to 55% in all states (current US coverage: 34%) and second booster uptake to 22% (current US coverage: 11%) would increase protection against infection by 4.5 percentage points (2.4-7.2) and protection against severe disease by 1.1 percentage points (1.0-1.5).Effective protection against SARS-CoV-2 infection and severe disease in November 2022 was substantially higher than in December 2021. Despite this high level of protection, a more transmissible or immune evading (sub)variant, changes in behavior, or ongoing waning of immunity could lead to a new SARS-CoV-2 wave.Question: How did population immunity against SARS-CoV-2 infection and subsequent severe disease change between December 2021, and November 2022?Findings: On November 9, 2022, the protection against a SARS-CoV-2 infection with the Omicron variant was estimated to be 63% (51%-75%) in the US, and the protection against severe disease was 89% (83%-92%).Meaning: As most of the newly acquired immunity has been accumulated in the December 2021-February 2022 Omicron wave, risk of reinfection and subsequent severe disease remains present at the beginning of the 2022-2023 winter, despite high levels of protection.

  View details for DOI 10.1101/2022.11.19.22282525

  View details for PubMedID 36451882

  View details for PubMedCentralID PMC9709792

• Protection against Omicron from Vaccination and Previous Infection in a Prison System. The New England journal of medicine Chin, E. T., Leidner, D., Lamson, L., Lucas, K., Studdert, D. M., Goldhaber-Fiebert, J. D., Andrews, J. R., Salomon, J. A. 2022

  Abstract

  Information regarding the protection conferred by vaccination and previous infection against infection with the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited.We evaluated the protection conferred by mRNA vaccines and previous infection against infection with the omicron variant in two high-risk populations: residents and staff in the California state prison system. We used a retrospective cohort design to analyze the risk of infection during the omicron wave using data collected from December 24, 2021, through April 14, 2022. Weighted Cox models were used to compare the effectiveness (measured as 1 minus the hazard ratio) of vaccination and previous infection across combinations of vaccination history (stratified according to the number of mRNA doses received) and infection history (none or infection before or during the period of B.1.617.2 [delta]-variant predominance). A secondary analysis used a rolling matched-cohort design to evaluate the effectiveness of three vaccine doses as compared with two doses.Among 59,794 residents and 16,572 staff, the estimated effectiveness of previous infection against omicron infection among unvaccinated persons who had been infected before or during the period of delta predominance ranged from 16.3% (95% confidence interval [CI], 8.1 to 23.7) to 48.9% (95% CI, 41.6 to 55.3). Depending on previous infection status, the estimated effectiveness of vaccination (relative to being unvaccinated and without previous documented infection) ranged from 18.6% (95% CI, 7.7 to 28.1) to 83.2% (95% CI, 77.7 to 87.4) with two vaccine doses and from 40.9% (95% CI, 31.9 to 48.7) to 87.9% (95% CI, 76.0 to 93.9) with three vaccine doses. Incremental effectiveness estimates of a third (booster) dose (relative to two doses) ranged from 25.0% (95% CI, 16.6 to 32.5) to 57.9% (95% CI, 48.4 to 65.7) among persons who either had not had previous documented infection or had been infected before the period of delta predominance.Our findings in two high-risk populations suggest that mRNA vaccination and previous infection were effective against omicron infection, with lower estimates among those infected before the period of delta predominance. Three vaccine doses offered significantly more protection than two doses, including among previously infected persons.

  View details for DOI 10.1056/NEJMoa2207082

  View details for PubMedID 36286260

• Differences in healthy longevity by HIV status and viral load among older South African adults: an observational cohort modelling study. The lancet. HIV Payne, C. F., Houle, B., Chinogurei, C., Herl, C. R., Kabudula, C. W., Kobayashi, L. C., Salomon, J. A., Manne-Goehler, J. 2022; 9 (10): e709-e716

  Abstract

  The population of people living with HIV in South Africa is rapidly ageing due to increased survivorship attributable to antiretroviral therapy (ART). We sought to understand how the combined effects of HIV and ART have led to differences in healthy longevity by HIV status and viral suppression in this context.In this observational cohort modelling study we use longitudinal data from the 2015 baseline interview (from Nov 13, 2014, to Nov 30, 2015) and the 2018 longitudinal follow-up interview (from Oct 12, 2018, to Nov 7, 2019) of the population-based study Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) to estimate life expectancy and disability-free life expectancy (DFLE) of adults aged 40 years and older in rural South Africa. Respondents who consented to HIV testing, responded to survey questions on disability, and who were either interviewed in both surveys or who died between survey waves were included in the analysis. We estimate life expectancy and DFLE by HIV status and viral suppression (defined as <200 copies per mL) using Markov-based microsimulation.Among the 4322 eligible participants from the HAALSI study, we find a clear gradient in remaining life expectancy and DFLE based on HIV serostatus and viral suppression. At age 45 years, the life expectancy of a woman without HIV was 33·2 years (95% CI 32·0-35·0), compared with 31·6 years (29·2-34·1) a woman with virally suppressed HIV, and 26·4 years (23·1-29·1) for a woman with unsuppressed HIV; life expectancy for a 45 year old man without HIV was 27·2 years (25·8-29·1), compared with 24·1 years (20·9-27·2) for a man with virally suppressed HIV, and 17·4 years (15·0-20·3) for a man with unsuppressed HIV. Men and women with viral suppression could expect to live nearly as many years of DFLE as HIV-uninfected individuals at ages 45 years and 65 years.These results highlight the tremendous benefits of ART for population health in high-HIV-prevalence contexts and reinforce the need for continued work in making ART treatment accessible to ageing populations.National Institutes of Health.

  View details for DOI 10.1016/S2352-3018(22)00198-9

  View details for PubMedID 36179754

• Estimating deaths averted and cost per life saved by scaling up mRNA COVID-19 vaccination in low-income and lower-middle-income countries in the COVID-19 Omicron variant era: a modelling study. BMJ open Savinkina, A., Bilinski, A., Fitzpatrick, M., Paltiel, A. D., Rizvi, Z., Salomon, J., Thornhill, T., Gonsalves, G. 2022; 12 (9): e061752

  Abstract

  OBJECTIVES: While almost 60% of the world has received at least one dose of COVID-19 vaccine, the global distribution of vaccination has not been equitable. Only 4% of the population of low-income countries (LICs) has received a full primary vaccine series, compared with over 70% of the population of high-income nations.DESIGN: We used economic and epidemiological models, parameterised with public data on global vaccination and COVID-19 deaths, to estimate the potential benefits of scaling up vaccination programmes in LICs and lower-middle-income countries (LMICs) in 2022 in the context of global spread of the Omicron variant of SARS-CoV2.SETTING: Low-income and lower-middle-income nations.MAIN OUTCOME MEASURES: Outcomes were expressed as number of avertable deaths through vaccination, costs of scale-up and cost per death averted. We conducted sensitivity analyses over a wide range of parameter estimates to account for uncertainty around key inputs.FINDINGS: Globally, universal vaccination in LIC/LMIC with three doses of an mRNA vaccine would result in an estimated 1.5million COVID-19 deaths averted with a total estimated cost of US$61billion and an estimated cost-per-COVID-19 death averted of US$40800 (sensitivity analysis range: US$7400-US$81 500). Lower estimated infection fatality ratios, higher cost-per-dose and lower vaccine effectiveness or uptake lead to higher cost-per-death averted estimates in the analysis.CONCLUSIONS: Scaling up COVID-19 global vaccination would avert millions of COVID-19 deaths and represents a reasonable investment in the context of the value of a statistical life. Given the magnitude of expected mortality facing LIC/LMIC without vaccination, this effort should be an urgent priority.

  View details for DOI 10.1136/bmjopen-2022-061752

  View details for PubMedID 36100306

• Eliciting national and subnational sets of disability weights in mainland China: Findings from the Chinese disability weight measurement study. The Lancet regional health. Western Pacific Liu, X., Wang, F., Yu, C., Zhou, M., Yu, Y., Qi, J., Yin, P., Yu, S., Zhou, Y., Lin, L., Liu, Y., Wang, Q., Zhong, W., Huang, S., Li, Y., Liu, L., Liu, Y., Ma, F., Zhang, Y., Tian, Y., Yu, Q., Zeng, J., Pan, J., Zhou, M., Kang, W., Zhou, J., Yu, H., Liu, Y., Li, S., Yu, H., Wang, C., Xia, T., Xi, J., Ren, X., Xing, X., Cheng, Q., Fei, F., Wang, D., Zhang, S., He, Y., Wen, H., Liu, Y., Shi, F., Wang, Y., Sun, P., Bai, J., Wang, X., Shen, H., Ma, Y., Yang, D., Mubarik, S., Cao, J., Meng, R., Zhang, Y., Guo, Y., Yan, Y., Zhang, W., Ke, S., Zhang, R., Wang, D., Zhang, T., Nomura, S., Hay, S. I., Salomon, J. A., Haagsma, J. A., Murray, C. J., Vos, T. 2022; 26: 100520

  Abstract

  Background: The disability weight (DW) quantifies the severity of health states from disease sequela and is a pivotal parameter for disease burden calculation. We conducted a national and subnational DW measurement in China.Methods: In 2020-2021, we conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces targeting health workers via professional networks. We fielded questions of paired comparison (PC) and population health equivalence (PHE). The PC data were analysed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale between 0 (no loss of health) and 1 (health loss equivalent to death).Findings: We used PC responses from 468,541 respondents to estimate DWs of health states. Eight of 11 domains of health had significantly negative coefficients in the regression of the difference between Chinese and Global Burden of Disease (GBD) DWs, suggesting lower DW values for health states with mention of these domains in their lay description. We noted considerable heterogeneity within domains, however. After applying these Chinese DWs to the 2019 GBD estimates for China, total years lived with disability (YLDs) increased by 14·9% to 177 million despite lower estimates for musculoskeletal disorders, cardiovascular diseases, mental disorders, diabetes and chronic kidney disease. The lower estimates of YLDs for these conditions were more than offset by higher estimates of common, low-severity conditions.Interpretation: The differences between the GBD and Chinese DWs suggest that there might be some contextual factors influencing the valuation of health states. While the reduced estimates for mental disorders, alcohol use disorder, and dementia could hint at a culturally different valuation of these conditions in China, the much greater shifts in YLDs from low-severity conditions more likely reflects methodological difficulty to distinguish between health states that vary a little in absolute DW value but a lot in relative terms.Funding: This work was supported by the National Natural Science Foundation of China [grant number 82173626], the National Key Research and Development Program of China [grant numbers 2018YFC1315302], Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304], and Ningxia Natural Science Foundation Project [grant number 2020AAC03436].

  View details for DOI 10.1016/j.lanwpc.2022.100520

  View details for PubMedID 35910433

• Reconstructing the course of the COVID-19 epidemic over 2020 for US states and counties: Results of a Bayesian evidence synthesis model. PLoS computational biology Chitwood, M. H., Russi, M., Gunasekera, K., Havumaki, J., Klaassen, F., Pitzer, V. E., Salomon, J. A., Swartwood, N. A., Warren, J. L., Weinberger, D. M., Cohen, T., Menzies, N. A. 2022; 18 (8): e1010465

  Abstract

  Reported COVID-19 cases and deaths provide a delayed and incomplete picture of SARS-CoV-2 infections in the United States (US). Accurate estimates of both the timing and magnitude of infections are needed to characterize viral transmission dynamics and better understand COVID-19 disease burden. We estimated time trends in SARS-CoV-2 transmission and other COVID-19 outcomes for every county in the US, from the first reported COVID-19 case in January 13, 2020 through January 1, 2021. To do so we employed a Bayesian modeling approach that explicitly accounts for reporting delays and variation in case ascertainment, and generates daily estimates of incident SARS-CoV-2 infections on the basis of reported COVID-19 cases and deaths. The model is freely available as the covidestim R package. Nationally, we estimated there had been 49 million symptomatic COVID-19 cases and 404,214 COVID-19 deaths by the end of 2020, and that 28% of the US population had been infected. There was county-level variability in the timing and magnitude of incidence, with local epidemiological trends differing substantially from state or regional averages, leading to large differences in the estimated proportion of the population infected by the end of 2020. Our estimates of true COVID-19 related deaths are consistent with independent estimates of excess mortality, and our estimated trends in cumulative incidence of SARS-CoV-2 infection are consistent with trends in seroprevalence estimates from available antibody testing studies. Reconstructing the underlying incidence of SARS-CoV-2 infections across US counties allows for a more granular understanding of disease trends and the potential impact of epidemiological drivers.

  View details for DOI 10.1371/journal.pcbi.1010465

  View details for PubMedID 36040963

• Evaluating the Performance of Centers for Disease Control and Prevention COVID-19 Community Levels as Leading Indicators of COVID-19 Mortality. Annals of internal medicine Salomon, J. A., Bilinski, A. 2022

  Abstract

  BACKGROUND: Centers for Disease Control and Prevention (CDC) defines low, medium, and high "COVID-19 community levels" to guide interventions, but associated mortality rates have not been reported.OBJECTIVE: To evaluate the diagnostic performance of CDC COVID-19 community level metrics as predictors of elevated community mortality risk.DESIGN: Time series analysis over the period of 30 May 2021 through 4 June 2022.SETTING: U.S. states and counties.PARTICIPANTS: U.S. population.MEASUREMENTS: CDC "COVID-19 community level" metrics based on hospital admissions, bed occupancy, and reported cases; reported COVID-19 deaths; and sensitivity, specificity, and predictive values for CDC and alternative metrics.RESULTS: Mean and median weekly mortality rates per 100000 population after onset of high COVID-19 community level 3 weeks prior were 2.6 and 2.4, respectively, (interquartile range [IQR], 1.7 to 3.1) across 90 high episodes in states and 4.3 and 2.1, respectively, (IQR, 0 to 5.4) across 7987 high episodes in counties. In 85 of 90 (94%) episodes in states and 4801 of 7987 (60%) episodes in counties, lagged weekly mortality after onset exceeded 0.9 per 100000 population, and in 57 of 90 (63%) episodes in states and 4018 of 7987 (50%) episodes in counties, lagged weekly mortality after onset exceeded 2.1 per 100000, which is equivalent to approximately 1000 daily deaths in the national population. Alternative metrics based on lower hospital admissions or case thresholds were associated with lower mortality and had higher sensitivity and negative predictive value for elevated mortality, but the CDC metrics had higher specificity and positive predictive value. Ratios between cases, hospitalizations, and deaths have varied substantially over time.LIMITATIONS: Aggregate mortality does not account for nonfatal outcomes or disparities. Continuing evolution of viral variants, immunity, clinical interventions, and public health mitigation strategies complicate prediction for future waves.CONCLUSION: Designing metrics for public health decision making involves tradeoffs between identifying early signals for action and avoiding undue restrictions when risks are modest. Explicit frameworks for evaluating surveillance metrics can improve transparency and decision support.PRIMARY FUNDING SOURCE: Council of State and Territorial Epidemiologists.

  View details for DOI 10.7326/M22-0803

  View details for PubMedID 35914253

• Metamodeling for Policy Simulations with Multivariate Outcomes. Medical decision making : an international journal of the Society for Medical Decision Making Zhong, H., Brandeau, M. L., Yazdi, G. E., Wang, J., Nolen, S., Hagan, L., Thompson, W. W., Assoumou, S. A., Linas, B. P., Salomon, J. A. 2022: 272989X221105079

  Abstract

  PURPOSE: Metamodels are simplified approximations of more complex models that can be used as surrogates for the original models. Challenges in using metamodels for policy analysis arise when there are multiple correlated outputs of interest. We develop a framework for metamodeling with policy simulations to accommodate multivariate outcomes.METHODS: We combine 2 algorithm adaptation methods-multitarget stacking and regression chain with maximum correlation-with different base learners including linear regression (LR), elastic net (EE) with second-order terms, Gaussian process regression (GPR), random forests (RFs), and neural networks. We optimize integrated models using variable selection and hyperparameter tuning. We compare the accuracy, efficiency, and interpretability of different approaches. As an example application, we develop metamodels to emulate a microsimulation model of testing and treatment strategies for hepatitis C in correctional settings.RESULTS: Output variables from the simulation model were correlated (average rho = 0.58). Without multioutput algorithm adaptation methods, in-sample fit (measured by R2) ranged from 0.881 for LR to 0.987 for GPR. The multioutput algorithm adaptation method increased R2 by an average 0.002 across base learners. Variable selection and hyperparameter tuning increased R2 by 0.009. Simpler models such as LR, EE, and RF required minimal training and prediction time. LR and EE had advantages in model interpretability, and we considered methods for improving the interpretability of other models.CONCLUSIONS: In our example application, the choice of base learner had the largest impact on R2; multioutput algorithm adaptation and variable selection and hyperparameter tuning had a modest impact. Although advantages and disadvantages of specific learning algorithms may vary across different modeling applications, our framework for metamodeling in policy analyses with multivariate outcomes has broad applicability to decision analysis in health and medicine.

  View details for DOI 10.1177/0272989X221105079

  View details for PubMedID 35735216

• Population immunity to pre-Omicron and Omicron SARS-CoV-2 variants in US states and counties through December 1, 2021. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Klaassen, F., Chitwood, M. H., Cohen, T., Pitzer, V. E., Russi, M., Swartwood, N. A., Salomon, J. A., Menzies, N. A. 2022

  Abstract

  BACKGROUND: Both SARS-CoV-2 infection and COVID-19 vaccination contribute to population-level immunity against SARS-CoV-2. This study estimates the immunological exposure and effective protection against future SARS-CoV-2 infection in each US state and county over 2020-2021, and how this changed with the introduction of the Omicron variant.METHODS: We used a Bayesian model to synthesize estimates of daily SARS-CoV-2 infections, vaccination data and estimates of the relative rates of vaccination conditional on infection status to estimate the fraction of the population with (i) immunological exposure to SARS-CoV-2 (ever infected with SARS-CoV-2 and/or received one or more doses of a COVID-19 vaccine), (ii) effective protection against infection, and (iii) effective protection against severe disease, for each US state and county from January 1, 2020, to December 1, 2021.RESULTS: The estimated percentage of the US population with a history of SARS-CoV-2 infection or vaccination as of December 1, 2021, was 88.2% (95% Credible Interval (CrI): 83.6%-93.5%). Accounting for waning and immune escape, effective protection against the Omicron variant on December 1, 2021, was 21.8% (95%CrI: 20.7%-23.4%) nationally and ranged between 14.4% (95%CrI: 13.2%-15.8%, West Virginia) to 26.4% (95%CrI: 25.3%-27.8%, Colorado). Effective protection against severe disease from Omicron was 61.2% (95%CrI: 59.1%-64.0%) nationally and ranged between 53.0% (95%CrI: 47.3%-60.0%, Vermont) and 65.8% (95%CrI: 64.9%-66.7%, Colorado).CONCLUSIONS: While over four-fifths of the US population had prior immunological exposure to SARS-CoV-2 via vaccination or infection on December 1, 2021, only a fifth of the population was estimated to have effective protection against infection with the immune-evading Omicron variant.

  View details for DOI 10.1093/cid/ciac438

  View details for PubMedID 35717642

• Estimation of the Lifetime Quality-Adjusted Life Years (QALYs) Lost Due to Syphilis acquired in the United States in 2018. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Lee, K., You, S., Li, Y., Chesson, H., Gift, T. L., Berruti, A. A., Hsu, K., Yaesoubi, R., Salomon, J. A., Ronn, M. 2022

  Abstract

  BACKGROUND: The purpose of this study was to estimate the health impact of syphilis in the United States in terms of the number of quality-adjusted life years (QALYs) lost attributable to infections in 2018.METHODS: We developed a Markov model which simulates the natural history and management of syphilis. The model was parameterized by sex and sexual orientation (women who have sex with men, men who have sex with women[MSW], and men who have sex with men[MSM]), and by age at primary infection. We developed a separate decision tree model to quantify health losses due to congenital syphilis. We estimated the average lifetime number of QALYs lost per infection, and the total expected lifetime number of QALYs lost due to syphilis acquired in 2018.RESULTS: We estimated the average number of discounted lifetime QALYs lost per infection as 0.09 [0.03-0.19 95% uncertainty interval (UI)]. The total expected number of QALYs lost due to syphilis acquired in 2018 was 13,349[5,071-31,360]. While per-case loss was the lowest among MSM(0.06), MSM accounted for 47.7% of the overall burden. For each case of congenital syphilis, we estimated 1.79[1.43-2.16] and 0.06[0.01-0.14] QALYs lost in the child and the mother, respectively. We projected 2,332[1,871-2,825] and 79[17-177] QALYs lost for children and mothers, respectively, due to congenital syphilis in 2018.CONCLUSIONS: Syphilis causes substantial health losses in adults and children. Quantifying these health losses in terms of QALYs can inform cost-effectiveness analyses and can facilitate comparisons of the burden of syphilis to that of other diseases.

  View details for DOI 10.1093/cid/ciac427

  View details for PubMedID 35684943

• Estimated Transmission Outcomes and Costs of SARS-CoV-2 Diagnostic Testing, Screening, and Surveillance Strategies Among a Simulated Population of Primary School Students. JAMA pediatrics Bilinski, A., Ciaranello, A., Fitzpatrick, M. C., Giardina, J., Shah, M., Salomon, J. A., Kendall, E. A. 2022

  Abstract

  Importance: In addition to illness, the COVID-19 pandemic has led to historic educational disruptions. In March 2021, the federal government allocated $10 billion for COVID-19 testing in US schools.Objective: Costs and benefits of COVID-19 testing strategies were evaluated in the context of full-time, in-person kindergarten through eighth grade (K-8) education at different community incidence levels.Design, Setting, and Participants: An updated version of a previously published agent-based network model was used to simulate transmission in elementary and middle school communities in the United States. Assuming dominance of the delta SARS-CoV-2 variant, the model simulated an elementary school (638 students in grades K-5, 60 staff) and middle school (460 students grades 6-8, 51 staff).Exposures: Multiple strategies for testing students and faculty/staff, including expanded diagnostic testing (test to stay) designed to avoid symptom-based isolation and contact quarantine, screening (routinely testing asymptomatic individuals to identify infections and contain transmission), and surveillance (testing a random sample of students to identify undetected transmission and trigger additional investigation or interventions).Main Outcomes and Measures: Projections included 30-day cumulative incidence of SARS-CoV-2 infection, proportion of cases detected, proportion of planned and unplanned days out of school, cost of testing programs, and childcare costs associated with different strategies. For screening policies, the cost per SARS-CoV-2 infection averted in students and staff was estimated, and for surveillance, the probability of correctly or falsely triggering an outbreak response was estimated at different incidence and attack rates.Results: Compared with quarantine policies, test-to-stay policies are associated with similar model-projected transmission, with a mean of less than 0.25 student days per month of quarantine or isolation. Weekly universal screening is associated with approximately 50% less in-school transmission at one-seventh to one-half the societal cost of hybrid or remote schooling. The cost per infection averted in students and staff by weekly screening is lowest for schools with less vaccination, fewer other mitigation measures, and higher levels of community transmission. In settings where local student incidence is unknown or rapidly changing, surveillance testing may detect moderate to large in-school outbreaks with fewer resources compared with schoolwide screening.Conclusions and Relevance: In this modeling study of a simulated population of primary school students and simulated transmission of COVID-19, test-to-stay policies and/or screening tests facilitated consistent in-person school attendance with low transmission risk across a range of community incidence. Surveillance was a useful reduced-cost option for detecting outbreaks and identifying school environments that would benefit from increased mitigation.

  View details for DOI 10.1001/jamapediatrics.2022.1326

  View details for PubMedID 35442396

• Cost-Effectiveness of Hepatitis B Testing and Vaccination of Adults Seeking Care for Sexually Transmitted Infections. Sexually transmitted diseases Hutton, D., Toy, M., Salomon, J. A., Conners, E. E., Nelson, N. P., Harris, A. M., So, S. 2022

  Abstract

  BACKGROUND: The estimated number of people living with hepatitis B virus (HBV) infection acquired through sexual transmission was 103,000 in 2018, with an estimated incidence of 8,300 new cases per year. While hepatitis B (HepB) vaccination is recommended by the Advisory Committee for Immunization Practices for persons seeking evaluation and treatment for sexually transmitted infections (STI), pre-vaccination testing is not yet recommended. Screening may link persons with chronic hepatitis B (CHB) to care and reduce unnecessary vaccination.METHODS: We used a Markov model to calculate the health impact, and cost-effectiveness of one-time HBV testing combined with the first dose of the hepatitis B vaccine for adults seeking care for STI. We ran a lifetime, societal perspective analysis for a hypothetical population of 100,000 ages 18-69 years. The disease progression estimates were taken from recent cohort studies and meta-analyses. In the US, an intervention that costs less than $100,000 per quality adjusted life year (QALY) is generally considered cost-effective. The strategies that were compared were: 1) vaccination without HBV screening, 2) vaccination and HBsAg screening, 3) vaccination and screening with HBsAg and anti-HBs, and 4) vaccination and screening with HBsAg, anti-HBs and anti-HBc. Data were obtained from Centers for Medicare and Medicaid services reimbursement, the CDC vaccine price list, and additional cost-effectiveness literature.RESULTS: Compared with current recommendations, the addition of one-time HBV testing is cost saving and would prevent an additional 138 cases of cirrhosis, 47 cases of decompensated cirrhosis, 90 cases of hepatocellular carcinoma, 33 liver transplants, and 163 HBV-related deaths, and gain 2185 QALYs, per 100,000 adults screened. Screening with the 3-tests panel would save $41.6-$42.7 million /100,000 adults tested compared with $41.5-$42.5 million for the 2-tests panel and $40.2-$40.3 million for HBsAg alone.CONCLUSIONS: One-time HBV pre-vaccination testing in addition to HepB vaccination for unvaccinated adults seeking care for STI would save lives, prevent new infections and unnecessary vaccination, and is cost saving.

  View details for DOI 10.1097/OLQ.0000000000001632

  View details for PubMedID 35312661

• Uptake of COVID-19 Vaccination Among Frontline Workers in California State Prisons JAMA HEALTH FORUM Prince, L., Long, E., Studdert, D. M., Leidner, D., Chin, E. T., Andrews, J. R., Salomon, J. A., Goldhaber-Fiebert, J. D. 2022; 3 (3): e220099

  Abstract

  Prisons and jails are high-risk environments for COVID-19. Vaccination levels among workers in many such settings remain markedly lower than those of residents and members of surrounding communities. The situation is troubling because prison staff are a key vector for COVID-19 transmission.To assess patterns and timing of staff vaccination in California state prisons and identify individual-level and community-level factors associated with remaining unvaccinated.This cohort study used data from December 22, 2020, through June 30, 2021, to quantify the fractions of staff and incarcerated residents who remained unvaccinated among 23 472 custody and 7617 health care staff who worked in roles requiring direct contact with residents at 33 of the 35 prisons operated by the California Department of Corrections and Rehabilitation. Multivariable probit regressions assessed demographic, community, and peer factors associated with staff vaccination uptake.Remaining unvaccinated throughout the study period.Of 23 472 custody staff, 3751 (16%) were women, and 1454 (6%) were Asian/Pacific Islander individuals, 1571 (7%) Black individuals, 9008 (38%) Hispanic individuals, and 6666 (28%) White individuals. Of 7617 health care staff, 5434 (71%) were women, and 2148 (28%) were Asian/Pacific Islander individuals, 1201 (16%) Black individuals, 1409 (18%) Hispanic individuals, and 1771 (23%) White individuals. A total of 6103 custody staff (26%) and 3961 health care staff (52%) received 1 or more doses of a COVID-19 vaccine during the first 2 months vaccines were offered, but vaccination rates stagnated thereafter. By June 30, 2021, 14 317 custody staff (61%) and 2819 health care staff (37%) remained unvaccinated. In adjusted analyses, remaining unvaccinated was positively associated with younger age (custody staff: age, 18-29 years vs ≥60 years, 75% [95% CI, 73%-76%] vs 45% [95% CI, 42%-48%]; health care staff: 52% [95% CI, 48%-56%] vs 29% [95% CI, 27%-32%]), prior COVID-19 infection (custody staff: 67% [95% CI, 66%-68%] vs 59% [95% CI, 59%-60%]; health care staff: 44% [95% CI, 42%-47%] vs 36% [95% CI, 36%-36%]), residing in a community with relatively low rates of vaccination (custody staff: 75th vs 25th percentile:, 63% [95% CI, 62%-63%] vs 60% [95% CI, 59%-60%]; health care staff: 40% [95% CI, 39%-41%] vs 34% [95% CI, 33%-35%]), and sharing shifts with coworkers who had relatively low rates of vaccination (custody staff: 75th vs 25th percentile, 64% [95% CI, 62%-66%] vs 59% [95% CI, 57%-61%]; health care staff: 38% [95% CI, 36%-41%] vs 35% [95% CI, 31%-39%]).This cohort study of California state prison custody and health care staff found that vaccination uptake plateaued at levels that posed ongoing risks of further outbreaks in the prisons and continuing transmission from prisons to surrounding communities. Prison staff decisions to forgo vaccination appear to be multifactorial, and vaccine mandates may be necessary to achieve adequate levels of immunity in this high-risk setting.

  View details for DOI 10.1001/jamahealthforum.2022.0099

  View details for Web of Science ID 000837243200004

  View details for PubMedID 35977288

  View details for PubMedCentralID PMC8917424

• Cost effectiveness of computed tomography versus ultrasound-based surveillance following endovascular aortic repair of intact infrarenal abdominal aortic aneurysms. Journal of vascular surgery Ho, V. T., Nguyen, A. T., Stern, J. R., Asch, S. M., Owens, D. K., Salomon, J. A., Dalman, R. L., Lee, J. T. 2022

  Abstract

  BACKGROUND: While Society for Vascular Surgery guidelines recommend computed tomography angiography (CTA) or ultrasound for surveillance following infrarenal endovascular aortic repair (EVAR), there is a lack of consensus regarding optimal timing and modalities. We hypothesized that ultrasound-based approaches would be more cost-effective and developed a cost-effectiveness analysis to estimate the lifetime costs and outcomes of various strategies.METHODS: We developed a decision tree with nested Markov models to compare five surveillance strategies: yearly CTA, yearly CDU, yearly CEU, CTA at first year followed by CDU, and CTA at first year followed by CEU. The model accounted for differential sensitivity, specificity, and risk of acute kidney injury after CTA, and was implemented on a monthly cycle with a willingness-to-pay threshold of $50,000 per quality-adjusted life year (QALY) and 3% annual discounting.RESULTS: Under base case assumptions, the CTA-CDU strategy was cost effective with a lifetime cost of $77950 for 7.74 QALYs. In sensitivity analysis, the CTA-CDU approach remained cost-effective when CEU specificity was less than 95%, and risk of acute kidney injury following CTA was less than 20%. At diagnostic sensitivities below 75% for CEU and 55% for CDU, a yearly CTA strategy maximized QALYs.CONCLUSION: A hybrid strategy in which CTA is performed in the first year and CDU is performed annually thereafter is the most cost-effective strategy for infrarenal EVAR surveillance in patients with less than a 20% risk of contrast-induced nephropathy. If the sensitivity of CEU and CDU are at the lower end of plausible estimates, a yearly CTA strategy is reasonable. Further research should aim to identify patients who may benefit from alternative surveillance strategies.

  View details for DOI 10.1016/j.jvs.2022.02.057

  View details for PubMedID 35278655

• Affordability and Value in Decision Rules for Cost-Effectiveness: A Survey of Health Economists. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research Bilinski, A., MacKay, E., Salomon, J. A., Pandya, A. 2022

  Abstract

  OBJECTIVES: New health technologies are often expensive, but may nevertheless meet standard thresholds for cost effectiveness, a situation exemplified by recent hepatitis C cures. Currently, cost-effectiveness analysis (CEA) does not supply practical means of weighing trade-offs between cost-effectiveness and affordability, particularly when costs and benefits are temporally separated and in health systems with multiple payers, such as the United States. We formally characterized disagreements in CEA theory and identified how these trade-offs arepresentlyaddressed in practice.METHODS: We surveyed 170 health economics researchers.RESULTS: When presented with a hypothetical cost-effective drug therapy in the United States that would require 20% of a state's Medicaid budget over 5 years, 34% of survey respondents recommended that policy makers fund the drug for all patients and 26% for a subset. By contrast, 26% recommended against funding the drug. We found additional disagreement regarding whether the willingness-to-pay threshold should be based on the budget (42%) or societal preferences (41%) and identified 4 approaches to weighing cost-effectiveness and affordability. A total of 61% of respondents did not believe that the threshold used in their last article (most often 1*-3* per capita gross domestic product) represented either the budget or societal willingness-to-pay threshold.CONCLUSIONS: We use these findings to recommend metrics that can inform translation of CEA theory into practice. By contextualizing cost and value, researchers can provide more actionable policy recommendations.

  View details for DOI 10.1016/j.jval.2021.11.1375

  View details for PubMedID 35219599

• All-cause versus cause-specific excess deaths for estimating influenza-associated mortality in Denmark, Spain, and the United States. Influenza and other respiratory viruses Schmidt, S. S., Iuliano, A. D., Vestergaard, L. S., Mazagatos-Ateca, C., Larrauri, A., Brauner, J. M., Olsen, S. J., Nielsen, J., Salomon, J. A., Krause, T. G. 2022

  Abstract

  BACKGROUND: Seasonal influenza-associated excess mortality estimates can be timely and provide useful information on the severity of an epidemic. This methodology can be leveraged during an emergency response or pandemic.METHOD: For Denmark, Spain, and the United States, we estimated age-stratified excess mortality for (i) all-cause, (ii) respiratory and circulatory, (iii) circulatory, (iv) respiratory, and (v) pneumonia, and influenza causes of death for the 2015/2016 and 2016/2017 influenza seasons. We quantified differences between the countries and seasonal excess mortality estimates and the death categories. We used a time-series linear regression model accounting for time and seasonal trends using mortality data from 2010 through 2017.RESULTS: The respective periods of weekly excess mortality for all-cause and cause-specific deaths were similar in their chronological patterns. Seasonal all-cause excess mortality rates for the 2015/2016 and 2016/2017 influenza seasons were 4.7 (3.3-6.1) and 14.3 (13.0-15.6) per 100,000 population, for the United States; 20.3 (15.8-25.0) and 24.0 (19.3-28.7) per 100,000 population for Denmark; and 22.9 (18.9-26.9) and 52.9 (49.1-56.8) per 100,000 population for Spain. Seasonal respiratory and circulatory excess mortality estimates were two to three times lower than the all-cause estimates.DISCUSSION: We observed fewer influenza-associated deaths when we examined cause-specific death categories compared with all-cause deaths and observed the same trends in peaks in deaths with all death causes. Because all-cause deaths are more available, these models can be used to monitor virus activity in near real time. This approach may contribute to the development of timely mortality monitoring systems during public health emergencies.

  View details for DOI 10.1111/irv.12966

  View details for PubMedID 35194940

• Evaluating spatially adaptive guidelines for the treatment of gonorrhea to reduce the incidence of gonococcal infection and increase the effective lifespan of antibiotics. PLoS computational biology Yaesoubi, R., Cohen, T., Hsu, K., Gift, T. L., St Cyr, S. B., Salomon, J. A., Grad, Y. H. 2022; 18 (2): e1009842

  Abstract

  In the absence of point-of-care gonorrhea diagnostics that report antibiotic susceptibility, gonorrhea treatment is empiric and determined by standardized guidelines. These guidelines are informed by estimates of resistance prevalence from national surveillance systems. We examined whether guidelines informed by local, rather than national, surveillance data could reduce the incidence of gonorrhea and increase the effective lifespan of antibiotics used in treatment guidelines. We used a transmission dynamic model of gonorrhea among men who have sex with men (MSM) in 16 U.S. metropolitan areas to determine whether spatially adaptive treatment guidelines based on local estimates of resistance prevalence can extend the effective lifespan of hypothetical antibiotics. The rate of gonorrhea cases in these metropolitan areas was 5,548 cases per 100,000 MSM in 2017. Under the current strategy of updating the treatment guideline when the prevalence of resistance exceeds 5%, we showed that spatially adaptive guidelines could reduce the annual rate of gonorrhea cases by 200 cases (95% uncertainty interval: 169, 232) per 100,000 MSM population while extending the use of a first-line antibiotic by 0.75 (0.55, 0.95) years. One potential strategy to reduce the incidence of gonorrhea while extending the effective lifespan of antibiotics is to inform treatment guidelines based on local, rather than national, resistance prevalence.

  View details for DOI 10.1371/journal.pcbi.1009842

  View details for PubMedID 35139073

• Cost-Effectiveness of Dapagliflozin for Non-diabetic Chronic Kidney Disease. Journal of general internal medicine Tisdale, R. L., Cusick, M. M., Aluri, K. Z., Handley, T. J., Joyner, A. K., Salomon, J. A., Chertow, G. M., Goldhaber-Fiebert, J. D., Owens, D. K. 2022

  Abstract

  BACKGROUND: In the USA, chronic kidney disease (CKD) affects 1 in 7 adults and costs $100 billion annually. The DAPA-CKD trial found dapagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, to be effective in reducing CKD progression and mortality in patients with diabetic and non-diabetic CKD. Currently, SGLT2 inhibitors are not considered standard of care for patients with non-diabetic CKD.OBJECTIVE: Determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic CKD.DESIGN: Markov model with lifetime time horizon and US healthcare sector perspective.PATIENTS: Patients with non-diabetic CKD INTERVENTION: Dapagliflozin plus standard care versus standard care only.MAIN MEASURES: Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3% annually; total incidence of kidney failure on kidney replacement therapy; average years on kidney replacement therapy.KEY RESULTS: Adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted QALYS (from 6.75 to 8.06), and reduced the total incidence of kidney failure on kidney replacement therapy (KRT) (from 17.4 to 11.0%) and average years on KRT (from 0.77 to 0.43) over the lifetime of the cohort. Dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs (from $245,900 to $324,8900, or $60,000 per QALY gained). Results were robust to variations in assumptions about dapagliflozin's efficacy over time and by CKD stage, added costs of kidney replacement therapy, and expected population annual CKD progression rates and sensitive to the cost of dapagliflozin. The net 1-year budgetary implication of treating all US patients with non-diabetic CKD could be up to $21 billion.CONCLUSIONS: Dapagliflozin improved life expectancy and reduced progression of CKD, the proportion of patients requiring kidney replacement therapy, and time on kidney replacement therapy in patients with non-diabetic CKD. Use of dapagliflozin meets conventional criteria for cost-effectiveness.

  View details for DOI 10.1007/s11606-021-07311-5

  View details for PubMedID 35137296

• Model-Estimated Association Between Simulated US Elementary School-Related SARS-CoV-2 Transmission, Mitigation Interventions, and Vaccine Coverage Across Local Incidence Levels. JAMA network open Giardina, J., Bilinski, A., Fitzpatrick, M. C., Kendall, E. A., Linas, B. P., Salomon, J., Ciaranello, A. L. 2022; 5 (2): e2147827

  Abstract

  Importance: With recent surges in COVID-19 incidence and vaccine authorization for children aged 5 to 11 years, elementary schools face decisions about requirements for masking and other mitigation measures. These decisions require explicit determination of community objectives (eg, acceptable risk level for in-school SARS-CoV-2 transmission) and quantitative estimates of the consequences of changing mitigation measures.Objective: To estimate the association between adding or removing in-school mitigation measures (eg, masks) and COVID-19 outcomes within an elementary school community at varying student vaccination and local incidence rates.Design, Setting, and Participants: This decision analytic model used an agent-based model to simulate SARS-CoV-2 transmission within a school community, with a simulated population of students, teachers and staff, and their household members (ie, immediate school community). Transmission was evaluated for a range of observed local COVID-19 incidence (0-50 cases per 100 000 residents per day, assuming 33% of all infections detected). The population used in the model reflected the mean size of a US elementary school, including 638 students and 60 educators and staff members in 6 grades with 5 classes per grade.Exposures: Variant infectiousness (representing wild-type virus, Alpha variant, and Delta variant), mitigation effectiveness (0%-100% reduction in the in-school secondary attack rate, representing increasingly intensive combinations of mitigations including masking and ventilation), and student vaccination levels were varied.Main Outcomes and Measures: The main outcomes were (1) probability of at least 1 in-school transmission per month and (2) mean increase in total infections per month among the immediate school community associated with a reduction in mitigation; multiple decision thresholds were estimated for objectives associated with each outcome. Sensitivity analyses on adult vaccination uptake, vaccination effectiveness, and testing approaches (for selected scenarios) were conducted.Results: With student vaccination coverage of 70% or less and moderate assumptions about mitigation effectiveness (eg, masking), mitigation could only be reduced when local case incidence was 14 or fewer cases per 100 000 residents per day to keep the mean additional cases associated with reducing mitigation to 5 or fewer cases per month. To keep the probability of any in-school transmission to less than 50% per month, the local case incidence would have to be 4 or fewer cases per 100 000 residents per day.Conclusions and Relevance: In this study, in-school mitigation measures (eg, masks) and student vaccinations were associated with substantial reductions in transmissions and infections, but the level of reduction varied across local incidence. These findings underscore the potential role for responsive plans that deploy mitigation strategies based on local COVID-19 incidence, vaccine uptake, and explicit consideration of community objectives.

  View details for DOI 10.1001/jamanetworkopen.2021.47827

  View details for PubMedID 35157056

• Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990-2019: results from the Global Burden of Disease Study 2019 LANCET INFECTIOUS DISEASES Ledesma, J. R., Ma, J., Vongpradith, A., Maddison, E. R., Novotney, A., Biehl, M. H., LeGrand, K. E., Ross, J. M., Jahagirdar, D., Bryazka, D., Feldman, R., Abolhassani, H., Abosetugn, A., Abu-Gharbieh, E., Adebayo, O. M., Adnani, Q., Afzal, S., Ahinkorah, B., Ahmad, S., Ahmadi, S., Rashid, T., Salih, Y., Aklilu, A., Akunna, C., Al Hamad, H., Alahdab, F., Alemayehu, Y., Alene, K., Ali, B., Ali, L., Alipour, V., Alizade, H., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Amit, A. L., Anderson, J. A., Androudi, S., Antonio, C. T., Antony, C. M., Anwer, R., Arabloo, J., Arja, A., Asemahagn, M. A., Atre, S. R., Azhar, G., Darshan, B. B., Babar, Z., Baig, A., Banach, M., Barqawi, H., Barra, F., Barrow, A., Basu, S., Belgaumi, U., Bhagavathula, A., Bhardwaj, N., Bhardwaj, P., Bhattacharjee, N., Bhattacharyya, K., Bijani, A., Bikbov, B., Boloor, A., Briko, N., Buonsenso, D., Nagaraja, S., Butt, Z. A., Carter, A., Carvalho, F., Charan, J., Chatterjee, S., Chattu, S., Chattu, V., Christopher, D. J., Chu, D., Claassens, M. M., Dadras, O., Dagnew, A., Dai, X., Dandona, L., Dandona, R., Daneshpajouhnejad, P., Darwesh, A., Dhamnetiya, D., Dianatinasab, M., Diaz, D., Linh Phuong Doan, Eftekharzadeh, S., Elhadi, M., Emami, A., Enany, S., Faraon, E. A., Farzadfar, F., Fernandes, E., Desideri, L., Filip, I., Fischer, F., Foroutan, M., Frank, T. D., Garcia-Basteiro, A. L., Garcia-Calavaro, C., Garg, T., Geberemariyam, B., Ghadiri, K., Ghashghaee, A., Golechha, M., Goodridge, A., Gupta, B., Gupta, S., Gupta, V., Gupta, V., Haider, M., Hamidi, S., Hanif, A., Haque, S., Harapan, H., Hargono, A., Hasaballah, A., Hashi, A., Hassan, S., Hassankhani, H., Hayat, K., Hezam, K., Holla, R., Hosseinzadeh, M., Hostiuc, M., Househ, M., Hussain, R., Ibitoye, S., Ilic, I. M., Ilic, M. D., Irvani, S., Ismail, N., Itumalla, R., Jaafari, J., Jacobsen, K. H., Jain, V., Javanmardi, F., Jayapal, S., Jayaram, S., Jha, R., Jonas, J. B., Joseph, N., Joukar, F., Kabir, Z., Kamath, A., Kanchan, T., Kandel, H., Katoto, P., Kayode, G. A., Kendrick, P. J., Kerbo, A., Khajuria, H., Khalilov, R., Khatab, K., Khoja, A. T., Khubchandani, J., Kim, M., Kim, Y., Kisa, A., Kisa, S., Kosen, S., Koul, P. A., Laxminarayana, S., Koyanagi, A., Krishan, K., Bicer, B., Kumar, A., Kumar, G., Kumar, N., Kumar, N., Kwarteng, A., Lak, H., Lal, D., Landires, I., Lasrado, S., Lee, S., Lee, W., Lin, C., Liu, X., Lopukhov, P. D., Lozano, R., Machado, D., Kunjathur, S., Madi, D., Mahajan, P., Majeed, A., Malik, A., Martins-Melo, F., Mehta, S., Memish, Z. A., Mendoza, W., Menezes, R. G., Merie, H., Mersha, A., Mesregah, M., Mestrovic, T., Mheidly, N., Misra, S., Mithra, P., Moghadaszadeh, M., Mohammadi, M., Mohammadian-Hafshejani, A., Mohammed, S., Molokhia, M., Moni, M., Al Montasir, A., Moore, C. E., Nagarajan, A., Nair, S., Nair, S., Naqvi, A., Swamy, S., Nayak, B., Nazari, J., Kandel, S., Nguyen, T., Nixon, M. R., Nnaji, C. A., Ntsekhe, M., Nunez-Samudio, V., Oancea, B., Odukoya, O., Olagunju, A. T., Oren, E., Mahesh, P. A., Parthasarathi, R., Kan, F., Pattanshetty, S. M., Paudel, R., Paul, P., Pawar, S., Pepito, V., Yigit, Perico, N., Pirestani, M., Polibin, R., Postma, M. J., Pourshams, A., Prashant, A., Pribadi, D., Radfar, A., Rafiei, A., Rahim, F., Rahimi-Movaghar, V., Rahman, M., Rahman, M., Rahmani, A., Ranasinghe, P., Rao, C. R., Rawaf, D., Rawaf, S., Reitsma, M. B., Remuzzi, G., Renzaho, A. N., Reta, M., Rezaei, N., Rezahosseini, O., Rezai, M., Rezapour, A., Roshandel, G., Roshchin, D. O., Sabour, S., Saif-Ur-Rahman, K. M., Salam, N., Kafil, H., Samaei, M., Samy, A. M., Saroshe, S., Sartorius, B., Sathian, B., Sawyer, S. M., Senthilkumaran, S., Seylani, A., Shafaat, O., Shaikh, M., Sharafi, K., Shetty, R. S., Shigematsu, M., Shin, J., Silva, J., Singh, J., Sinha, S., Skryabin, V., Skryabina, A., Spurlock, E., Sreeramareddy, C. T., Steiropoulos, P., Sufiyan, M., Tabuchi, T., Tadesse, E., Tamir, Z., Tarkang, E., Tekalegn, Y., Tesfay, F., Tessema, B., Thapar, R., Tleyjeh, I. I., Tobe-Gai, R., Bach Xuan Tran, Tsegaye, B., Tsegaye, G., Ullah, A., Umeokonkwo, C., Tahbaz, S., Bay Vo, Giang Thu Vu, Waheed, Y., Walters, M. K., Whisnant, J. L., Woldekidan, M., Wubishet, B., Jabbari, S., Yazie, T., Yeshaw, Y., Yi, S., Yonemoto, N., Yu, C., Yunusa, I., Zastrozhin, M., Zastrozhina, A., Zhang, Z., Zumla, A., Mokdad, A. H., Salomon, J. A., Jr, R., Lim, S. S., Naghavi, M., Vos, T., Hay, S., Murray, C. L., Kyu, H., GBD 2019 Tb Collaborators 2022; 22 (2): 222-241

  Abstract

  Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019.We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates.Globally, in 2019, among HIV-negative individuals, there were 1·18 million (95% uncertainty interval 1·08-1·29) deaths due to tuberculosis and 8·50 million (7·45-9·73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000-279 000) deaths due to tuberculosis and 1·15 million (1·01-1·32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000-425 000) more deaths and 1·01 million (0·82-1·23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820-11 400) more deaths and 81 100 (63 300-100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1·5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4·27 (3·69-5·02), 6·17 (5·48-7·02), and 1·17 (1·07-1·28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2·23 (2·03-2·44) times greater among males than females, whereas the fraction due to unsafe sex was 1·06 (1·05-1·08) times greater among females than males.As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestones.Bill & Melinda Gates Foundation.

  View details for DOI 10.1016/S1473-3099(21)00449-7

  View details for Web of Science ID 000762847000004

  View details for PubMedID 34563275

  View details for PubMedCentralID PMC8799634

• Problems with evidence assessment in COVID-19 health policy impact evaluation: a systematic review of study design and evidence strength. BMJ open Haber, N. A., Clarke-Deelder, E., Feller, A., Smith, E. R., Salomon, J. A., MacCormack-Gelles, B., Stone, E. M., Bolster-Foucault, C., Daw, J. R., Hatfield, L. A., Fry, C. E., Boyer, C. B., Ben-Michael, E., Joyce, C. M., Linas, B. S., Schmid, I., Au, E. H., Wieten, S. E., Jarrett, B., Axfors, C., Nguyen, V. T., Griffin, B. A., Bilinski, A., Stuart, E. A. 1800; 12 (1): e053820

  Abstract

  INTRODUCTION: Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment.METHODS: We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on 26 November 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation.RESULTS: After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-sectional), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes.DISCUSSION: The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigour to be actionable by policy-makers. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.

  View details for DOI 10.1136/bmjopen-2021-053820

  View details for PubMedID 35017250

• Effectiveness of COVID-19 vaccines among incarcerated people in California state prisons: retrospective cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Chin, E. T., Leidner, D., Zhang, Y., Long, E., Prince, L., Schrag, S. J., Verani, J. R., Wiegand, R. E., Alarid-Escudero, F., Goldhaber-Fiebert, J. D., Studdert, D. M., Andrews, J. R., Salomon, J. A. 2022

  Abstract

  Prisons and jails are high-risk settings for COVID-19. Vaccines may substantially reduce these risks, but evidence is needed on COVID-19 vaccine effectiveness for incarcerated people, who are confined in large, risky congregate settings.We conducted a retrospective cohort study to estimate effectiveness of mRNA vaccines, BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna), against confirmed SARS-CoV-2 infections among incarcerated people in California prisons from December 22, 2020 through March 1, 2021. The California Department of Corrections and Rehabilitation provided daily data for all prison residents including demographic, clinical, and carceral characteristics, as well as COVID-19 testing, vaccination, and outcomes. We estimated vaccine effectiveness using multivariable Cox models with time-varying covariates, adjusted for resident characteristics and infection rates across prisons.Among 60,707 cohort members, 49% received at least one BNT162b2 or mRNA-1273 dose during the study period. Estimated vaccine effectiveness was 74% (95% confidence interval [CI], 64-82%) from day 14 after first dose until receipt of second dose and 97% (95% CI, 88-99%) from day 14 after second dose. Effectiveness was similar among the subset of residents who were medically vulnerable: 74% [95% CI, 62-82%] and 92% [95% CI, 74-98%] from 14 days after first and second doses, respectively.Consistent with results from randomized trials and observational studies in other populations, mRNA vaccines were highly effective in preventing SARS-CoV-2 infections among incarcerated people. Prioritizing incarcerated people for vaccination, redoubling efforts to boost vaccination, and continuing other ongoing mitigation practices are essential in preventing COVID-19 in this disproportionately affected population.

  View details for DOI 10.1093/cid/ciab1032

  View details for PubMedID 35083482

• The overlapping burden of the three leading causes of disability and death in sub-Saharan African children. Nature communications Reiner, R. C., LBD Triple Burden Collaborators, Hay, S. I., Welgan, C. A., Troeger, C. E., Baumann, M. M., Weiss, D. J., Deshpande, A., Blacker, B. F., Miller-Petrie, M. K., Earl, L., Bhatt, S., Abolhassani, H., Abosetugn, A. E., Abu-Gharbieh, E., Adekanmbi, V., Adetokunboh, O. O., Aghaali, M., Aji, B., Alahdab, F., Al-Aly, Z., Alhassan, R. K., Ali, S., Alizade, H., Aljunid, S. M., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Altirkawi, K. A., Alvis-Guzman, N., Amare, A. T., Amini, S., Amugsi, D. A., Ancuceanu, R., Andrei, C. L., Ansari, F., Anvari, D., Appiah, S. C., Arabloo, J., Aremu, O., Atout, M. M., Ausloos, M., Ausloos, F., Ayanore, M. A., Aynalem, Y. A., Azene, Z. N., Badawi, A., Baig, A. A., Banach, M., Bedi, N., Bhagavathula, A. S., Bhandari, D., Bhardwaj, N., Bhardwaj, P., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Birhanu, T. T., Bitew, Z. W., Boloor, A., Brady, O. J., Butt, Z. A., Car, J., Carvalho, F., Casey, D. C., Chattu, V. K., Chowdhury, M. A., Chu, D., Coelho, C. H., Cook, A. J., Damiani, G., Daoud, F., Gela, J. D., Darwish, A. H., Daryani, A., Das, J. K., Davis Weaver, N., Deribe, K., Desalew, A., Dharmaratne, S. D., Dianatinasab, M., Diaz, D., Djalalinia, S., Dorostkar, F., Dubljanin, E., Duko, B., Dwyer-Lindgren, L., Effiong, A., El Sayed Zaki, M., El Tantawi, M., Enany, S., Fattahi, N., Feigin, V. L., Fernandes, E., Ferrara, P., Fischer, F., Foigt, N. A., Folayan, M. O., Foroutan, M., Frostad, J. J., Fukumoto, T., Gaidhane, A. M., Gebrekrstos, H. G., Gebremeskel, L., Gebreslassie, A. A., Gething, P. W., Gezae, K. E., Ghadiri, K., Ghashghaee, A., Golechha, M., Gubari, M. I., Hadgu, F. B., Hamidi, S., Handiso, D. W., Hashi, A., Hassan, S., Hayat, K., Herteliu, C., Ho, H. C., Holla, R., Hosseinzadeh, M., Househ, M., Hussain, R., Hwang, B., Ibitoye, S. E., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Irvani, S. S., Jaafari, J., Javaheri, T., Jha, R. P., Johnson, K. B., Jonas, J. B., Jozwiak, J. J., Kabir, A., Kalhor, R., Kanchan, T., Karch, A., Kayode, G. A., Keiyoro, P. N., Khader, Y. S., Khalil, I. A., Khan, M. N., Khan, M., Khan, G., Khatab, K., Khater, M. M., Khatib, M. N., Kianipour, N., Kim, Y. J., Kimokoti, R. W., Kisa, S., Kisa, A., Kissoon, N., Kochhar, S., Koolivand, A., Kopec, J. A., Koyanagi, A., Krishan, K., Kumar, P., Kurmi, O. P., Kusuma, D., Lal, D. K., Lami, F. H., Landires, I., Lansingh, V. C., Lasrado, S., La Vecchia, C., Lazzar-Atwood, A., Lee, P. H., LeGrand, K. E., Lewycka, S., Li, B., Lim, S. S., Lindstedt, P. A., Liu, X., Longbottom, J., Lopez, A. D., Magdy Abd El Razek, H., Mahasha, P. W., Maleki, A., Mamun, A. A., Mansournia, M. A., Marczak, L. B., Martins-Melo, F. R., Mayala, B. K., Meharie, B. G., Melese, A., Mendoza, W., Menezes, R. G., Mengesha, E. W., Mensah, G. A., Meretoja, T. J., Mestrovic, T., Miller, T. R., Mirrakhimov, E. M., Moazen, B., Mohammad Gholi Mezerji, N., Mohammadi, S., Mohammed, S., Mokdad, A. H., Moradi, M., Moradzadeh, R., Moraga, P., Mosser, J. F., Murray, C. J., Naderi, M., Nagarajan, A. J., Nazari, J., Ndejjo, R., Negoi, I., Ngunjiri, J. W., Nguyen, Q. P., Nguyen, H. L., Nnaji, C. A., Noubiap, J. J., Nunez-Samudio, V., Olagunju, A. T., Olusanya, J. O., Olusanya, B. O., Omer, M. O., Onwujekwe, O. E., Otstavnov, N., Otstavnov, S. S., Owolabi, M. O., P A, M., Padubidri, J. R., Pana, A., Peprah, E. K., Pham, H. Q., Pigott, D. M., Pirestani, M., Postma, M. J., Pottoo, F. H., Pourjafar, H., Quazi Syed, Z., Rahim, F., Rahimi-Movaghar, V., Rahman, M. H., Rao, S. J., Rao, P. C., Rathi, P., Rawaf, S., Rawaf, D. L., Rawal, L., Rawassizadeh, R., Regassa, L. D., Renzaho, A. M., Rezaei, N., Rezai, M. S., Ribeiro, A. I., Rickard, J., Rios-Gonzalez, C. M., Rumisha, S. F., Sabour, S., Sajadi, S. M., Salomon, J. A., Samadi Kafil, H., Samy, A. M., Sanabria, J., Sartorius, B., Saxena, D., Schaeffer, L. E., Senthilkumaran, S., Sha, F., Shaheen, A. A., Shaikh, M. A., Sharma, R., Sheikh, A., Shibuya, K., Shigematsu, M., Il Shin, J., Simonetti, B., Singh, J. A., Smith, D. L., Soheili, A., Sokhan, A., Spurlock, E. E., Sreeramareddy, C. T., Sufiyan, M. B., Swartz, S. J., Tadesse, D. B., Tamiru, A. T., Tefera, Y. G., Temsah, M., Tessema, Z. T., Titova, M. V., Tran, B. X., Truong, P. N., Unnikrishnan, B., Upadhyay, E., Vasankari, T. J., Vasseghian, Y., Violante, F. S., Vu, G. T., Waheed, Y., Wamai, R. G., Wassie, E. G., Welay, F. T., Wickramasinghe, N. D., Wiens, K. E., Wijeratne, T., Wiysonge, C. S., Wondmeneh, T. G., Yamada, T., Yaya, S., Yeshitila, Y. G., Yip, P., Yonemoto, N., Yu, C., Yuce, D., Yusefzadeh, H., Zaidi, Z., Zamanian, M., Zangeneh, A., Zhang, Z., Zhang, Y., Ziapour, A. 2022; 13 (1): 7457

  Abstract

  Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival.

  View details for DOI 10.1038/s41467-022-34240-6

  View details for PubMedID 36473841

• The US COVID-19 Trends and Impact Survey: Continuous real-time measurement of COVID-19 symptoms, risks, protective behaviors, testing, and vaccination. Proceedings of the National Academy of Sciences of the United States of America Salomon, J. A., Reinhart, A., Bilinski, A., Chua, E. J., La Motte-Kerr, W., Ronn, M. M., Reitsma, M. B., Morris, K. A., LaRocca, S., Farag, T. H., Kreuter, F., Rosenfeld, R., Tibshirani, R. J. 1800; 118 (51)

  Abstract

  The US COVID-19 Trends and Impact Survey (CTIS) is a large, cross-sectional, internet-based survey that has operated continuously since April 6, 2020. By inviting a random sample of Facebook active users each day, CTIS collects information about COVID-19 symptoms, risks, mitigating behaviors, mental health, testing, vaccination, and other key priorities. The large scale of the survey-over 20 million responses in its first year of operation-allows tracking of trends over short timescales and allows comparisons at fine demographic and geographic detail. The survey has been repeatedly revised to respond to emerging public health priorities. In this paper, we describe the survey methods and content and give examples of CTIS results that illuminate key patterns and trends and help answer high-priority policy questions relevant to the COVID-19 epidemic and response. These results demonstrate how large online surveys can provide continuous, real-time indicators of important outcomes that are not subject to public health reporting delays and backlogs. The CTIS offers high value as a supplement to official reporting data by supplying essential information about behaviors, attitudes toward policy and preventive measures, economic impacts, and other topics not reported in public health surveillance systems.

  View details for DOI 10.1073/pnas.2111454118

  View details for PubMedID 34903656

• Lifetime burden of disease due to incident tuberculosis: a global reappraisal including post-tuberculosis sequelae LANCET GLOBAL HEALTH Menzies, N. A., Quaife, M., Allwood, B. W., Byrne, A. L., Coussens, A. K., Harries, A. D., Marx, F. M., Meghji, J., Pedrazzoli, D., Salomon, J. A., Sweeney, S., van Kampen, S. C., Wallis, R. S., Houben, R. J., Cohen, T. 2021; 9 (12): E1679-E1687

  View details for Web of Science ID 000720751200025

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

  Abstract

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

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

  View details for PubMedID 34826066

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

  Abstract

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

  View details for DOI 10.1002/hec.4434

  View details for PubMedID 34626032

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

  View details for DOI 10.1001/jamanetworkopen.2021.30343

  View details for PubMedID 34668949

• Cost Effectiveness of Computed Tomography Versus Ultrasound-Based Surveillance Following Endovascular Aortic Repair of Intact Abdominal Aortic Aneurysms Ho, V. T., Nguyen, A. T., Stern, J. R., Asch, S. M., Owens, D. K., Salomon, J. A., Dalman, R. L., Lee, J. T. MOSBY-ELSEVIER. 2021: E414-E415

  View details for Web of Science ID 000707158200208

• Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019 LANCET HIV Jahagirdar, D., Walters, M. K., Novotney, A., Brewer, E. D., Frank, T. D., Carter, A., Biehl, M. H., Abbastabar, H., Abhilash, E. S., Abu-Gharbieh, E., Abu-Raddad, L., Adekanmbi, V., Adeyinka, D., Adnani, Q., Afzal, S., Aghababaei, S., Ahinkorah, B., Ahmad, S., Ahmadi, K., Ahmadi, S., Ahmadpour, E., Ahmed, M., Rashid, T., Salih, Y., Aklilu, A., Akram, T., Akunna, C., Al Hamad, H., Alahdab, F., Alanezi, F., Aleksandrova, E. A., Alene, K., Ali, L., Alipour, V., Almustanyir, S., Alvis-Guzman, N., Ameyaw, E., Amu, H., Andrei, C., Andrei, T., Anvari, D., Arabloo, J., Aremu, O., Arulappan, J., Atnafu, D., Quintanilla, B., Ayza, M., Azari, S., Darshan, B. B., Banach, M., Barnighausen, T., Barra, F., Barrow, A., Basu, S., Bazargan-Hejazi, S., Belay, H., Berheto, T., Bezabhe, W., Bezabih, Y., Bhagavathula, A., Bhardwaj, N., Bhardwaj, P., Bhattacharyya, K., Bibi, S., Bijani, A., Bisignano, C., Bolarinwa, O., Boloor, A., Boltaev, A. A., Briko, N., Buonsenso, D., Burkart, K., Butt, Z. A., Cao, C., Charan, J., Chatterjee, S., Chattu, S., Chattu, V., Choudhari, S., Dinh-Toi Chu, Couto, R. S., Cowden, R. G., Dachew, B., Dadras, O., Dagnew, A., Dahlawi, S. A., Dai, X., Dandona, L., Dandona, R., das Neves, J., Degenhardt, L., Demeke, F., Desta, A., Deuba, K., Dhamnetiya, D., Dhungana, G., Dianatinasab, M., Diaz, D., Djalalinia, S., Linh Phuong Doan, Dorostkar, F., Edinur, H., Effiong, A., Eftekharzadeh, S., Zaki, M., Elayedath, R., Elhadi, M., El-Jaafary, S., El-Khatib, Z., Elsharkawy, A., Endalamaw, A., Endries, A., Eskandarieh, S., Ezeonwumelu, I., Ezzikouri, S., Farahmand, M., Faraon, E. A., Fasanmi, A., Ferrero, S., Desideri, L., Filip, I., Fischer, F., Folayan, M., Foroutan, M., Fukumoto, T., Gad, M. M., Gadanya, M. A., Gaidhane, A., Garg, T., Gayesa, R., Gebreyohannes, E., Gesesew, H., Obsa, A., Ghadiri, K., Ghashghaee, A., Gilani, S., Ginindza, T. G., Glushkova, E., Golechha, M., Gugnani, H., Gupta, B., Gupta, S., Gupta, V., Gupta, V., Hamidi, S., Handanagic, S., Haque, S., Harapan, H., Hargono, A., Hasaballah, A., Hashi, A., Hassan, S., Hassanipour, S., Hayat, K., Heredia-Pi, I., Hezam, K., Holla, R., Hoogar, P., Hoque, M., Hosseini, M., Hosseinzadeh, M., Hsairi, M., Hussain, R., Ibitoye, S., Idrisov, B., Ikuta, K. S., Ilesanmi, O., Ilic, I. M., Ilic, M. D., Irvani, S., Islam, M., Ismail, N., Itumalla, R., Iyamu, I., Jabbarinejad, R., Jain, V., Jayawardena, R., Jha, R., Joseph, N., Kabir, A., Kabir, Z., Kalhor, R., Kaliyadan, F., Kamath, A., Kanchan, T., Kandel, H., Kassahun, G., Katoto, P., Kayode, G. A., Kebede, E., Kebede, H., Khajuria, H., Khalid, N., Khan, E., Khan, G., Khatab, K., Kim, M., Kim, Y., Kisa, A., Kisa, S., Kochhar, S., Korshunov, V., Koul, P. A., Laxminarayana, S., Koyanagi, A., Krishan, K., Defo, B., Kumar, G., Kumar, M., Kumar, N., Kwarteng, A., Lal, D., Landires, I., Lasrado, S., Lassi, Z. S., Lazarus, J., Lee, J., Lee, Y., LeGrand, K. E., Lin, C., Liu, X., Maddison, E. R., Abd El Razek, H., Mahasha, P., Majeed, A., Makki, A., Malik, A., Manamo, W., Mansournia, M., Martins-Melo, F., Masoumi, S., Memish, Z. A., Menezes, R. G., Mengesha, E., Merie, H., Mersha, A., Mestrovic, T., Meylakhs, P., Mheidly, N., Miller, T. R., Mirica, A., Moazen, B., Mohammad, Y., Mohammadi, M., Mohammed, A., Mohammed, S., Mohammed, S., Moitra, M., Mokdad, A. H., Molokhia, M., Moni, M., Moradi, G., Moradi, Y., Mpundu-Kaambwa, C., Mubarik, S., Munro, S. B., Mwanri, L., Nachega, J. B., Nagarajan, A., Narayana, A., Naveed, M., Nayak, B., Nduaguba, S. O., Kandel, S., Nguefack-Tsague, G., Trang Huyen Nguyen, Nixon, M. R., Nnaji, C. A., Noubiap, J., Nunez-Samudio, V., Nyirenda, T., Oghenetega, O., Olagunju, A. T., Olakunde, B., Owopetu, O., Mahesh, P. A., Padubidri, J., Pakhale, S., Parekh, T., Kan, F., Pawar, S., Filipino Pepito, V., Peprah, E. K., Pinheiro, M., Pokhrel, K., Polibin, R., Pollok, R. G., Postma, M. J., Syed, Z., Radfar, A., Radhakrishnan, R., Rahim, F., Rahimi-Movaghar, V., Rahimzadeh, S., Rahman, M., Rahmani, A., Ram, P., Ranabhat, C., Ranasinghe, P., Rao, C. R., Rao, S. J., Rathi, P., Rawaf, D., Rawaf, S., Regassa, L., Rehman, I., Renzaho, A. N., Rezaei, N., Rezahosseini, O., Rezai, M., Rezapour, A., Ripon, R., Rodrigues, V., Roshchin, D. O., Rwegerera, G. M., Saeed, U., Moghaddam, S., Sagar, R., Saif-Ur-Rahman, K. M., Salem, M., Samaei, M., Samy, A. M., Santric-Milicevic, M. M., Saroshe, S., Sathian, B., Satpathy, M., Sawhney, M., Schutte, A., Seylani, A., Shaikh, M., Shaka, M., Shamshad, H., Shamsizadeh, M., Shannawaz, M., Shetty, A., Il Shin, J., Shivakumar, K. M., Singh, J. A., Skryabin, V., Skryabina, A., Somayaji, R., Soshnikov, S., Spurlock, E., Stein, D. J., Sufiyan, M., Tadbiri, H., Tadesse, B., Tadesse, E., Tamiru, A., Tarkang, E., Taveira, N., Tekalegn, Y., Tesfay, F., Tessema, G., Thapar, R., Tovani-Palone, M., Traini, E., Bach Xuan Tran, Tsai, A. C., Tusa, B., Ullah, S., Umeokonkwo, C., Unnikrishnan, B., Tahbaz, S., Villafane, J., Vladimirov, S., Bay Vo, Vongpradith, A., Giang Thu Vu, Waheed, Y., Wamai, R. G., Wang, G., Wang, Y., Ward, P., Westerman, R., Winkler, A., Yadav, L., Jabbari, S., Yazie, T., Yi, S., Yirdaw, B., Yonemoto, N., Yu, C., Yunusa, I., Zastrozhin, M., Zastrozhina, A., Zhang, Z., Zumla, A., Salomon, J. A., Eaton, J. W., Naghavi, M., Dwyer-Lindgren, L., Wang, H., Lim, S. S., Hay, S., Murray, C. L., Kyu, H. H., GBD 2019 HIV Collaborators 2021; 8 (10): E633-E651

  Abstract

  The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic.To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0).In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1-38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78-0·91) per female living with HIV in 2019, 0·99 male infections (0·91-1·10) for every female infection, and 1·02 male deaths (0·95-1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58-35·43, and a 39·66% decrease in deaths, 36·49-42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05-0·06) and the global incidence-to-mortality ratio was 1·94 (1·76-2·12). No regions met suggested thresholds for progress.Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics.The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.

  View details for Web of Science ID 000723115600001

  View details for PubMedID 34592142

  View details for PubMedCentralID PMC8491452

• Multimorbidity and mortality in an older, rural black South African population cohort with high prevalence of HIV findings from the HAALSI Study. BMJ open Wade, A. N., Payne, C. F., Berkman, L., Chang, A., Gomez-Olive, F. X., Kabudula, C., Kahn, K., Salomon, J. A., Tollman, S., Witham, M., Davies, J. 2021; 11 (9): e047777

  Abstract

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

  View details for DOI 10.1136/bmjopen-2020-047777

  View details for PubMedID 34526338

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

  Abstract

  Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier.Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress.Bill & Melinda Gates Foundation.

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

  View details for Web of Science ID 000692628000023

  View details for PubMedID 34416195

  View details for PubMedCentralID PMC8429803

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

  View details for DOI 10.1002/jia2.25790

  View details for PubMedID 34546663

• Cost Effectiveness of Computed Tomography Versus Ultrasound-Based Surveillance After Endovascular Aortic Repair of Intact Abdominal Aortic Aneurysms Ho, V. T., Nguyen, A. T., Stern, J. R., Asch, S. M., Owens, D. K., Salomon, J. A., Dalman, R. L., Lee, J. T. MOSBY-ELSEVIER. 2021: E190-E191

  View details for Web of Science ID 000691401100304

• Trends, mechanisms, and racial/ethnic differences of tuberculosis incidence in the US-born population aged 50 years or older in the United States. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Kim, S., Cohen, T., Horsburgh, C. R., Miller, J. W., Hill, A. N., Marks, S. M., Li, R., Kammerer, J. S., Salomon, J. A., Menzies, N. A. 2021

  Abstract

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

  View details for DOI 10.1093/cid/ciab668

  View details for PubMedID 34323959

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

  Abstract

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

  View details for DOI 10.1093/aje/kwab185

  View details for PubMedID 34180960

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

  Abstract

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

  View details for DOI 10.1136/bmjopen-2020-046060

  View details for PubMedID 34140342

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

  Abstract

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

  View details for DOI 10.1093/ageing/afab111

  View details for PubMedID 34107011

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

  Abstract

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

  View details for DOI 10.1001/jamacardio.2021.1437

  View details for PubMedID 34037681

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

  Abstract

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

  View details for DOI 10.1111/add.15574

  View details for PubMedID 33999485

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

  Abstract

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

  View details for DOI 10.1097/OLQ.0000000000001467

  View details for PubMedID 33993161

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

  Abstract

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

  View details for DOI 10.1093/cid/ciab405

  View details for PubMedID 33956937

• MODELING INTERVENTIONS TO EXPAND MEDICATION-ASSISTED TREATMENT AMONG VETERANS WITH OPIOID USE DISORDER IN THE VETERANS HEALTH ADMINISTRATION Ching, J. H., Trafton, J. A., Owens, D. K., Salomon, J. A., Goldhaber-Fiebert, J. D. SAGE PUBLICATIONS INC. 2021: E189-E190

  View details for Web of Science ID 000648637500155

• ADAPTIVE POLICIES FOR USE OF PHYSICAL DISTANCING INTERVENTIONS DURING THE COVID-19 PANDEMIC Yaesoubi, R., Havumaki, J., Chitwood, M., Menzies, N. A., Gonsalves, G., Salomon, J. A., Paltiel, A., Cohen, T. SAGE PUBLICATIONS INC. 2021: E332-E333

  View details for Web of Science ID 000648637500256

• SPATIALLY ADAPTIVE GUIDELINES FOR THE TREATMENT OF GONORRHEA TO INCREASE THE EFFECTIVE LIFESPAN OF ANTIBIOTICS: A MATHEMATICAL MODELING STUDY Yaesoubi, R., Cohen, T., Gift, T., St Cyr, S., Salomon, J. A., Grad, Y. SAGE PUBLICATIONS INC. 2021: E214-E216

  View details for Web of Science ID 000648637500172

• How do Japanese rate the severity of different diseases and injuries?-an assessment of disability weights for 231 health states by 37,318 Japanese respondents. Population health metrics Nomura, S., Yamamoto, Y., Yoneoka, D., Haagsma, J. A., Salomon, J. A., Ueda, P., Mori, R., Santomauro, D., Vos, T., Shibuya, K. 2021; 19 (1): 21

  Abstract

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

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

  View details for PubMedID 33892742

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

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

  View details for PubMedID 33782884

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

  Abstract

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

  View details for DOI 10.1136/bmjopen-2020-043261

  View details for PubMedID 33653752

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

  Abstract

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

  View details for DOI 10.1177/0272989X21990391

  View details for PubMedID 33535889

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

  Abstract

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

  View details for DOI 10.1101/2021.01.27.21250388

  View details for PubMedID 33532804

  View details for PubMedCentralID PMC7852255

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

  Abstract

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

  View details for DOI 10.1177/0272989X21990371

  View details for PubMedID 33504258

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

  Abstract

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

  View details for DOI 10.1097/EDE.0000000000001271

  View details for PubMedID 33009253

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

  Abstract

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

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

  View details for PubMedID 34798027

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

  Abstract

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

  View details for DOI 10.7326/M21-0600

  View details for PubMedID 34097433

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

  Abstract

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

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

  View details for PubMedID 34364404

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

  View details for DOI 10.1377/hlthaff.2021.01203

  View details for PubMedID 34495717

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

  Abstract

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

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

  View details for PubMedID 34291377

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

  Abstract

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

  View details for DOI 10.1097/EDE.0000000000001418

  View details for PubMedID 34669631

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

  View details for DOI 10.1056/NEJMc2114089

  View details for PubMedID 34670040

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

  Abstract

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

  View details for DOI 10.1177/23814683211049249

  View details for PubMedID 34660906

  View details for PubMedCentralID PMC8512280

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

  View details for DOI 10.1056/NEJMc2105282

  View details for PubMedID 33979505

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

  Abstract

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

  View details for DOI 10.1377/hlthaff.2021.00098

  View details for PubMedID 33979192

• Nationwide Cost-Effectiveness Analysis of Surgical Stabilization of Rib Fractures by Flail Chest Status and Age Groups Journal of Trauma and Acute Care Surgery Choi, J., Mulaney, B., Laohavinij, W., Trimble, R., Tennakoon, L., Spain, D. A., Salomon, J. A., Goldhaber-Fiebert, J. D., Forrester, J. D. 2021

  View details for DOI 10.1097/TA.0000000000003021

• Mapping Inequality in SARS-CoV-2 Household Exposure and Transmission Risk in the USA. Journal of general internal medicine Reitsma, M. B., Salomon, J. A., Goldhaber-Fiebert, J. D. 2021

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

  View details for PubMedID 33604818

  View details for PubMedCentralID PMC7891469

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

  View details for DOI 10.7326/M20-8137

  View details for PubMedID 33395334

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

  Abstract

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

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

  View details for Web of Science ID 000599489600008

  View details for PubMedID 33328634

  View details for PubMedCentralID PMC7739806

• Five insights from the Global Burden of Disease Study 2019 LANCET Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abedi, A., Abedi, P., Abegaz, K., Abolhassani, H., Abosetugn, A., Aboyans, V., Abrams, E. M., Abreu, L., Abrigo, M. M., Abu Haimed, A., Abualhasan, A., Abu-Gharbieh, E., Abu-Raddad, L., Abushouk, A. I., Acebedo, A., Ackerman, I. N., Adabi, M., Adair, T., Adamu, A. A., Adebayo, O. M., Adedeji, I., Adekanmbi, V., Adelson, J. D., Adeoye, A., Adetokunboh, O. O., Adham, D., Advani, S. M., Afarideh, M., Afshari, M., Afshin, A., Agardh, E. E., Agarwal, G., Agasthi, P., Agesa, K. M., Aghaali, M., Aghamir, S., Agrawal, A., Ahmad, T., Ahmadi, A., Ahmadi, K., Ahmadi, M., Ahmadieh, H., Ahmadpour, E., Ahmed, M., Aji, B., Akalu, T., Akinyemi, R., Akinyemiju, T., Akombi, B., Akunna, C., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alam, S., Alam, T., Alanezi, F., Alanzi, T. M., Albertson, S. B., Alcalde-Rabanal, J., Alema, N., Alemu, B., Alemu, Y., Alhabib, K. F., Alhassan, R., Ali, M., Ali, S., Alicandro, G., Alijanzadeh, M., Alinia, C., Alipour, V., Alizade, H., Aljunid, S., Alla, F., Allebeck, P., Almadi, M., Almasi, A., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Almulhim, A. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alumran, A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amare, A. T., Amare, B., Amini, S., Amini-Rarani, M., Aminorroaya, A., Amiri, F., Amit, A. L., Amugsi, D. A., Amul, G., Anbesu, E., Ancuceanu, R., Anderlini, D., Anderson, J. A., Andrei, C., Andrei, T., Androudi, S., Angus, C., Anjomshoa, M., Ansari, F., Ansari, I., Ansari-Moghaddam, A., Antonazzo, I., Antonio, C. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Appiah, S., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Arba, A., Aremu, O., Ariani, F., Aripov, T., Armoon, B., Arnlov, J., Arowosegbe, O., Aryal, K. K., Arzani, A., Asaad, M., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Asgari, S., Asghari, B., Jafarabadi, M., Ashbaugh, C., Assmus, M., Atafar, Z., Athari, S., Atnafu, D., Atout, M., Atre, S. R., Atteraya, M., Ausloos, F., Ausloos, M., Avila-Burgos, L., Avokpaho, E., Quintanilla, B., Ayano, G., Ayanore, M., Aynalem, G., Aynalem, Y., Ayza, M., Azari, S., Azarian, G., Azene, Z., Azhar, G., Azzopardi, P. S., Darshan, B. B., Babaee, E., Badawi, A., Badiye, A. D., Bagherzadeh, M., Bagli, E., Bahrami, M., Baig, A., Bairwa, M., Bakhshaei, M., Bakhtiari, A., Bakkannavar, S. M., Balachandran, A., Balakrishnan, S., Balalla, S., Balassyano, S., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Banik, P., Bannick, M. S., Bante, A., Bante, S., Baraki, A., Barboza, M. A., Barker-Collo, S., Barnighausen, T., Barrero, L. H., Barthelemy, C. M., Barua, L., Barzegar, A., Basaleem, H., Bassat, Q., Basu, S., Baune, B. T., Bayati, M., Baye, B., Bazmandegan, G., Becker, J. S., Bedi, N., Beghi, E., Behzadifar, M., Bejot, Y., Bekuma, T., Bell, M. L., Bello, A. K., Bender, R. G., Bennett, D. A., Bennitt, F. B., Bensenor, I. M., Benziger, C. P., Berhe, K., Berman, A. E., Bernabe, E., Bernstein, R. S., Bertolacci, G. J., Bhagavathula, A., Bhageerathy, R., Bhala, N., Bhandari, D., Bhardwaj, P., Bhat, A., Bhattacharyya, K., Bhattarai, S., Bhutta, Z. A., Bibi, S., Biehl, M. H., Bijani, A., Bikbov, B., Bilano, V., Bin Sayeed, M., Biondi, A., Birihane, B., Bisanzio, D., Bisignano, C., Biswas, R., Bitew, H., Bjorge, T., Bockarie, M., Bohlouli, S., Bohluli, M., Bojia, H., Bolla, S., Boloor, A., Boon-Dooley, A. S., Borges, G., Borzi, A., Borzouei, S., Bose, D., Bosetti, C., Boufous, S., Bourne, R., Brady, O. J., Braithwaite, D., Brauer, M., Brayne, C., Breitborde, N. K., Breitner, S., Brenner, H., Breusov, A. V., Briant, P., Briggs, A. M., Briko, A., Briko, N., Britton, G. B., Brugha, T., Bryazka, D., Buchbinder, R., Bumgarner, B. R., Burkart, K., Burnett, R., Nagaraja, S., Busse, R., Butt, Z. A., Caetano dos Santos, F., Cahill, L. E., Cahuana-Hurtado, L., Cai, T., Callender, C. H., Camera, L., Campos-Nonato, I. R., Rincon, J., Cao, J., Car, J., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J., Castaneda-Orjuela, C. A., Castelpietra, G., Castle, C. D., Castro, E., Castro, F., Catala-Lopez, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chalek, J., Chandan, J., Chang, A. R., Chang, A. Y., Chang, J., Chang, K., Charan, J., Charlson, F. J., Chattu, V., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Chin, K., Chirinos-Caceres, J., Cho, D., Choi, J., Christensen, H., Chu, D., Chung, M. T., Chung, S., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Cislaghi, B., Classen, T., Cohen, A. J., Collins, E. L., Comfort, H., Compton, K., Conti, S., Cooper, O. R., Corso, B., Cortesi, P., Costa, V., Cousin, E., Cowden, R. G., Cowie, B. C., Cromwell, E. A., Croneberger, A. J., Cross, D. H., Cross, M., Crowe, C., Cruz, J. A., Cummins, S., Cunningham, M., Dahlawi, S. A., Dai, H., Dai, H., Damasceno, A., Damiani, G., D'Amico, E., Dandona, L., Dandona, R., Daneshpajouhnejad, P., Dangel, W., Danielsson, A., Gela, J., Dargan, P. I., Darwesh, A., Daryani, A., Das, J. K., Das Gupta, R., Das Neves, J., Dash, A., Davey, G., Davila-Cervantes, C., Davis, A. C., Davitoiu, D., Davletov, K., De Leo, D., De Neve, J., Dean, F. E., DeCleene, N. K., Deen, A., Degenhardt, L., DeLang, M., Dellavalle, R., Demeke, F., Demoz, G., Demsie, D., Denova-Gutierrez, E., Dereje, N., Deribe, K., Dervenis, N., Desai, R., Desalew, A., Dessie, G., Deuba, K., Dharmaratne, S., Dhungana, G., Dianatinasab, M., da Silva, D., Diaz, D., Forooshani, Z., Dichgans, M., Didarloo, A., Dingels, Z. V., Dippenaar, I. N., Dirac, M., Djalalinia, S., Do, H., Dokova, K., Doku, D., Dolecek, C., Dolgert, A. J., Dorostkar, F., Doshi, C. P., Doshi, P. P., Doshmangir, L., Douiri, A., Doxey, M. C., Doyle, K. E., Driscoll, T., Dubljanin, E., Dunachie, S. J., Duncan, B. B., Duraes, A., Eagan, A., Ebrahimi, H., Kalan, M., Edvardsson, D., Effiong, A., Ehrlich, J. R., El Nahas, N., El Sayed, I., Zaki, M., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., Elhabashy, H., El-Jaafary, S. I., Elsharkawy, A., Elyazar, I. F., Emamian, M., Emmons-Bell, S., Erskine, H. E., Eshrati, B., Eskandari, K., Eskandarieh, S., Esmaeilnejad, S., Esmaeilzadeh, F., Esteghamati, A., Esteghamati, S., Estep, K., Etemadi, A., Etisso, A., Ezekannagha, O., Fanzo, J., Farag, T., Farahmand, M., Faraj, A., Faraon, E. A., Fareed, M., Faridnia, R., Farinha, C., Farioli, A., Faris, P., Faro, A., Faruque, M., Farzadfar, F., Fattahi, N., Fazaeli, A., Fazlzadeh, M., Feigin, V. L., Feldman, R., Fereshtehnejad, S., Fernandes, E., Ferrara, G., Ferrara, P., Ferrari, A. J., Ferreira, M. L., Feyissa, G., Filip, I., Fischer, F., Fisher, J. L., Fitzgerald, R., Flohr, C., Flor, L., Foigt, N. A., Folayan, M., Fomenkov, A., Force, L. M., Fornari, C., Foroutan, M., Fox, J. T., Francis, J., Frank, T. D., Franklin, R., Freitas, M., Fu, W., Fukumoto, T., Fukutaki, K., Fuller, J. E., Fullman, N., Furtado, J. M., Gad, M. M., Gaidhane, A., Gakidou, E., Galles, N. C., Gallus, S., Gamkrelidze, A., Garcia-Basteiro, A. L., Gardner, W. M., Geberemariyam, B., Gebrehiwot, A., Gebremedhin, K., Gebremeskel, G., Gebremeskel, L. G., Gebresillassie, B., Gebreslassie, A., Geramo, Y., Geremew, A., Hayoon, A., Gesesew, H., Gething, P. W., Gezae, K., Ghadimi, M., Ghadiri, K., Ghaffarifar, F., Ghafourifard, M., Ghajar, A., Ghamari, F., Ghashghaee, A., Ghiasvand, H., Ghith, N., Gholamian, A., Ghosh, R., Giampaoli, S., Gilani, S., Gill, P., Gill, T. K., Gillum, R. F., Ginawi, I., Ginindza, T. G., Gitimoghaddam, M., Giussani, G., Glagn, M., Glushkova, E., Gnedovskaya, E. V., Godinho, M., Goharinezhad, S., Golechha, M., Goli, S., Gomez, R., Gona, P. N., Gopalani, S., Goren, E., Gorini, G., Gorman, T. M., Gottlich, H., Goudarzi, H., Goudarzian, A., Goulart, A. C., Goulart, B., Grada, A., Greaves, F., Grivna, M., Grosso, G., Gubari, M., Gudi, N., Gugnani, H., Guimaraes, A., Guimaraes, R., Guled, R., Gultie, T., Guo, G., Guo, Y., Gupta, R., Gupta, R., Sharan, S., Gupta, T., Haagsma, J. A., Hachinski, V., Haddock, B., Hafezi-Nejad, N., Hafiz, A., Hagins, H., Haile, L. M., Haile, T., Haj-Mirzaian, A., Haj-Mirzaian, A., Hall, B. J., Halvaei, I., Hamadeh, R. R., Abdullah, K., Hameed, S., Hamidi, S., Hamilton, E. B., Hammer, M. S., Han, C., Han, H., Handiso, D., Hanif, A., Hankey, G. J., Haririan, H., Haro, J., Harvey, J. D., Hasaballah, A. I., Hasan, M., Hasanpoor, E., Hasanzadeh, A., Hashemian, M., Hashi, A., Hassan, A., Hassan, S., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, R. J., Hay, S. I., Hayat, K., Heibati, B., Heidari, B., Heidari, G., Heidari-Soureshjani, R., Hendrie, D., Henny, K., Henok, A., Henrikson, H. J., Henry, N. J., Herbert, M. 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  Abstract

  The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.

  View details for Web of Science ID 000579154000005

  View details for PubMedID 33069324

• Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 LANCET Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abolhassani, H., Aboyans, V., Abrams, E. M., Abreu, L., Abrigo, M. M., Abu-Raddad, L., Abushouk, A. I., Acebedo, A., Ackerman, I. N., Adabi, M., Adamu, A. A., Adebayo, O. M., Adekanmbi, V., Adelson, J. D., Adetokunboh, O. O., Adham, D., Afshari, M., Afshin, A., Agardh, E. E., Agarwal, G., Agesa, K. M., Aghaali, M., Aghamir, S., Agrawal, A., Ahmad, T., Ahmadi, A., Ahmadi, M., Ahmadieh, H., Ahmadpour, E., Akalu, T., Akinyemi, R., Akinyemiju, T., Akombi, B., Al-Aly, Z., Alam, K., Alam, N., Alam, S., Alam, T., Alanzi, T. M., Albertson, S. B., Alcalde-Rabanal, J., Alema, N., Ali, M., Ali, S., Alicandro, G., Alijanzadeh, M., Alinia, C., Alipour, V., Aljunid, S., Alla, F., Allebeck, P., Almasi-Hashiani, A., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Aminorroaya, A., Amiri, F., Amit, A. L., Amugsi, D. A., Amul, G., Anderlini, D., Andrei, C., Andrei, T., Anjomshoa, M., Ansari, F., Ansari, I., Ansari-Moghaddam, A., Antonio, C. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Ariani, F., Arnlov, J., Aryal, K. K., Arzani, A., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Asghari, B., Ashbaugh, C., Atnafu, D., Atre, S. R., Ausloos, F., Ausloos, M., Quintanilla, B., Ayano, G., Ayanore, M., Aynalem, Y., Azari, S., Azarian, G., Azene, Z., Babaee, E., Badawi, A., Bagherzadeh, M., Bakhshaei, M., Bakhtiari, A., Balakrishnan, S., Balalla, S., Balassyano, S., Banach, M., Banik, P., Bannick, M. S., Bante, A., Baraki, A., Barboza, M. A., Barker-Collo, S., Barthelemy, C. M., Barua, L., Barzegar, A., Basu, S., Baune, B. T., Bayati, M., Bazmandegan, G., Bedi, N., Beghi, E., Bejot, Y., Bello, A. K., Bender, R. G., Bennett, D. A., Bennitt, F. B., Bensenor, I. M., Benziger, C. P., Berhe, K., Bernabe, E., Bertolacci, G. J., Bhageerathy, R., Bhala, N., Bhandari, D., Bhardwaj, P., Bhattacharyya, K., Bhutta, Z. A., Bibi, S., Biehl, M. H., Bikbov, B., Bin Sayeed, M., Biondi, A., Birihane, B., Bisanzio, D., Bisignano, C., Biswas, R., Bohlouli, S., Bohluli, M., Bolla, S., Boloor, A., Boon-Dooley, A. S., Borges, G., Borzi, A., Bourne, R., Brady, O. J., Brauer, M., Brayne, C., Breitborde, N. K., Brenner, H., Briant, P., Briggs, A. M., Briko, N., Britton, G. B., Bryazka, D., Buchbinder, R., Bumgarner, B. R., Busse, R., Butt, Z. A., dos Santos, F., Camera, L., Campos-Nonato, I. R., Car, J., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J., Castaneda-Orjuela, C. 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V., Dirac, M., Djalalinia, S., Do, H., Dokova, K., Dorostkar, F., Doshi, C. P., Doshmangir, L., Douiri, A., Doxey, M. C., Driscoll, T., Dunachie, S. J., Duncan, B. B., Duraes, A., Eagan, A., Kalan, M., Edvardsson, D., Ehrlich, J. R., El Nahas, N., El Sayed, I., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., Elhabashy, H., El-Jaafary, S. I., Elyazar, I. F., Emamian, M., Emmons-Bell, S., Erskine, H. E., Eshrati, B., Eskandarieh, S., Esmaeilnejad, S., Esmaeilzadeh, F., Esteghamati, A., Estep, K., Etemadi, A., Etisso, A., Farahmand, M., Faraj, A., Fareed, M., Faridnia, R., Farinha, C., Farioli, A., Faro, A., Faruque, M., Farzadfar, F., Fattahi, N., Fazlzadeh, M., Feigin, V. L., Feldman, R., Fereshtehnejad, S., Fernandes, E., Ferrari, A. J., Ferreira, M. L., Filip, I., Fischer, F., Fisher, J. L., Fitzgerald, R., Flohr, C., Flor, L., Foigt, N. A., Folayan, M., Force, L. M., Fornari, C., Foroutan, M., Fox, J. T., Freitas, M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. 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  Abstract

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

  View details for Web of Science ID 000579154000007

  View details for PubMedID 33069326

  View details for PubMedCentralID PMC7567026

• Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 LANCET Murray, C. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K., Abolhassani, H., Aboyans, V., Abreu, L., Abrigo, M. M., Abualhasan, A., Abu-Raddad, L., Abushouk, A. I., Adabi, M., Adekanmbi, V., Adeoye, A., Adetokunboh, O. O., Adham, D., Advani, S. M., Agarwal, G., Aghamir, S., Agrawal, A., Ahmad, T., Ahmadi, K., Ahmadi, M., Ahmadieh, H., Ahmed, M., Akalu, T., Akinyemi, R., Akinyemiju, T., Akombi, B., Akunna, C., Alahdab, F., Al-Aly, Z., Alam, K., Alam, S., Alam, T., Alanezi, F., Alanzi, T. M., Alemu, B., Alhabib, K. F., Ali, M., Ali, S., Alicandro, G., Alinia, C., Alipour, V., Alizade, H., Aljunid, S., Alla, F., Allebeck, P., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Alonso, J., Altirkawi, K. A., Amini-Rarani, M., Amiri, F., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Anderson, J. A., Andrei, C., Andrei, T., Angus, C., Anjomshoa, M., Ansari, F., Ansari-Moghaddam, A., Antonazzo, I., Antonio, C. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Appiah, S., Arabloo, J., Arab-Zozani, M., Ariani, F., Armoon, B., Arnlov, J., Arzani, A., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Ashbaugh, C., Assmus, M., Atafar, Z., Atnafu, D., Atout, M., Ausloos, F., Ausloos, M., Quintanilla, B., Ayano, G., Ayanore, M., Azari, S., Azarian, G., Azene, Z., Badawi, A., Badiye, A. D., Bahrami, M., Bakhshaei, M., Bakhtiari, A., Bakkannavar, S. M., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Bante, A., Baraki, A., Barker-Collo, S., Barnighausen, T., Barrero, L. H., Barthelemy, C. M., Barua, L., Basu, S., Baune, B. T., Bayati, M., Becker, J. S., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bennitt, F. B., Bensenor, I. M., Berhe, K., Berman, A. E., Bhagavathula, A., Bhageerathy, R., Bhala, N., Bhandari, D., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Bikbov, B., Bin Sayeed, M., Biondi, A., Birihane, B., Bisignano, C., Biswas, R., Bitew, H., Bohlouli, S., Bohluli, M., Boon-Dooley, A. S., Borges, G., Borzi, A., Borzouei, S., Bosetti, C., Boufous, S., Braithwaite, D., Breitborde, N. K., Breitner, S., Brenner, H., Briant, P., Briko, A., Briko, N., Britton, G. B., Bryazka, D., Bumgarner, B. R., Burkart, K., Burnett, R., Nagaraja, S., Butt, Z. A., dos Santos, F., Cahill, L. E., Camera, L., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J., Chang, K., Charlson, F. J., Chattu, V., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Cho, D., Choi, J., Christensen, H., Chu, D., Chung, M. T., Chung, S., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Classen, T., Cohen, A. J., Compton, K., Cooper, O. R., Costa, V., Cousin, E., Cowden, R. G., Cross, D. H., Cruz, J. A., Dahlawi, S. A., Damasceno, A., Damiani, G., Dandona, L., Dandona, R., Dangel, W., Danielsson, A., Dargan, P. I., Darwesh, A., Daryani, A., Das, J. K., Das Gupta, R., das Neves, J., Davila-Cervantes, C., Davitoiu, D., De Leo, D., Degenhardt, L., DeLang, M., Dellavalle, R., Demeke, F., Demoz, G., Demsie, D., Denova-Gutierrez, E., Dervenis, N., Dhungana, G., Dianatinasab, M., da Silva, D., Diaz, D., Forooshani, Z., Djalalinia, S., Do, H., Dokova, K., Dorostkar, F., Doshmangir, L., Driscoll, T., Duncan, B. B., Duraes, A., Eagan, A., Edvardsson, D., El Nahas, N., El Sayed, I., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., El-Jaafary, S. I., Elyazar, I. F., Emmons-Bell, S., Erskine, H. E., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Estep, K., Etemadi, A., Etisso, A., Fanzo, J., Farahmand, M., Fareed, M., Faridnia, R., Farioli, A., Faro, A., Faruque, M., Farzadfar, F., Fattahi, N., Fazlzadeh, M., Feigin, V. L., Feldman, R., Fereshtehnejad, S., Fernandes, E., Ferrara, G., Ferrari, A. J., Ferreira, M. L., Filip, I., Fischer, F., Fisher, J. L., Flor, L., Foigt, N. A., Folayan, M., Fomenkov, A., Force, L. M., Foroutan, M., Franklin, R., Freitas, M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gakidou, E., Gallus, S., Garcia-Basteiro, A. L., Gardner, W. M., Geberemariyam, B., Gebreslassie, A., Geremew, A., Hayoon, A., Gething, P. W., Ghadimi, M., Ghadiri, K., Ghaffarifar, F., Ghafourifard, M., Ghamari, F., Ghashghaee, A., Ghiasvand, H., Ghith, N., Gholamian, A., Ghosh, R., Gill, P., Ginindza, T. G., Giussani, G., Gnedovskaya, E. V., Goharinezhad, S., Gopalani, S., Gorini, G., Goudarzi, H., Goulart, A. C., Greaves, F., Grivna, M., Grosso, G., Gubari, M., Gugnani, H., Guimaraes, R., Guled, R., Guo, G., Guo, Y., Gupta, R., Gupta, T., Haddock, B., Hafezi-Nejad, N., Hafiz, A., Haj-Mirzaian, A., Haj-Mirzaian, A., Hall, B. J., Halvaei, I., Hamadeh, R. R., Hamidi, S., Hammer, M. S., Hankey, G. J., Haririan, H., Haro, J., Hasaballah, A. I., Hasan, M., Hasanpoor, E., Hashi, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Henrikson, H. J., Herbert, M. E., Herteliu, C., Heydarpour, F., Hird, T. R., Hoek, H. W., Holla, R., Hoogar, P., Hosgood, H., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsairi, M., Hsieh, V., Hu, G., Hu, K., Huda, T. M., Humayun, A., Huynh, C. K., Hwang, B., Iannucci, V. C., Ibitoye, S., Ikeda, N., Ikuta, K. S., Ilesanmi, O., Ilic, I. M., Ilic, M. D., Inbaraj, L., Ippolito, H., Iqbal, U., Irvani, S., Irvine, C., Islam, M., Islam, S., Iso, H., Ivers, R. Q., Iwu, C. D., Iwu, C., Iyamu, I., Jaafari, J., Jacobsen, K. H., Jafari, H., Jafarinia, M., Jahani, M., Jakovljevic, M., Jalilian, F., James, S. L., Janjani, H., Javaheri, T., Javidnia, J., Jeemon, P., Jenabi, E., Jha, R., Jha, V., Ji, J. S., Johansson, L., John, O., John-Akinola, Y. O., Johnson, C., Jonas, J. B., Joukar, F., Jozwiak, J., Jurisson, M., Kabir, A., Kabir, Z., Kalani, H., Kalani, R., Kalankesh, L. R., Kalhor, R., Kanchan, T., Kapoor, N., Matin, B., Karch, A., Karim, M., Kassa, G., Katikireddi, S., Kayode, G. A., Karyani, A., Keiyoro, P., Keller, C., Kemmer, L., Kendrick, P. J., Khalid, N., Khammarnia, M., Khan, E., Khan, M., Khatab, K., Khater, M. M., Khatib, M., Khayamzadeh, M., Khazaei, S., Kieling, C., Kim, Y., Kimokoti, R. W., Kisa, A., Kisa, S., Kivimaki, M., Knibbs, L. D., Knudsen, A., Kocarnik, J. M., Kochhar, S., Kopec, J. A., Korshunov, V., Koul, P. A., Koyanagi, A., Kraemer, M. G., Krishan, K., Krohn, K. J., Kromhout, H., Defo, B., Kumar, G., Kumar, V., Kurmi, O. P., Kusuma, D., La Vecchia, C., Lacey, B., Lal, D., Lalloo, R., Lallukka, T., Lami, F., Landires, I., Lang, J. J., Langan, S. M., Larsson, A. O., Lasrado, S., Lauriola, P., Lazarus, J. V., Lee, P. H., Lee, S., LeGrand, K. E., Leigh, J., Leonardi, M., Lescinsky, H., Leung, J., Levi, M., Li, S., Lim, L., Linn, S., Liu, S., Liu, S., Liu, Y., Lo, J., Lopez, A. D., Lopez, J. F., Lopukhov, P. D., Lorkowski, S., Lotufo, P. A., Lu, A., Lugo, A., Maddison, E. R., Mahasha, P., Mahdavi, M., Mahmoudi, M., Majeed, A., Maleki, A., Maleki, S., Malekzadeh, R., Malta, D., Mamun, A. A., Manda, A., Manguerra, H., Mansour-Ghanaei, F., Mansouri, B., Mansournia, M., Herrera, A., Maravilla, J. C., Marks, A., Martin, R. V., Martini, S., Martins-Melo, F., Masaka, A., Masoumi, S., Mathur, M., Matsushita, K., Maulik, P. K., McAlinden, C., McGrath, J. J., McKee, M., Mehndiratta, M., Mehri, F., Mehta, K. M., Memish, Z. A., Mendoza, W., Menezes, R. G., Mengesha, E., Mereke, A., Mereta, S., Meretoja, A., Meretoja, T. J., Mestrovic, T., Miazgowski, B., Miazgowski, T., Michalek, I., Miller, T. R., Mills, E. J., Mini, G. K., Miri, M., Mirica, A., Mirrakhimov, E. M., Mirzaei, H., Mirzaei, M., Mirzaei, R., Mirzaei-Alavijeh, M., Misganaw, A., Mithra, P., Moazen, B., Mohammad, D. K., Mohammad, Y., Mezerji, N., Mohammadian-Hafshejani, A., Mohammadifard, N., Mohammadpourhodki, R., Mohammed, A., Mohammed, H., Mohammed, J., Mohammed, S., Mokdad, A. H., Molokhia, M., Monasta, L., Mooney, M. D., Moradi, G., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morawska, L., Morgado-da-Costa, J., Morrison, S., Mosapour, A., Mosser, J. F., Mouodi, S., Mousavi, S., Khaneghah, A., Mueller, U., Mukhopadhyay, S., Mullany, E. C., Musa, K., Muthupandian, S., Nabhan, A. F., Naderi, M., Nagarajan, A., Nagel, G., Naghavi, M., Naghshtabrizi, B., Naimzada, M., Najafi, F., Nangia, V., Nansseu, J., Naserbakht, M., Nayak, V. C., Negoi, I., Ngunjiri, J. W., Nguyen, C., Nguyen, H., Nguyen, M., Nigatu, Y. T., Nikbakhsh, R., Nixon, M. R., Nnaji, C. A., Nomura, S., Norrving, B., Noubiap, J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Oancea, B., Odell, C. M., Ogbo, F., Oh, I., Okunga, E., Oladnabi, M., Olagunju, A. T., Olusanya, B., Olusanya, J., Omer, M., Ong, K. L., Onwujekwe, O. E., Orpana, H. M., Ortiz, A., Osarenotor, O., Osei, F. B., Ostroff, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., Mahesh, P. A., Padubidri, J., Palladino, R., Panda-Jonas, S., Pandey, A., Parry, C. H., Pasovic, M., Pasupula, D., Patel, S., Pathak, M., Patten, S. B., Patton, G. C., Toroudi, H., Peden, A. E., Pennini, A., Pepito, V., Peprah, E. K., Pereira, D. M., Pesudovs, K., Pham, H., Phillips, M. R., Piccinelli, C., Pilz, T. M., Piradov, M. A., Pirsaheb, M., Plass, D., Polinder, S., Polkinghorne, K. R., Pond, C., Postma, M. J., Pourjafar, H., Pourmalek, F., Poznanska, A., Prada, S. I., Prakash, V., Pribadi, D., Pupillo, E., Syed, Z., Rabiee, M., Rabiee, N., Radfar, A., Rafiee, A., Raggi, A., Rahman, M., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Ram, P., Ramezanzadeh, K., Ranabhat, C., Rao, P. C., Rao, S. J., Rashedi, V., Rathi, P., Rawaf, D., Rawaf, S., Rawal, L., Rawassizadeh, R., Rawat, R., Razo, C., Redford, S., Reiner, R. C., Reitsma, M., Remuzzi, G., Renjith, V., Renzaho, A. N., Resnikoff, S., Rezaei, N., Rezaei, N., Rezapour, A., Rhinehart, P., Riahi, S., Ribeiro, D., Ribeiro, D., Rickard, J., Rivera, J. A., Roberts, N. S., Rodriguez-Ramirez, S., Roever, L., Ronfani, L., Room, R., Roshandel, G., Roth, G. A., Rothenbacher, D., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Saeedi, R., Moghaddam, S., Safari, Y., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sajadi, S., Salam, N., Salamati, P., Salem, H., Salem, M., Salimzadeh, H., Salman, O., Salomon, J. A., Samad, Z., Kafil, H., Sambala, E., Samy, A. M., Sanabria, J., Sanchez-Pimienta, T. G., Santomauro, D., Santos, I. S., Santos, J., Santric-Milicevic, M. M., Saraswathy, S., Sarmiento-Suarez, R., Sarrafzadegan, N., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Saxena, S., Schaeffer, L. E., Schiavolin, S., Schlaich, M. P., Schmidt, M., Schutte, A., Schwebel, D. C., Schwendicke, F., Senbeta, A., Senthilkumaran, S., Sepanlou, S. G., Serdar, B., Serre, M. L., Shadid, J., Shafaat, O., Shahabi, S., Shaheen, A. A., Shaikh, M., Shalash, A. S., Shams-Beyranvand, M., Shamsizadeh, M., Sharafi, K., Sheikh, A., Sheikhtaheri, A., Shibuya, K., Shield, K., Shigematsu, M., Il Shin, J., Shin, M., Shiri, R., Shirkoohi, R., Shuval, K., Siabani, S., Sierpinski, R., Sigfusdottir, I., Sigurvinsdottir, R., Silva, J., Simpson, K. E., Singh, J. A., Singh, P., Skiadaresi, E., Skou, S., Skryabin, V., Smith, E. R., Soheili, A., Soltani, S., Soofi, M., Sorensen, R. D., Soriano, J. B., Sorrie, M., Soshnikov, S., Soyiri, I. N., Spencer, C. N., Spotin, A., Sreeramareddy, C. T., Srinivasan, V., Stanaway, J. D., Stein, C., Stein, D. J., Steiner, C., Stockfelt, L., Stokes, M. A., Straif, K., Stubbs, J. L., Sufiyan, M., Suleria, H., Abdulkader, R., Sulo, G., Sultan, I., Szumowski, L., Tabares-Seisdedos, R., Tabb, K. M., Tabuchi, T., Taherkhani, A., Tajdini, M., Takahashi, K., Takala, J. S., Tamiru, A., Taveira, N., Tehrani-Banihashemi, A., Temsah, M., Tesema, G., Tessema, Z., Thurston, G. D., Titova, M., Tohidinik, H., Tonelli, M., Topor-Madry, R., Topouzis, F., Torre, A. E., Touvier, M., Tovani-Palone, M., Tran, B., Travillian, R., Tsatsakis, A., Car, L., Tyrovolas, S., Uddin, R., Umeokonkwo, C., Unnikrishnan, B., Upadhyay, E., Vacante, M., Valdez, P. R., van Donkelaar, A., Vasankari, T., Vasseghian, Y., Veisani, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S., Vos, T., Vukovic, R., Waheed, Y., Wallin, M., Wang, Y., Wang, Y., Watson, A., Wei, J., Wei, M., Weintraub, R. 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  Abstract

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

  View details for Web of Science ID 000579154000008

  View details for PubMedID 33069327

  View details for PubMedCentralID PMC7566194

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

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

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

  View details for Web of Science ID 000579154000009

  View details for PubMedID 32861314

  View details for PubMedCentralID PMC7562819

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

  Abstract

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

  View details for DOI 10.1097/QAI.0000000000002497

  View details for PubMedID 32925361

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

  Abstract

  Sustainable Development Goal (SDG) 3 aims to "ensure healthy lives and promote well-being for all at all ages". While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available.We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated.Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7·9 trillion (95% uncertainty interval 7·8-8·0) in 2017 and is expected to increase to $11·0 trillion (10·7-11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20·2 billion (17·0-25·0) and on tuberculosis it was $10·9 billion (10·3-11·8), and in malaria-endemic countries spending on malaria was $5·1 billion (4·9-5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019, $374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6-81·7) in 2015 to 83·1% (82·8-83·3) in 2030.Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed.The Bill & Melinda Gates Foundation.

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

  View details for Web of Science ID 000579138700029

  View details for PubMedID 32334655

  View details for PubMedCentralID PMC7180045

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

  Abstract

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

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

  View details for PubMedID 32891137

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

  Abstract

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

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

  View details for PubMedID 32827484

• Cost-effectiveness of post-treatment follow-up examinations and secondary prevention of tuberculosis in a high-incidence setting: a model-based analysis LANCET GLOBAL HEALTH Marx, F. M., Cohen, T., Menzies, N. A., Salomon, J. A., Theron, G., Yaesoubi, R. 2020; 8 (9): E1223–E1233

  View details for Web of Science ID 000577328800026

• Modeling Contact Tracing Strategies for COVID-19 in the Context of Relaxed Physical Distancing Measures. JAMA network open Bilinski, A., Mostashari, F., Salomon, J. A. 2020; 3 (8): e2019217

  View details for DOI 10.1001/jamanetworkopen.2020.19217

  View details for PubMedID 32821920

• Cost-effectiveness of first-line therapy for advanced renal cell carcinoma in the immunotherapy era. Parikh, D., Serrato, P., Srinivas, S., Ryckman, T., Salomon, J., Goldhaber-Fiebert, J. D. LIPPINCOTT WILLIAMS & WILKINS. 2020

  View details for Web of Science ID 000560368307310

• Population-Level Benefits of Extragenital Gonorrhea Screening among Men Who Have Sex with Men: An Exploratory Modeling Analysis. Sexually transmitted diseases Earnest, R., Ronn, M. M., Bellerose, M., Gift, T. L., Berruti, A. A., Hsu, K. K., Testa, C., Zhu, L., Malyuta, Y., Menzies, N. A., Salomon, J. A. 2020

  Abstract

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

  View details for DOI 10.1097/OLQ.0000000000001189

  View details for PubMedID 32355108

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

  Abstract

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

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

  View details for PubMedID 32286412

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

  View details for DOI 10.1093/cid/ciz383

  View details for Web of Science ID 000532686300022

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

  Abstract

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

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

  View details for PubMedID 32133577

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

  Abstract

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

  View details for DOI 10.1097/QAD.0000000000002502

  View details for PubMedID 32044844

• ESTIMATED MORTALITY RATES AMONG TREATED AND UNTREATED VETERANS WITH OPIOID USE DISORDER IN THE VETERANS HEALTH ADMINISTRATION Ching, J. H., Trafton, J. A., Goldhaber-Fiebert, J. D., Owens, D. K., Salomon, J. A. SAGE PUBLICATIONS INC. 2020: E105–E106

  View details for Web of Science ID 000509275600095

• Hepatitis C Management at Federally Qualified Health Centers during the Opioid Epidemic: A Cost-Effectiveness Study. The American journal of medicine Assoumou, S. A., Nolen, S. n., Hagan, L. n., Wang, J. n., Eftekhari Yazdi, G. n., Thompson, W. W., Mayer, K. H., Puro, J. n., Zhu, L. n., Salomon, J. A., Linas, B. P. 2020

  Abstract

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

  View details for DOI 10.1016/j.amjmed.2020.05.029

  View details for PubMedID 32603791

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

  Abstract

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

  View details for DOI 10.1093/cid/ciaa1558

  View details for PubMedID 33045075

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

  Abstract

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

  View details for DOI 10.1371/journal.pmed.1003077

  View details for PubMedID 32243443

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

  Abstract

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

  View details for DOI 10.1016/j.epidem.2020.100419

  View details for PubMedID 33242759

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

  Abstract

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

  View details for DOI 10.1097/QAI.0000000000002497

  View details for PubMedID 33177475

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

  Abstract

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

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

  View details for PubMedID 32972395

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

  Abstract

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

  View details for DOI 10.1097/OLQ.0000000000001249

  View details for PubMedID 32976353

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

  Abstract

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

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

  View details for PubMedID 32645277

• Partnering with Facebook on a university-based rapid turn-around global survey SURVEY RESEARCH METHODS Kreuter, F., Barkay, N., Bilinski, A., Bradford, A., Chiu, S., Eliat, R., Fan, J., Galili, T., Haimovich, D., Kim, B., LaRocca, S., Li, Y., Morris, K., Presser, S., Salomon, J. A., Sarig, T., Stewart, K., Stuart, E. A., Tibshirani, R. 2020; 14 (2): 159–62

  View details for DOI 10.18148/srm/2020.v14i2.7761

  View details for Web of Science ID 000539200900023

• ESTIMATION AND CORRECTION OF BIAS IN NETWORK SIMULATIONS BASED ON RESPONDENT-DRIVEN SAMPLING DATA Zhu, L., Menzies, N. A., Wang, J., Linas, B. P., Goodreau, S. M., Salomon, J. A. SAGE PUBLICATIONS INC. 2020: E297–E299

  View details for Web of Science ID 000509275600252

• AN AGENT-BASED NETWORK MODEL OF HEPATITIS C VIRUS TRANSMISSION AMONG PEOPLE WHO INJECT DRUGS CALIBRATED TO A HIGH-BURDEN RURAL POPULATION IN THE UNITED STATES Zhu, L., Havens, J. R., Rudolph, A. E., Young, A. M., Yazdi, G., Thompson, W. W., Hagan, L., Randall, L. M., Linas, B. P., Salomon, J. A. SAGE PUBLICATIONS INC. 2020: E262–E263

  View details for Web of Science ID 000509275600224

• ADAPTIVE GUIDELINES FOR THE TREATMENT OF GONORRHEA INFECTION TO INCREASE THE EFFECTIVE LIFESPAN OF ANTIBIOTICS IN THE CONTEXT OF RISING ANTIMICROBIAL RESISTANCE: A MATHEMATICAL MODELING STUDY Yaesoubi, R., Cohen, T., Hsu, K., Gift, T., Chesson, H., Salomon, J., Grad, Y. SAGE PUBLICATIONS INC. 2020: E289–E291

  View details for Web of Science ID 000509275600247

• COST-EFFECTIVENESS OF POST-TREATMENT FOLLOW-UP AND SECONDARY PREVENTION OF TUBERCULOSIS IN A HIGH-INCIDENCE SETTING - A MODEL-BASED ANALYSIS Marx, F., Cohen, T., Menzies, N., Salomon, J., Yaesoubi, R. SAGE PUBLICATIONS INC. 2020: E360–E361

  View details for Web of Science ID 000509275600302

• CALIBRATION TO CROSS-SECTIONAL DATA WHEN BIRTH COHORT TRENDS EXIST AS EXEMPLIFIED BY MODELS OF HEAVY DRINKING IN CHINA: CONSISTENCY WITH CALIBRATION TARGETS DESPITE MARKEDLY DIFFERENT PARAMETERS AND FUTURE PROJECTIONS Lee, K., Salomon, J. A., Goldhaber-Fiebert, J. D. SAGE PUBLICATIONS INC. 2020: E125–E126

  View details for Web of Science ID 000509275600110

• CALIBRATION TO CROSS-SECTIONAL DATA WHEN BIRTH COHORT TRENDS EXIST AS EXEMPLIFIED BY MODELS OF HEAVY DRINKING IN CHINA: CONSISTENCY WITH CALIBRATION TARGETS DESPITE MARKEDLY DIFFERENT PARAMETERS AND FUTURE PROJECTIONS Lee, K., Salomon, J., Goldhaber-Fiebert, J. D. SAGE PUBLICATIONS INC. 2020: E378–E379

  View details for Web of Science ID 000509275600315

• AGE- AND TIME-TRENDS IN HARMFUL ALCOHOL USE IN CHINA: PROJECTING BURDEN AND THE POTENTIAL FOR INTERVENTION BENEFIT Lee, K., Salomon, J., Goldhaber-Fiebert, J. D. SAGE PUBLICATIONS INC. 2020: E49–E50

  View details for Web of Science ID 000509275600053

• META-MODELLING FOR POLICY SIMULATIONS WITH MULTIVARIATE OUTCOMES Zhong, H., Yazdi, G., Wang, J., Nolen, S., Linas, B. P., Brandeau, M. L., Salomon, J. SAGE PUBLICATIONS INC. 2020: E69–E70

  View details for Web of Science ID 000509275600068

• Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 LANCET HIV Frank, T. D., Carter, A., Jahagirdar, D., Biehl, M. H., Douwes-Schultz, D., Larson, S., Arora, M., Dwyer-Lindgren, L., Steuben, K. M., Abbastabar, H., Abu-Raddad, L., Abyu, D., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adetokunboh, O. O., Ahmadi, A., Ahmadi, K., Ahmadian, E., Ahmadpour, E., Ahmed, M., Akal, C., Alahdab, F., Alam, N., Albertson, S. B., Alemnew, B. T., Alene, K., Alipour, V., Alvis-Guzman, N., Amini, S., Anbari, Z., Anber, N., Anjomshoa, M., Antonio, C. T., Arabloo, J., Aremu, O., Areri, H., Asfaw, E., Ashagre, A., Asmelash, D., Asrat, A. A., Avokpaho, E. A., Awasthi, A., Awoke, N., Ayanore, M., Azari, S., Badawi, A., Bagherzadeh, M., Banach, M., Barac, A., Barnighausen, T., Basu, S., Bedi, N., Behzadifar, M., Bekele, B., Belay, S., Belay, Y., Belayneh, Y., Berhane, A., Bhat, A., Bhattacharyya, K., Biadgo, B., Bijani, A., Bin Sayeed, M., Bitew, H., Blinov, A., Bogale, K., Bojia, H., Nagaraja, S., Butt, Z. A., Cahuana-Hurtado, L., Rincon, J., Carvalho, F., Chattu, V., Christopher, D. J., Chu, D., Crider, R., Dahiru, T., Dandona, L., Dandona, R., Daryani, A., das Neves, J., De Neve, J., Degenhardt, L., Demeke, F., Demis, A., Demissie, D., Demoz, G., Deribe, K., Des Jarlais, D., Dhungana, G., Diaz, D., Djalalinia, S., Huyen Phuc Do, Linh Phuong Doan, Duber, H., Dubey, M., Dubljanin, E., Duken, E., Adema, B., Effiong, A., Eftekhari, A., Zaki, M., El-Jaafary, S., El-Khatib, Z., Elsharkawy, A., Endries, A., Eskandarieh, S., Eyawo, O., Farzadfar, F., Fatima, B., Fentahun, N., Fernandes, E., Filip, I., Fischer, F., Folayan, M., Foroutan, M., Fukumoto, T., Fullman, N., Garcia-Basteiro, A. L., Gayesa, R., Gebremedhin, K., Gebremeskel, G., Gebreyohannes, K., Gedefaw, G., Gelaw, B. K., Gesesew, H., Geta, B., Gezae, K., Ghadiri, K., Ghashghaee, A., Ginindza, T. G., Gugnani, H., Guimares, R., Haile, M., Hailu, G., Haj-Mirzaian, A., Haj-Mirzaian, A., Hamidi, S., Handanagic, S., Handiso, D., Hanfore, L., Hasanzadeh, A., Hassankhani, H., Hassen, H., Hay, S., Henok, A., Chi Linh Hoang, Hosgood, H., Hosseinzadeh, M., Hsairi, M., Ibitoye, S., Idrisov, B., Ikuta, K. S., Ilesanmi, O., Irvani, S., Iwu, C., Jacobsen, K. H., James, S. L., Jenabi, E., Jha, R., Jonas, J. B., Shushtari, Z., Kabir, A., Kabir, Z., Kadel, R., Kasaeian, A., Kassa, B., Kassa, G., Kassa, T., Kayode, G. A., Kebede, M. M., Kefale, A., Kengne, A., Khader, Y., Khafaie, M., Khalid, N., Khan, E., Khan, G., Khan, J., Khang, Y., Khatab, K., Khazaei, S., Khoja, A. T., Kiadaliri, A. A., Kim, Y., Kisa, A., Kisa, S., Kochhar, S., Komaki, H., Koul, P. A., Koyanagi, A., Defo, B., Kumar, G., Kumar, M., Kuupiel, D., Lal, D., Lee, J., Lenjebo, T., Leshargie, C., Macarayan, E., Maddison, E. R., Abd El Razek, H., Magis-Rodriguez, C., Mahasha, P., Majdan, M., Majeed, A., Malekzadeh, R., Manafi, N., Mapoma, C., Martins-Melo, F., Masaka, A., Mayenga, E., Mehta, V., Meles, G., Meles, H., Melese, A., Melku, M., Memiah, P. N., Memish, Z. A., Mena, A., Mendoza, W., Mengistu, D., Mengistu, G., Meretoja, T. J., Mestrovic, T., Miller, T. R., Moazen, B., Mohajer, B., Mohamadi-Bolbanabad, A., Mohammad, K., Mohammad, Y., Darwesh, A., Mezerji, N., Mohammadi, M., Mohammadibakhsh, R., Mohammadoo-Khorasani, M., Mohammed, J., Mohammed, S., Mohebi, F., Mokdad, A. H., Moodley, Y., Moossavi, M., Moradi, G., Moradi-Lakeh, M., Moschos, M. M., Mossie, T., Mousavi, S., Muchie, K., Muluneh, A., Muriithi, M. K., Mustafa, G., Muthupandian, S., Nagarajan, A., Naik, G., Najafi, F., Nazari, J., Ndwandwe, D., Cuong Tat Nguyen, Huong Lan Thi Nguyen, Son Hoang Nguyen, Trang Huyen Nguyen, Ningrum, D., Nixon, M. R., Nnaji, C. A., Noroozi, M., Noubiap, J., Shiadeh, M., Obsa, M., Odame, E., Ofori-Asenso, R., Ogbo, F., Okoro, A., Oladimeji, O., Olagunju, A. T., Olagunju, T. O., Olum, S., Asante, K., Oren, E., Otstavnov, S. S., Mahesh, P. A., Padubidri, J., Pakhale, S., Pakpour, A. H., Patel, S., Paulos, K., Pepito, V., Peprah, E. K., Piroozi, B., Pourshams, A., Qorbani, M., Rabiee, M., Rabiee, N., Radfar, A., Rafay, A., Rafiei, A., Rahim, F., Rahimi-Movaghar, A., Rahimi-Movaghar, V., Rahman, S., Ranabhat, C., Rawaf, S., Reis, C., Renjith, V., Reta, M., Rezai, M., Rios Gonazlez, C., Roro, E., Rostami, A., Rubino, S., Moghaddam, S., Safari, S., Sagar, R., Sahraian, M., Salem, M., Salimi, Y., Salomon, J. A., Sambala, E., Samy, A. M., Sartorius, B., Satpathy, M., Sawhney, M., Sayyah, M., Schutte, A., Sepanlou, S. G., Seyedmousavi, S., Shabaninejad, H., Shaheen, A. A., Shaikh, M., Shallo, S., Shamsizadeh, M., Sharifi, H., Shibuya, K., Shin, J., Shirkoohi, R., Santos Silva, D., Alves Silveira, D., Singh, J. A., Sisay, M. M., Sisay, M., Sisay, S., Smith, A. E., Sokhan, A., Somayaji, R., Soshnikov, S., Stein, D. J., Sufiyan, M., Sunguya, B. F., Sykes, B. L., Tadesse, B., Tadesse, D., Tamirat, K., Taveira, N., Tekelemedhin, S., Temesgen, H., Tesfay, F., Teshale, M., Thapa, S., Tlaye, K., Topp, S. M., Tovani-Palone, M., Bach Xuan Tran, Khanh Bao Tran, Ullah, I., Unnikrishnan, B., Uthman, O. A., Veisani, Y., Vladimirov, S., Wada, F., Waheed, Y., Weldegwergs, K., Weldesamuel, G. T., Westerman, R., Wijeratne, T., Wolde, H., Wondafrash, D., Wonde, T., Wondmagegn, B., Yeshanew, A., Yilma, M., Yimer, E. M., Yonemoto, N., Yotebieng, M., Youm, Y., Yu, C., Zaidi, Z., Zarghi, A., Zenebe, Z., Zewale, T., Ziapour, A., Zodpey, S., Naghavi, M., Vollset, S., Wang, H., Lim, S. S., Kyu, H., L Murray, C. J., GBD 2017 HIV Collaborators 2019; 6 (12): E831–E859

  Abstract

  Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories.We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package-a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections.Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets.Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact.Bill & Melinda Gates Foundation, National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.

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

  View details for Web of Science ID 000500912300019

  View details for PubMedID 31439534

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

  Abstract

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

  View details for DOI 10.1097/QAI.0000000000002219

  View details for PubMedID 31764269

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

  Abstract

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

  View details for DOI 10.1016/j.drugpo.2019.10.006

  View details for PubMedID 31740175

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

  Abstract

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

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

  View details for PubMedID 31718615

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

  Abstract

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

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

  View details for PubMedID 31626560

• Open vs Laparoscopic vs Robotic Surgery for Rectal Cancer: A Cost-Effectiveness Analysis Chandler, J. M., Conway, A. A., Huckels, J., Pooni, R. K., Zarnett, L. J., Lee, K., Kin, C. J., Salomon, J. A., Owens, D. K. ELSEVIER SCIENCE INC. 2019: S67

  View details for Web of Science ID 000492740900109

• Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Ronn, M. M., Menzies, N. A., Gift, T. L., Chesson, H. W., Trikalinos, T. A., Bellerose, M., Malyuta, Y., Berruti, A., Gaydos, C. A., Hsu, K. K., Salomon, J. A. 2019

  Abstract

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

  View details for DOI 10.1093/cid/ciz519

  View details for PubMedID 31504314

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

  Abstract

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

  View details for DOI 10.1002/jia2.25336

  View details for PubMedID 31287625

• OPTIMIZING SCREENING FOR CHLAMYDIA: IS THERE A ROLE FOR SCREENING HETEROSEXUAL MEN? Ronn, M., Gift, T., Chesson, H., Malyuta, Y., Hsu, K., Salomon, J. BMJ PUBLISHING GROUP. 2019: A70

  View details for DOI 10.1136/sextrans-2019-sti.182

  View details for Web of Science ID 000506050100179

• HIV treatment cascade for older adults in rural South Africa. Sexually transmitted infections Rohr, J. K., Manne-Goehler, J., Gomez-Olive, F. X., Wagner, R. G., Rosenberg, M., Geldsetzer, P., Kabudula, C., Kahn, K., Tollman, S., Barnighausen, T., Salomon, J. A. 2019

  Abstract

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

  View details for DOI 10.1136/sextrans-2018-053925

  View details for PubMedID 31243144

• Depressive Symptoms and Their Relation to Age and Chronic Diseases Among Middle-Aged and Older Adults in Rural South Africa JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Geldsetzer, P., Vaikath, M., Wagner, R., Rohr, J. K., Montana, L., Gomez-Olive, F. X., Rosenberg, M. S., Manne-Goehler, J., Mateen, F. J., Payne, C. F., Kahn, K., Tollman, S. M., Salomon, J. A., Gaziano, T. A., Baernighausen, T., Berkman, L. F. 2019; 74 (6): 957–63

  View details for DOI 10.1093/gerona/gly145

  View details for Web of Science ID 000475713200028

• The Effect of HIV Self-Testing Delivery Models on Female Sex Workers' Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda AIDS AND BEHAVIOR Ortblad, K. F., Musoke, D., Ngabirano, T., Nakitende, A., Harling, G., Haberer, J. E., McConnell, M., Salomon, J. A., Oldenburg, C. E., Barnighausen, T. 2019; 23 (5): 1225–39

  View details for DOI 10.1007/s10461-019-02393-z

  View details for Web of Science ID 000467642000011

• The impact of Medicare part D on income-related inequality in pharmaceutical expenditure. International journal for equity in health Carvalho, N., Petrie, D., Chen, L., Salomon, J. A., Clarke, P. 2019; 18 (1): 57

  Abstract

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

  View details for PubMedID 30992000

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

  View details for DOI 10.1093/aje/kwy272

  View details for Web of Science ID 000467881700007

• Does Incident Circumcision Lead to Risk Compensation? Evidence From a Population Cohort in KwaZulu-Natal, South Africa JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES Ortblad, K. F., Harling, G., Chimbindi, N., Tanser, F., Salomon, J. A., Baernighausen, T. 2019; 80 (3): 269–75

  View details for DOI 10.1097/QAI.0000000000001912

  View details for Web of Science ID 000480762300009

• Short-Term Effects and Long-Term Cost-Effectiveness of Universal Hepatitis C Testing in Prenatal Care OBSTETRICS AND GYNECOLOGY Tasillo, A., Yazdi, G., Nolen, S., Schillie, S., Vellozzi, C., Epstein, R., Randall, L., Salomon, J. A. 2019; 133 (2): 289–300

  View details for DOI 10.1097/AOG.0000000000003062

  View details for Web of Science ID 000460488400009

• The Effect of HIV Self-Testing Delivery Models on Female Sex Workers' Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda. AIDS and behavior Ortblad, K. F., Kibuuka Musoke, D., Ngabirano, T., Nakitende, A., Harling, G., Haberer, J. E., McConnell, M., Salomon, J. A., Oldenburg, C. E., Barnighausen, T. 2019

  Abstract

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

  View details for PubMedID 30652205

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

  Abstract

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

  View details for PubMedID 30633134

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

  Abstract

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

  View details for PubMedID 30608525

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

  Abstract

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

  View details for DOI 10.1097/QAD.0000000000002437

  View details for PubMedID 31800403

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

  Abstract

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

  View details for DOI 10.1136/bmjgh-2018-001386

  View details for PubMedID 31423345

• Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study. JAMA oncology Fitzmaurice, C. n., Abate, D. n., Abbasi, N. n., Abbastabar, H. n., Abd-Allah, F. n., Abdel-Rahman, O. n., Abdelalim, A. n., Abdoli, A. n., Abdollahpour, I. n., Abdulle, A. S., Abebe, N. D., Abraha, H. N., Abu-Raddad, L. J., Abualhasan, A. n., Adedeji, I. A., Advani, S. M., Afarideh, M. n., Afshari, M. n., Aghaali, M. n., Agius, D. n., Agrawal, S. n., Ahmadi, A. n., Ahmadian, E. n., Ahmadpour, E. n., Ahmed, M. B., Akbari, M. E., Akinyemiju, T. n., Al-Aly, Z. n., AlAbdulKader, A. M., Alahdab, F. n., Alam, T. n., Alamene, G. M., Alemnew, B. T., Alene, K. A., Alinia, C. n., Alipour, V. n., Aljunid, S. M., Bakeshei, F. A., Almadi, M. A., Almasi-Hashiani, A. n., Alsharif, U. n., Alsowaidi, S. n., Alvis-Guzman, N. n., Amini, E. n., Amini, S. n., Amoako, Y. A., Anbari, Z. n., Anber, N. H., Andrei, C. L., Anjomshoa, M. n., Ansari, F. n., Ansariadi, A. n., Appiah, S. C., Arab-Zozani, M. n., Arabloo, J. n., Arefi, Z. n., Aremu, O. n., Areri, H. A., Artaman, A. n., Asayesh, H. n., Asfaw, E. T., Ashagre, A. F., Assadi, R. n., Ataeinia, B. n., Atalay, H. T., Ataro, Z. n., Atique, S. n., Ausloos, M. n., Avila-Burgos, L. n., Avokpaho, E. F., Awasthi, A. n., Awoke, N. n., Ayala Quintanilla, B. P., Ayanore, M. A., Ayele, H. T., Babaee, E. n., Bacha, U. n., Badawi, A. n., Bagherzadeh, M. n., Bagli, E. n., Balakrishnan, S. n., Balouchi, A. n., Bärnighausen, T. W., Battista, R. J., Behzadifar, M. n., Behzadifar, M. n., Bekele, B. B., Belay, Y. B., Belayneh, Y. M., Berfield, K. K., Berhane, A. n., Bernabe, E. n., Beuran, M. n., Bhakta, N. n., Bhattacharyya, K. n., Biadgo, B. n., Bijani, A. n., Bin Sayeed, M. S., Birungi, C. n., Bisignano, C. n., Bitew, H. n., Bjørge, T. n., Bleyer, A. n., Bogale, K. A., Bojia, H. A., Borzì, A. M., Bosetti, C. n., Bou-Orm, I. R., Brenner, H. n., Brewer, J. D., Briko, A. N., Briko, N. I., Bustamante-Teixeira, M. T., Butt, Z. A., Carreras, G. n., Carrero, J. J., Carvalho, F. n., Castro, C. n., Castro, F. n., Catalá-López, F. n., Cerin, E. n., Chaiah, Y. n., Chanie, W. F., Chattu, V. K., Chaturvedi, P. n., Chauhan, N. S., Chehrazi, M. n., Chiang, P. P., Chichiabellu, T. Y., Chido-Amajuoyi, O. G., Chimed-Ochir, O. n., Choi, J. J., Christopher, D. J., Chu, D. T., Constantin, M. M., Costa, V. M., Crocetti, E. n., Crowe, C. S., Curado, M. P., Dahlawi, S. M., Damiani, G. n., Darwish, A. H., Daryani, A. n., das Neves, J. n., Demeke, F. M., Demis, A. B., Demissie, B. W., Demoz, G. T., Denova-Gutiérrez, E. n., Derakhshani, A. n., Deribe, K. S., Desai, R. n., Desalegn, B. B., Desta, M. n., Dey, S. n., Dharmaratne, S. D., Dhimal, M. n., Diaz, D. n., Dinberu, M. T., Djalalinia, S. n., Doku, D. T., Drake, T. M., Dubey, M. n., Dubljanin, E. n., Duken, E. E., Ebrahimi, H. n., Effiong, A. n., Eftekhari, A. n., El Sayed, I. n., Zaki, M. E., El-Jaafary, S. I., El-Khatib, Z. n., Elemineh, D. A., Elkout, H. n., Ellenbogen, R. G., Elsharkawy, A. n., Emamian, M. H., Endalew, D. A., Endries, A. Y., Eshrati, B. n., Fadhil, I. n., Fallah, V. n., Faramarzi, M. n., Farhangi, M. A., Farioli, A. n., Farzadfar, F. n., Fentahun, N. n., Fernandes, E. n., Feyissa, G. T., Filip, I. n., Fischer, F. n., Fisher, J. L., Force, L. M., Foroutan, M. n., Freitas, M. n., Fukumoto, T. n., Futran, N. D., Gallus, S. n., Gankpe, F. G., Gayesa, R. T., Gebrehiwot, T. T., Gebremeskel, G. G., Gedefaw, G. A., Gelaw, B. K., Geta, B. n., Getachew, S. n., Gezae, K. E., Ghafourifard, M. n., Ghajar, A. n., Ghashghaee, A. n., Gholamian, A. n., Gill, P. S., Ginindza, T. T., Girmay, A. n., Gizaw, M. n., Gomez, R. S., Gopalani, S. V., Gorini, G. n., Goulart, B. N., Grada, A. n., Ribeiro Guerra, M. n., Guimaraes, A. L., Gupta, P. C., Gupta, R. n., Hadkhale, K. n., Haj-Mirzaian, A. n., Haj-Mirzaian, A. n., Hamadeh, R. R., Hamidi, S. n., Hanfore, L. K., Haro, J. M., Hasankhani, M. n., Hasanzadeh, A. n., Hassen, H. Y., Hay, R. J., Hay, S. I., Henok, A. n., Henry, N. J., Herteliu, C. n., Hidru, H. D., Hoang, C. L., Hole, M. K., Hoogar, P. n., Horita, N. n., Hosgood, H. D., Hosseini, M. n., Hosseinzadeh, M. n., Hostiuc, M. n., Hostiuc, S. n., Househ, M. n., Hussen, M. M., Ileanu, B. n., Ilic, M. D., Innos, K. n., Irvani, S. S., Iseh, K. R., Islam, S. M., Islami, F. n., Jafari Balalami, N. n., Jafarinia, M. n., Jahangiry, L. n., Jahani, M. A., Jahanmehr, N. n., Jakovljevic, M. n., James, S. L., Javanbakht, M. n., Jayaraman, S. n., Jee, S. H., Jenabi, E. n., Jha, R. P., Jonas, J. B., Jonnagaddala, J. n., Joo, T. n., Jungari, S. 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M., Sartorius, B. n., Sarveazad, A. n., Sathian, B. n., Satpathy, M. n., Savic, M. n., Sawhney, M. n., Sayyah, M. n., Schneider, I. J., Schöttker, B. n., Sekerija, M. n., Sepanlou, S. G., Sepehrimanesh, M. n., Seyedmousavi, S. n., Shaahmadi, F. n., Shabaninejad, H. n., Shahbaz, M. n., Shaikh, M. A., Shamshirian, A. n., Shamsizadeh, M. n., Sharafi, H. n., Sharafi, Z. n., Sharif, M. n., Sharifi, A. n., Sharifi, H. n., Sharma, R. n., Sheikh, A. n., Shirkoohi, R. n., Shukla, S. R., Si, S. n., Siabani, S. n., Silva, D. A., Silveira, D. G., Singh, A. n., Singh, J. A., Sisay, S. n., Sitas, F. n., Sobngwi, E. n., Soofi, M. n., Soriano, J. B., Stathopoulou, V. n., Sufiyan, M. B., Tabarés-Seisdedos, R. n., Tabuchi, T. n., Takahashi, K. n., Tamtaji, O. R., Tarawneh, M. R., Tassew, S. G., Taymoori, P. n., Tehrani-Banihashemi, A. n., Temsah, M. H., Temsah, O. n., Tesfay, B. E., Tesfay, F. H., Teshale, M. Y., Tessema, G. A., Thapa, S. n., Tlaye, K. G., Topor-Madry, R. n., Tovani-Palone, M. R., Traini, E. n., Tran, B. X., Tran, K. B., Tsadik, A. G., Ullah, I. n., Uthman, O. A., Vacante, M. n., Vaezi, M. n., Varona Pérez, P. n., Veisani, Y. n., Vidale, S. n., Violante, F. S., Vlassov, V. n., Vollset, S. E., Vos, T. n., Vosoughi, K. n., Vu, G. T., Vujcic, I. S., Wabinga, H. n., Wachamo, T. M., Wagnew, F. S., Waheed, Y. n., Weldegebreal, F. n., Weldesamuel, G. T., Wijeratne, T. n., Wondafrash, D. Z., Wonde, T. E., Wondmieneh, A. B., Workie, H. M., Yadav, R. n., Yadegar, A. n., Yadollahpour, A. n., Yaseri, M. n., Yazdi-Feyzabadi, V. n., Yeshaneh, A. n., Yimam, M. A., Yimer, E. M., Yisma, E. n., Yonemoto, N. n., Younis, M. Z., Yousefi, B. n., Yousefifard, M. n., Yu, C. n., Zabeh, E. n., Zadnik, V. n., Moghadam, T. Z., Zaidi, Z. n., Zamani, M. n., Zandian, H. n., Zangeneh, A. n., Zaki, L. n., Zendehdel, K. n., Zenebe, Z. M., Zewale, T. A., Ziapour, A. n., Zodpey, S. n., Murray, C. J. 2019

  Abstract

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

  View details for DOI 10.1001/jamaoncol.2019.2996

  View details for PubMedID 31560378

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

  Abstract

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

  View details for DOI 10.1097/OLQ.0000000000001108

  View details for PubMedID 31842089

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

  Abstract

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

  View details for DOI 10.1097/QAD.0000000000002437

  View details for PubMedID 31725434

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

  Abstract

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

  View details for PubMedID 30618461

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

  Abstract

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

  View details for PubMedID 31095676

• Multimorbidity and care for hypertension, diabetes and HIV among older adults in rural South Africa BULLETIN OF THE WORLD HEALTH ORGANIZATION Chang, A. Y., Gomez-Olive, X., Manne-Goehler, J., Wade, A. N., Tollman, S., Gaziano, T. A., Salomon, J. A. 2019; 97 (1): 10–23

  View details for DOI 10.2471/BLT.18.217000

  View details for Web of Science ID 000457332700012

• Modelling hospital operations: insight from using data from paper registries in the obstetrics ward at a hospital in Addis Ababa, Ethiopia. BMJ global health Bigelow, B. n., Desalegn, D. N., Salomon, J. A., Verguet, S. n. 2019; 4 (3): e001281

  Abstract

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

  View details for DOI 10.1136/bmjgh-2018-001281

  View details for PubMedID 31179031

  View details for PubMedCentralID PMC6528765

• Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. Nature Burstein, R. n., Henry, N. J., Collison, M. L., Marczak, L. B., Sligar, A. n., Watson, S. n., Marquez, N. n., Abbasalizad-Farhangi, M. n., Abbasi, M. n., Abd-Allah, F. n., Abdoli, A. n., Abdollahi, M. n., Abdollahpour, I. n., Abdulkader, R. S., Abrigo, M. R., Acharya, D. n., Adebayo, O. M., Adekanmbi, V. n., Adham, D. n., Afshari, M. n., Aghaali, M. n., Ahmadi, K. n., Ahmadi, M. n., Ahmadpour, E. n., Ahmed, R. n., Akal, C. G., Akinyemi, J. O., Alahdab, F. n., Alam, N. n., Alamene, G. M., Alene, K. A., Alijanzadeh, M. n., Alinia, C. n., Alipour, V. n., Aljunid, S. M., Almalki, M. J., Al-Mekhlafi, H. M., Altirkawi, K. n., Alvis-Guzman, N. n., Amegah, A. K., Amini, S. n., Amit, A. M., Anbari, Z. n., Androudi, S. n., Anjomshoa, M. n., Ansari, F. n., Antonio, C. A., Arabloo, J. n., Arefi, Z. n., Aremu, O. n., Armoon, B. n., Arora, A. n., Artaman, A. n., Asadi, A. n., Asadi-Aliabadi, M. n., Ashraf-Ganjouei, A. n., Assadi, R. n., Ataeinia, B. n., Atre, S. R., Quintanilla, B. P., Ayanore, M. A., Azari, S. n., Babaee, E. n., Babazadeh, A. n., Badawi, A. n., Bagheri, S. n., Bagherzadeh, M. n., Baheiraei, N. n., Balouchi, A. n., Barac, A. n., Bassat, Q. n., Baune, B. T., Bayati, M. n., Bedi, N. n., Beghi, E. n., Behzadifar, M. n., Behzadifar, M. n., Belay, Y. B., Bell, B. n., Bell, M. L., Berbada, D. A., Bernstein, R. S., Bhattacharjee, N. V., Bhattarai, S. n., Bhutta, Z. A., Bijani, A. n., Bohlouli, S. n., Breitborde, N. J., Britton, G. n., Browne, A. J., Nagaraja, S. B., Busse, R. n., Butt, Z. A., Car, J. n., Cárdenas, R. n., Castañeda-Orjuela, C. A., Cerin, E. n., Chanie, W. F., Chatterjee, P. n., Chu, D. T., Cooper, C. n., Costa, V. M., Dalal, K. n., Dandona, L. n., Dandona, R. n., Daoud, F. n., Daryani, A. n., Das Gupta, R. n., Davis, I. n., Davis Weaver, N. n., Davitoiu, D. V., De Neve, J. W., Demeke, F. M., Demoz, G. T., Deribe, K. n., Desai, R. n., Deshpande, A. n., Desyibelew, H. D., Dey, S. n., Dharmaratne, S. D., Dhimal, M. n., Diaz, D. n., Doshmangir, L. n., Duraes, A. R., Dwyer-Lindgren, L. n., Earl, L. n., Ebrahimi, R. n., Ebrahimpour, S. n., Effiong, A. n., Eftekhari, A. n., Ehsani-Chimeh, E. n., El Sayed, I. n., El Sayed Zaki, M. n., El Tantawi, M. n., El-Khatib, Z. n., Emamian, M. H., Enany, S. n., Eskandarieh, S. n., Eyawo, O. n., Ezalarab, M. n., Faramarzi, M. n., Fareed, M. n., Faridnia, R. n., Faro, A. n., Fazaeli, A. A., Fazlzadeh, M. n., Fentahun, N. n., Fereshtehnejad, S. M., Fernandes, J. C., Filip, I. n., Fischer, F. n., Foigt, N. A., Foroutan, M. n., Francis, J. M., Fukumoto, T. n., Fullman, N. n., Gallus, S. n., Gebre, D. G., Gebrehiwot, T. T., Gebremeskel, G. G., Gessner, B. D., Geta, B. n., Gething, P. W., Ghadimi, R. n., Ghadiri, K. n., Ghajarzadeh, M. n., Ghashghaee, A. n., Gill, P. S., Gill, T. K., Golding, N. n., Gomes, N. G., Gona, P. N., Gopalani, S. V., Gorini, G. n., Goulart, B. N., Graetz, N. n., Greaves, F. n., Green, M. S., Guo, Y. n., Haj-Mirzaian, A. n., Haj-Mirzaian, A. n., Hall, B. J., Hamidi, S. n., Haririan, H. n., Haro, J. M., Hasankhani, M. n., Hasanpoor, E. n., Hasanzadeh, A. n., Hassankhani, H. n., Hassen, H. Y., Hegazy, M. I., Hendrie, D. n., Heydarpour, F. n., Hird, T. R., Hoang, C. L., Hollerich, G. n., Rad, E. H., Hoseini-Ghahfarokhi, M. n., Hossain, N. n., Hosseini, M. n., Hosseinzadeh, M. n., Hostiuc, M. n., Hostiuc, S. n., Househ, M. n., Hsairi, M. n., Ilesanmi, O. S., Imani-Nasab, M. H., Iqbal, U. n., Irvani, S. S., Islam, N. n., Islam, S. M., Jürisson, M. n., Balalami, N. J., Jalali, A. n., Javidnia, J. n., Jayatilleke, A. U., Jenabi, E. n., Ji, J. S., Jobanputra, Y. B., Johnson, K. n., Jonas, J. B., Shushtari, Z. J., Jozwiak, J. J., Kabir, A. n., Kahsay, A. n., Kalani, H. n., Kalhor, R. n., Karami, M. n., Karki, S. n., Kasaeian, A. n., Kassebaum, N. J., Keiyoro, P. N., Kemp, G. R., Khabiri, R. n., Khader, Y. S., Khafaie, M. A., Khan, E. A., Khan, J. n., Khan, M. S., Khang, Y. H., Khatab, K. n., Khater, A. n., Khater, M. M., Khatony, A. n., Khazaei, M. n., Khazaei, S. n., Khazaei-Pool, M. n., Khubchandani, J. n., Kianipour, N. n., Kim, Y. J., Kimokoti, R. W., Kinyoki, D. K., Kisa, A. n., Kisa, S. n., Kolola, T. n., Kosen, S. n., Koul, P. A., Koyanagi, A. n., Kraemer, M. U., Krishan, K. n., Krohn, K. J., Kugbey, N. n., Kumar, G. A., Kumar, M. n., Kumar, P. n., Kuupiel, D. n., Lacey, B. n., Lad, S. D., Lami, F. H., Larsson, A. O., Lee, P. H., Leili, M. n., Levine, A. J., Li, S. n., Lim, L. L., Listl, S. n., Longbottom, J. n., Lopez, J. C., Lorkowski, S. n., Magdeldin, S. n., Abd El Razek, H. M., Abd El Razek, M. M., Majeed, A. n., Maleki, A. n., Malekzadeh, R. n., Malta, D. C., Mamun, A. A., Manafi, N. n., Manda, A. L., Mansourian, M. n., Martins-Melo, F. R., Masaka, A. n., Massenburg, B. B., Maulik, P. K., Mayala, B. K., Mazidi, M. n., McKee, M. n., Mehrotra, R. n., Mehta, K. M., Meles, G. G., Mendoza, W. n., Menezes, R. G., Meretoja, A. n., Meretoja, T. J., Mestrovic, T. n., Miller, T. R., Miller-Petrie, M. K., Mills, E. J., Milne, G. J., Mini, G. K., Mir, S. M., Mirjalali, H. n., Mirrakhimov, E. M., Mohamadi, E. n., Mohammad, D. K., Darwesh, A. M., Mezerji, N. M., Mohammed, A. S., Mohammed, S. n., Mokdad, A. H., Molokhia, M. n., Monasta, L. n., Moodley, Y. n., Moosazadeh, M. n., Moradi, G. n., Moradi, M. n., Moradi, Y. n., Moradi-Lakeh, M. n., Moradinazar, M. n., Moraga, P. n., Morawska, L. n., Mosapour, A. n., Mousavi, S. M., Mueller, U. O., Muluneh, A. G., Mustafa, G. n., Nabavizadeh, B. n., Naderi, M. n., Nagarajan, A. J., Nahvijou, A. n., Najafi, F. n., Nangia, V. n., Ndwandwe, D. E., Neamati, N. n., Negoi, I. n., Negoi, R. I., Ngunjiri, J. W., Thi Nguyen, H. L., Nguyen, L. H., Nguyen, S. H., Nielsen, K. R., Ningrum, D. N., Nirayo, Y. L., Nixon, M. R., Nnaji, C. A., Nojomi, M. n., Noroozi, M. n., Nosratnejad, S. n., Noubiap, J. J., Motlagh, S. N., Ofori-Asenso, R. n., Ogbo, F. A., Oladimeji, K. E., Olagunju, A. T., Olfatifar, M. n., Olum, S. n., Olusanya, B. O., Oluwasanu, M. M., Onwujekwe, O. E., Oren, E. n., Ortega-Altamirano, D. D., Ortiz, A. n., Osarenotor, O. n., Osei, F. B., Osgood-Zimmerman, A. E., Otstavnov, S. S., Owolabi, M. O., P A, M. n., Pagheh, A. S., Pakhale, S. n., Panda-Jonas, S. n., Pandey, A. n., Park, E. K., Parsian, H. n., Pashaei, T. n., Patel, S. K., Pepito, V. C., Pereira, A. n., Perkins, S. n., Pickering, B. V., Pilgrim, T. n., Pirestani, M. n., Piroozi, B. n., Pirsaheb, M. n., Plana-Ripoll, O. n., Pourjafar, H. n., Puri, P. n., Qorbani, M. n., Quintana, H. n., Rabiee, M. n., Rabiee, N. n., Radfar, A. n., Rafiei, A. n., Rahim, F. n., Rahimi, Z. n., Rahimi-Movaghar, V. n., Rahimzadeh, S. n., Rajati, F. n., Raju, S. B., Ramezankhani, A. n., Ranabhat, C. L., Rasella, D. n., Rashedi, V. n., Rawal, L. n., Reiner, R. C., Renzaho, A. M., Rezaei, S. n., Rezapour, A. n., Riahi, S. M., Ribeiro, A. I., Roever, L. n., Roro, E. M., Roser, M. n., Roshandel, G. n., Roshani, D. n., Rostami, A. n., Rubagotti, E. n., Rubino, S. n., Sabour, S. n., Sadat, N. n., Sadeghi, E. n., Saeedi, R. n., Safari, Y. n., Safari-Faramani, R. n., Safdarian, M. n., Sahebkar, A. n., Salahshoor, M. R., Salam, N. n., Salamati, P. n., Salehi, F. n., Zahabi, S. S., Salimi, Y. n., Salimzadeh, H. n., Salomon, J. A., Sambala, E. Z., Samy, A. M., Santric Milicevic, M. M., Jose, B. P., Saraswathy, S. Y., Sarmiento-Suárez, R. n., Sartorius, B. n., Sathian, B. n., Saxena, S. n., Sbarra, A. N., Schaeffer, L. E., Schwebel, D. C., Sepanlou, S. G., Seyedmousavi, S. n., Shaahmadi, F. n., Shaikh, M. A., Shams-Beyranvand, M. n., Shamshirian, A. n., Shamsizadeh, M. n., Sharafi, K. n., Sharif, M. n., Sharif-Alhoseini, M. n., Sharifi, H. n., Sharma, J. n., Sharma, R. n., Sheikh, A. n., Shields, C. n., Shigematsu, M. n., Shiri, R. n., Shiue, I. n., Shuval, K. n., Siddiqi, T. J., Silva, J. P., Singh, J. A., Sinha, D. N., Sisay, M. M., Sisay, S. n., Sliwa, K. n., Smith, D. L., Somayaji, R. n., Soofi, M. n., Soriano, J. B., Sreeramareddy, C. T., Sudaryanto, A. n., Sufiyan, M. B., Sykes, B. L., Sylaja, P. N., Tabarés-Seisdedos, R. n., Tabb, K. M., Tabuchi, T. n., Taveira, N. n., Temsah, M. H., Terkawi, A. S., Tessema, Z. T., Thankappan, K. R., Thirunavukkarasu, S. n., To, Q. G., Tovani-Palone, M. R., Tran, B. X., Tran, K. B., Ullah, I. n., Usman, M. S., Uthman, O. A., Vahedian-Azimi, A. n., Valdez, P. R., van Boven, J. F., Vasankari, T. J., Vasseghian, Y. n., Veisani, Y. n., Venketasubramanian, N. n., Violante, F. S., Vladimirov, S. K., Vlassov, V. n., Vos, T. n., Vu, G. T., Vujcic, I. S., Waheed, Y. n., Wakefield, J. n., Wang, H. n., Wang, Y. n., Wang, Y. P., Ward, J. L., Weintraub, R. G., Weldegwergs, K. G., Weldesamuel, G. T., Westerman, R. n., Wiysonge, C. S., Wondafrash, D. Z., Woyczynski, L. n., Wu, A. M., Xu, G. n., Yadegar, A. n., Yamada, T. n., Yazdi-Feyzabadi, V. n., Yilgwan, C. S., Yip, P. n., Yonemoto, N. n., Lebni, J. Y., Younis, M. Z., Yousefifard, M. n., Yousof, H. S., Yu, C. n., Yusefzadeh, H. n., Zabeh, E. n., Moghadam, T. Z., Bin Zaman, S. n., Zamani, M. n., Zandian, H. n., Zangeneh, A. n., Zerfu, T. A., Zhang, Y. n., Ziapour, A. n., Zodpey, S. n., Murray, C. J., Hay, S. I. 2019; 574 (7778): 353–58

  Abstract

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

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

  View details for PubMedID 31619795

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

  Abstract

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

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

  View details for Web of Science ID 000451086800036

  View details for PubMedID 30392731

  View details for PubMedCentralID PMC6251968

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

  Abstract

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

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

  View details for Web of Science ID 000450899900030

  View details for PubMedID 30507459

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

  Abstract

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

  View details for PubMedID 30531298

• Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries LANCET Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., Garcia-Saiso, S., Salomon, J. A. 2018; 392 (10160): 2203–12

  View details for DOI 10.1016/S0140-6736(18)31430-2

  View details for Web of Science ID 000450358900032

• Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries (vol 392, pg 2203, 2018) LANCET Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., Garcia-Saiso, S., Salomon, J. A. 2018; 392 (10160): 2170

  View details for DOI 10.1016/S0140-6736(18)31668-4

  View details for Web of Science ID 000450358900025

• Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Stanaway, J. D., Afshin, A., Gakidou, E., Lim, S. S., Abate, D., Abate, K., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdollahpour, I., Abdulkader, R., Abebe, M., Abebe, Z., Abera, S. F., Abil, O., Abraha, H., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N. E., Accrombessi, M., Acharya, D., Acharya, P., Adamu, A. A., Adane, A., Adebayo, O. M., Adedoyin, R., Adekanmbi, V., Ademi, Z., Adetokunboh, O., Adib, M. G., Admasie, A., Adsuar, J. C., Afanvi, K., Afarideh, M., Agarwal, G., Aggarwal, A., Aghayan, S., Agrawal, A., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmadieh, H., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Akbari, M., Akinyemiju, T., Akseer, N., Al-Aly, Z., Al-Eyadhy, A., Al-Mekhlafi, H. M., Alandab, F., Alam, K., Alam, S., Alam, T., Alashi, A., Alavian, S., Alene, K., Ali, K., Ali, S., Alijanzadeh, M., Alizadeh-Navaei, R., Aljunid, S., Alkerwi, A., Alla, F., Alsharif, U., Altirkawi, K., Alvis-Guzman, N., Amare, A. T., Ammar, W., Anber, N., Anderson, J. A., Andrei, C., Androudi, S., Animut, M., Anjomshoa, M., Ansha, M., Anto, J. M., Antonio, C. T., Anwari, P., Appiah, L., Appiah, S., Arabloo, J., Aremu, O., Amlov, J., Artaman, A., Aryal, K. K., Asayesh, H., Ataro, Z., Ausloos, M., Avokpaho, E. A., Awasthi, A., Quintanilla, B., Ayer, R., Ayuk, T. B., Azzopardi, P. S., Babazadeff, A., Badali, H., Badawi, A., Balakrishnan, K., Bali, A., Ball, K., Bellew, S. H., Banach, M., Banoub, J., Barac, A., Barker-Collo, S., Bamighausen, T., Barrero, L. H., Basu, S., Baune, B. T., Bazargan-Hejazi, S., Bedi, N., Beghi, E., Behzadifar, M., Behzadifar, M., Bejoy, Y., Bekele, B., Bekru, F., Belay, E., Belay, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Bergeron, G., Berhane, A., Bemabe, E., Bemstein, R. S., Beuran, M., Beyranvand, T., Bhala, N., Bhalla, A., Bhattarai, S., Bhutta, Z. A., Biadgo, B., Bijani, A., Bikbov, B., Bilano, V., Bililign, N., Bin Sayeed, M., Bisanzio, D., Biswas, T., Bjorge, T., Blacker, B. F., Bleyer, A., Borschmann, R., Bou-Orm, I. R., Boufous, S., Bourne, R., Brady, O. J., Brauer, M., Brazinova, A., Breitborde, N. K., Brenner, H., Briko, A., Britton, G., Brugha, T., Buchbindet, R., Burnett, R. T., Busse, R., Butt, Z. A., Cahill, L. E., Cahuana-Hurtado, L., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaneda-Orjuela, C. A., Rivas, J., Castro, F., Catala-Lopez, F., Causey, K., Cercy, K. M., Cerin, E., Chaiah, Y., Chang, H., Chang, J., Chang, K., Charlson, F. J., Chattopadhyay, A., Chattu, V., Chee, M., Cheng, C., Chew, A., Chiang, P., Chimed-Ochir, O., Chin, K., Chitheer, A., Choi, J. J., Chowdhury, R., Christensen, H., Christopher, D. J., Chung, S., Cicuttini, F. M., Grillo, M., Cohen, A. J., Collado-Mateo, D., Cooper, C., Cooper, O. R., Coresh, J., Cornaby, L., Cortesi, P., Cortinovis, M., Costa, M., Cousin, E., Criqui, M. H., Cromwell, E. A., Cundiff, D. K., Daba, A., Dachew, B., Dadi, A., Damasceno, A., Dandona, L., Dandona, R., Darby, S. C., Dargan, P. I., Daryani, A., Das Gupta, R., Das Neves, J., Dasa, T., Dash, A., Davitoiu, D., Davletov, K., De la Cruz-Gongora, V., De la Hoz, F., De Leo, D., De Neve, J., Degenhardt, L., Deiparine, S., Dellavalle, R. P., Demoz, G., Denova-Gutierrez, E., Deribe, K., Dervenis, N., Deshpande, A., Jarlais, D., Dessie, G., Deveber, G., Dey, S., Dharmaratne, S., Dhimal, M., Dinberu, M., Ding, E. L., Diro, H., Djalalinia, S., Huyen Phoc Do, Dokova, K., Doku, D., La Doyle, K., Driscoll, T. R., Dubey, M., Dubljanin, E., Duken, E., Duncan, B. B., Duraes, A. R., Ebert, N., Ebrahimi, H., Ebrahimpour, S., Edvardsson, D., Elfiong, A., Eggen, A., El Bcheraoui, C., El-Khatib, I., Elyazar, I., Enayati, A., Endries, A., Er, B., Erskine, H. E., Eskandarieh, S., Esteghamati, A., Estep, K., Fakhim, H., Faramarzi, M., Fareed, M., Farid, T. A., Farinha, C., Farioli, A., Faro, A., Farvid, M. S., Farzaei, M., Fatima, B., Fay, K. A., Fazaeli, A., Feigin, V. L., Feigl, A. B., Fereshtehnejad, S., Fernandes, E., Fernandes, J. C., Ferrara, G., Ferrari, A. J., Ferreira, M. L., Filip, I., Finger, J., Fischer, F., Foigt, N. A., Foreman, K. J., Fukumoto, T., Fullman, N., Furst, T., Furtado, J. M., Futran, N. D., Gall, S., Gallus, S., Gamkrelidze, A., Ganji, M., Garcia-Basteiro, A. L., Gardner, W., Gebre, A., Gebremedhin, A., Gebremichael, T., Gelano, T., Geleijnse, J. M., Geramo, Y., Gething, P. W., Geese, K., Ghadimi, R., Ghadiri, K., Falavarjani, K., Ghasemi-Kasman, M., Ghimire, M., Ghosh, R., Ghoshal, A., Giampaoli, S., Gill, P., Gill, T. K., Gillum, R. F., Ginawi, I., Giussani, G., Gnedovskaya, E. V., Godwin, W. W., Goli, S., Gomez-Dantes, H., Gona, P. N., Gopalani, S., Goulart, A. C., Grada, A., Grams, M. E., Grosso, G., Gugnani, H., Guo, Y., Gupta, R., Gupta, R., Gupta, T., Gutierrez, R., Gutierrez-Torres, D. S., Haagsma, J. A., Habtewold, T., Hachinski, V., Hafezi-Nejad, N., Hagos, T. B., Hailegiyorgis, T., Hailu, G., Haj-Mirzaian, A., Haj-Mirzaian, A., Hamadeh, R. R., Hamidi, S., Handal, A. J., Hankey, G. J., Liao, Y., Harb, H. L., Harikrishnan, S., Haro, J., Hassankhani, H., Hassen, H., Havmoeller, R., Hawley, C. N., Hay, S. I., Hedayatizadeh-Omran, A., Heibati, B., Heidari, B., Heidari, M., Hendrie, D., Henok, A., Heredia-Pi, I., Herteliu, C., Heydarpour, F., Heydarpour, S., Hibstu, D. T., Higazi, T. B., Hilawe, E., Hoek, H. W., Hoffiman, H. J., Hole, M. K., Rad, E., Hoogar, P., Hosgood, H., Hosseini, S., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Hoy, D. G., Hsairi, M., Hsiao, T., Hu, G., Ha, H., Huang, J. J., Hussen, M., Huynh, C. K., Iburg, K., Ikeda, N., Ilesanmi, O., Iqbal, U., Irvani, S., Irvine, C., Islam, S., Islami, F., Jackson, M. D., Jacobsen, K. H., Jahangiry, L., Jahanmehr, N., Jain, S., Jakovljevic, M., James, S. L., Jassal, S. K., Jayatilleke, A., Jeemon, P., Jha, R., Jha, V., Ji, J. S., Jonas, J. B., Jonnagaddala, J., Shushtari, Z., Joshi, A., Jozwiak, J., Jurisson, M., Kabir, Z., Kahsay, A., Kalani, R., Kanchan, T., Kant, S., Kar, C., Karami, M., Matin, B., Karch, A., Karema, C., Karimi, N., Karimi, S. M., Kasaeian, A., Kassa, D. H., Kassa, G., Kassa, T., Kassebaum, N. J., Katikireddi, S., Kaul, A., Kawakami, N., Kazemi, Z., Karyani, A., Kefale, A., Keiyoro, P., Kemp, G., Kengne, A., Keren, A., Kesavachandran, C., Khader, Y., Khafaei, B., Khafaie, M., Khajavi, A., Khalid, N., Khalil, I. A., Khan, G., Khan, M., Khan, M., Khang, Y., Khater, M. M., Khazaei, M., Khazaie, H., Khoja, A. T., Khosravi, A., Khosravi, M., Kiadaliri, A. A., Kiirithio, D. N., Kim, C., Kim, D., Kim, Y., Kim, Y., Kimokoti, R. W., Kinfh, Y., Kisa, A., Kissimova-Skarbek, K., Kivimaki, M., Knibbs, L. D., Knudsen, A., Kochhar, S., Kokubo, Y., Kolola, T., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Kravchenko, M. A., Krishan, K., Krohn, K. J., Kromhout, H., Defo, B., Bicer, B., Kumar, G., Kumar, M., Kuzin, I., Kyu, H., Lachat, C., Lad, D. P., Lad, S. D., Lafranconi, A., Lalloo, R., Lallukka, T., Lami, F., Lang, J. J., Lansingh, V. C., Larson, S., Latifi, A., Lazarus, J. V., Lee, P. 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  View details for DOI 10.1016/S0140-6736(18)32225-6

  View details for Web of Science ID 000449710900007

• Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Murray, C. L., Callender, C. H., Kulikoff, X., Srinivasan, V., Abate, D., Abate, K., Abay, S. M., Abbasi, N., Abbastabar, H., Abdela, J., Abdelalim, A., Abdel-Rahman, O., Abdi, A., Abdoli, N., Abdollahpour, I., Abdulkader, R., Abebe, H., Abebe, M., Abebe, Z., Abebo, T., Abejie, A., Aboyans, V., Abraha, H., Abreu, D., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N. E., Accrombessi, M., Acharya, P., Adamu, A. A., Adebayo, O. M., Adedeji, I., Adekanmbi, V., Adetokunboh, O. O., Adhena, B., Adhikari, T., Adib, M. C., Adou, A., Adsuar, J. C., Afarideh, M., Afshin, A., Agarwal, G., Agesa, K. M., Aghayan, S., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmed, M., Ahmed, S., Aichour, A., Aichour, I., Aichour, M., Akanda, A. S., Akbari, M., Akibu, M., Akinyemi, R., Akinyemiju, T., Akseer, N., Alahdab, F., Al-Aly, Z., Alam, K., Alebel, A., Aleman, A. V., Alene, K., Al-Eyadhy, A., Ali, R., Alijanzadeh, M., Alizadeh-Navaei, R., Aljunid, S., Alkerwi, A., Alla, F., Allebeck, P., Almasi, A., Alonso, J., Al-Raddadi, R. M., Alsharif, U., Altirkawi, K., Alvis-Guzman, N., Amare, A. T., Ammar, W., Anber, N., Andrei, C., Androudi, S., Animut, M., Ansari, H., Ansha, M., Antonio, C. T., Appiah, S., Aremu, O., Areri, H., Arian, N., Arnlov, J., Artaman, A., Aryal, K. K., Asayesh, H., Asfaw, E., Asgedom, S., Assadi, R., Atey, T., Afique, S., Atteraya, M., Ausloos, M., Avokpaho, E. A., Awasthi, A., Quintanilla, B., Ayele, Y., Ayer, R., Ayuk, T. B., Azzopardi, P. S., Babalola, T., Babazadeh, A., Radali, H., Badawi, A., Bali, A., Ranach, M., Barker-Collo, S., Barnighausen, T., Barrero, L. H., Basaleem, H., Bassat, Q., Basu, A., Baune, B. 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  View details for DOI 10.1016/S0140-6736(18)32278-5

  View details for Web of Science ID 000449710900008

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  Abstract

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

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

  View details for Web of Science ID 000449710900006

  View details for PubMedID 30415748

  View details for PubMedCentralID PMC6252083

• Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017 LANCET Lozano, R., Fullman, N., Abate, D., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdel-Rahman, O., Abdi, A., Abdollahpour, I., Abdulkader, R., Abebe, N., Abebe, Z., Abejie, A., Abera, S. P., Abil, O., Aboyans, V., Abraha, H., Abrham, A., Abu-Raddad, L., Abu-Rmeileh, N., Abyu, G. Y., Accrombessi, M., Acharya, D., Acharya, P., Adamu, A. A., Adebayo, O. M., Adedeji, I., Adedoyin, R., Adekanmbi, V., Adetokunboh, O., Adhena, B., Adhikari, T., Adib, M. G., Adou, A., Adsuar, J. C., Afarideh, M., Afshari, M., Afshin, A., Agarwal, G., Aghayan, S., Agius, D., Agrawal, A., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmadieh, F., Ahmed, M., Ahmed, S., Akalu, T., Akanda, A. S., Akbari, M., Akibu, M., Akinyemi, R., Akinyemiju, T., Akseer, N., Alandab, T., Al-Aly, Z., Alam, K., Alam, T., Abujeer, A., Alebel, A., Alene, K., Al-Eyadhy, A., Athabib, S., Ali, R., Alijanzadeh, M., Alizadeh-Nayaei, R., Aljunid, S., Alkerwi, A., Alla, F., Allebeck, P., Allen, C. A., Almasi, A., Al-Maskari, F., Al-Mekhlafi, H. M., Alonso, J., Al-Raddadi, R. M., Alsharif, U., Altirkawi, K., Alvis-Guzman, N., Amare, A. T., Amenu, K., Amini, E., Ammar, W., Anber, N., Anderson, J. A., Andrei, C., Androudi, S., Animut, M., Anjomshoa, M., Ansari, H., Ansariadi, A., Ansha, M., Antonio, C. T., Anwari, P., Appiah, L., Aremu, O., Areri, H., Arnlov, J., Arora, M., Aryal, K. K., Asayesh, H., Asfaw, E., Asgedom, S., Asghar, R., Assadi, R., Ataro, Z., Atique, S., Atre, S. R., Atteraya, M., Ausloos, M., Avila-Burgos, L., Avokpaho, E. A., Awasthi, A., Quintanilla, B., Ayele, H., Ayele, Y., Ayer, R., Azarpazhooh, M., Azzopardi, P. 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  View details for DOI 10.1016/S0140-6736(18)32281-5

  View details for Web of Science ID 000449710900010

• Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 LANCET James, S. G., Abate, D., Abate, K., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdollahpour, I., Abdulkader, R., Abebe, Z., Abera, S. F., Abil, O., Abraha, H., Abu-Raddad, L., Abu-Rmeileh, N. E., Accrombessi, M., Acharya, D., Acharya, P., Ackerman, I. N., Adamu, A. A., Adebayo, O. M., Adekanmbi, V., Adetokunboh, O. O., Adib, M. G., Adsuar, J. C., Afanvi, K., Afarideh, M., Afshin, A., Agarwal, G., Agesa, K. M., Aggarwal, R., Aghayan, S., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmadieh, H., Ahmed, M., Aichour, A., Aichour, I., Aichour, M., Akinyemiju, T., Akseer, N., Al-Aly, Z., Al-Eyadhy, A., Al-Mekhlafi, H. M., Al-Raddadi, R. 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J., Weldegebreal, F., Weldegwergs, K., Werdecker, A., West, T., Whiteford, H. A., Widecka, J., Wijeratne, T., Wilner, L. B., Wilson, S., Winkler, A., Wiyeh, A. B., Wiysonge, C., Wolfe, C. A., Woolf, A. D., Wu, S., Wu, Y., Wyper, G. A., Xavier, D., Xu, G., Yadgir, S., Yadollahpour, A., Jabbari, S., Yamada, T., Yan, L. L., Yano, Y., Yaseri, M., Yasin, Y., Yeshaneh, A., Yimer, E. M., Yip, P., Yisma, E., Yonemoto, N., Yoon, S., Yotebieng, M., Younis, M. Z., Yousefifard, M., Yu, C., Zadnik, V., Zaidi, Z., Bin Zaman, S., Zamani, M., Zare, Z., Zeleke, A., Zenebe, Z., Zhang, K., Zhao, Z., Zhou, M., Zodpey, S., Zucker, I., Vos, T., Murray, C. L., GBD 2017 Dis Injury Incidence Pr 2018; 392 (10159): 1789–1858

  View details for DOI 10.1016/S0140-6736(18)32279-7

  View details for Web of Science ID 000449710900005

• Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016 LANCET INFECTIOUS DISEASES Troeger, C., Blacker, B. F., Khalil, I. A., Rao, P. C., Cao, S., Zimsen, S. M., Albertson, S., Stanaway, J. D., Deshpande, A., Brown, A., Abebe, Z., Alvis-Guzman, N., Amare, A. T., Asgedom, S., Alamrew Anteneh, Z., Antonio, C. T., Aremu, O., Asfaw, E., Atey, T., Atique, S., Avokpaho, E., Awasthi, A., Ayele, H., Barac, A., Barreto, M. L., Bassat, Q., Belay, S., Bensenor, I. M., Bhutta, Z. A., Bijani, A., Bizuneh, H., Castaneda-Orjuela, C. A., Dadi, A., Dandona, L., Dandona, R., Huyen Phuc Do, Dubey, M., Dubljanin, E., Edessa, D., Endries, A., Eshrati, B., Farag, T., Feyissa, G., Foreman, K. J., Forouzanfar, M. H., Fullman, N., Gething, P. W., Gishu, M., Godwin, W. W., Gugnani, H., Gupta, R., Hailu, G., Hassen, H., Hibstu, D., Ilesanmi, O. S., Jonas, J. B., Kahsay, A., Kang, G., Kasaeian, A., Khader, Y., Khan, E., Khan, M., Khang, Y., Kissoon, N., Kochhar, S., Kotloff, K. L., Koyanagi, A., Kumar, G., Abd El Razek, H., Malekzadeh, R., Malta, D., Mehata, S., Mendoza, W., Mengistu, D., Menota, B., Mezgebe, H., Mlashu, F., Murthy, S., Naik, G. A., Cuong Tat Nguyen, Trang Huyen Nguyen, Ningrum, D., Ogbo, F., Olagunju, A., Paudel, D., Platts-Mills, J. A., Qorbani, M., Rafay, A., Rai, R., Rana, S. M., Ranabhat, C., Rasella, D., Ray, S. E., Reis, C., Renzaho, A. N., Rezai, M., Ruhago, G., Safiri, S., Salomon, J. A., Sanabria, J., Sartorius, B., Sawhney, M., Sepanlou, S. G., Shigematsu, M., Sisay, M., Somayaji, R., Sreeramareddy, C. T., Sykes, B. L., Taffere, G., Topor-Madry, R., Bach Xuan Tran, Tuem, K., Ukwaja, K., Vollset, S., Walson, J. L., Weaver, M. R., Weldegwergs, K., Werdecker, A., Workicho, A., Yenesew, M., Yirsaw, B., Yonemoto, N., Zaki, M., Vos, T., Lim, S. S., Naghavi, M., Murray, C. L., Mokdad, A. H., Hay, S. I., Reiner, R. C., GBD 2016 Diarrhoeal Dis Collabora 2018; 18 (11): 1211–28

  Abstract

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

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

  View details for Web of Science ID 000448325300031

  View details for PubMedID 30243583

  View details for PubMedCentralID PMC6202444

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

  Abstract

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

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

  View details for Web of Science ID 000448325300030

  View details for PubMedID 30243584

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

  Abstract

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

  View details for PubMedID 30248277

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

  Abstract

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

  View details for PubMedID 30272631

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

  Abstract

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

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

  View details for Web of Science ID 000445098800025

  View details for PubMedID 30146330

  View details for PubMedCentralID PMC6148333

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

  View details for PubMedID 30196093

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

  Abstract

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

  View details for PubMedID 30195398

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

  Abstract

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

  View details for PubMedID 29762657

  View details for PubMedCentralID PMC6119121

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

  View details for PubMedID 29847478

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

  Abstract

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

  View details for PubMedID 29420742

  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 PubMedID 30012266

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

  View details for PubMedID 30064672

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

  Abstract

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

  View details for PubMedID 29653698

  View details for PubMedCentralID PMC6070419

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

  Abstract

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

  View details for PubMedID 29970074

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

  Abstract

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

  View details for PubMedID 29939214

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

  Abstract

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

  View details for DOI 10.1097/OLQ.0000000000000876

  View details for PubMedID 29894368

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

  Abstract

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

  View details for PubMedID 29879167

• Feasibility of a Health-Utility Approach to Quantifying Noneconomic Losses from Personal Injury JOURNAL OF EMPIRICAL LEGAL STUDIES Carvalho, N., Fish, D., Grant, G. M., Salomon, J. A., Studdert, D. M. 2018; 15 (2): 278–319

  View details for Web of Science ID 000431655600002

• 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-+

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

  Abstract

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

  View details for PubMedID 29634829

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

  Abstract

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

  View details for PubMedID 29472018

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

  Abstract

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

  View details for PubMedID 29561843

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

  Abstract

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

  View details for PubMedID 29020343

  View details for PubMedCentralID PMC5881674

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

  Abstract

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

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

  View details for PubMedID 29893224

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

  Abstract

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

  View details for PubMedID 29641820

  View details for PubMedCentralID PMC6145754

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

  Abstract

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

  View details for PubMedID 30566506

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

  Abstract

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

  View details for PubMedID 30554997

• Inference With Difference-in-Differences With a Small Number of Groups A Review, Simulation Study, and Empirical Application Using SHARE Data MEDICAL CARE Rokicki, S., Cohen, J., Fink, G., Salomon, J. A., Landrum, M. 2018; 56 (1): 97–105

  View details for Web of Science ID 000429128000016

• The Optimal Age for Screening Adolescents and Young Adults Without Identified Risk Factors for HIV JOURNAL OF ADOLESCENT HEALTH Neilan, A. M., Dunville, R., Ocfemia, M., Salomon, J. A., Francke, J. A., Bulteel, A. B., Wang, L., Hsu, K. K., DiNenno, E. A., Walensky, R. P., Parker, R. A., Freedberg, K. A., Ciaranello, A. L. 2018; 62 (1): 22–28

  Abstract

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

  View details for PubMedID 29273141

  View details for PubMedCentralID PMC5745059

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

  Abstract

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

  View details for PubMedID 29304947

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

  Abstract

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

  View details for PubMedID 29281995

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

  Abstract

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

  View details for PubMedID 29200354

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

  View details for PubMedID 28983565

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

  Abstract

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

  View details for PubMedID 29049814

  View details for PubMedCentralID PMC5808933

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

  Abstract

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

  View details for PubMedID 29112050

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

  Abstract

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

  View details for PubMedID 28968710

  View details for PubMedCentralID PMC5853443

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

  Abstract

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

  View details for PubMedID 29025634

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

  Abstract

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

  View details for PubMedID 29150535

  View details for PubMedCentralID PMC5777525

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

  Abstract

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

  View details for PubMedID 29077762

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

  Abstract

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

  View details for PubMedID 28968399

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

  Abstract

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

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

  View details for Web of Science ID 000410630000002

  View details for PubMedID 28919115

  View details for PubMedCentralID PMC5605514

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

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

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

  View details for Web of Science ID 000410630000006

  View details for PubMedID 28919119

  View details for PubMedCentralID PMC5614451

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

  Abstract

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

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

  View details for Web of Science ID 000410630000003

  View details for PubMedID 28919116

  View details for PubMedCentralID PMC5605883

• Improving Vignette Descriptions and Question Formats to Measure Distance Vision: Evidence from Cognitive Interviews among Students in China FIELD METHODS Su, Y., Willis, G., Salomon, J. A. 2017; 29 (3): 175–93

  View details for DOI 10.1177/1525822X16680810

  View details for Web of Science ID 000405577800001

• Performance of self-reported HIV status in determining true HIV status among older adults in rural South Africa: a validation study JOURNAL OF THE INTERNATIONAL AIDS SOCIETY Rohr, J. K., Gomez-Olive, F., Rosenberg, M., Manne-Goehler, J., Geldsetzer, P., Wagner, R. G., Houle, B., Salomon, J. A., Kahn, K., Tollman, S., Berkman, L., Baernighausen, T. 2017; 20: 21691

  Abstract

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

  View details for PubMedID 28782333

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

  Abstract

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

  View details for DOI 10.1056/NEJMoa1614362

  View details for Web of Science ID 000404730000005

  View details for PubMedID 28604169

  View details for PubMedCentralID PMC5477817

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

  Abstract

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

  View details for PubMedID 28527533

  View details for PubMedCentralID PMC5491406

• EVALUATING CHLAMYDIA TRENDS IN THE UNITED STATES 2000-2015 USING A PAIR FORMATION TRANSMISSION MODEL Ronn, M. M., Tuite, A., Menzies, N. A., Gift, T., Chesson, H., Torrone, E., Wolf, E. E., Galer, K., Hsu, K., Salomon, J. A. BMJ PUBLISHING GROUP. 2017: A2–A3

  View details for DOI 10.1136/sextrans-2017-053264.5

  View details for Web of Science ID 000442492000006

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

  Abstract

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

  View details for PubMedID 28384795

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

  Abstract

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

  View details for PubMedID 28441697

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

  Abstract

  National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.Bill & Melinda Gates Foundation.

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

  View details for PubMedID 28528753

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

  Abstract

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

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

  View details for Web of Science ID 000400973500025

  View details for PubMedID 28390697

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

  Abstract

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

  View details for PubMedID 28407643

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

  Abstract

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

  View details for DOI 10.1001/jamaoncol.2016.5688

  View details for Web of Science ID 000399425800017

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

  Abstract

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

  View details for PubMedID 28126460

• SCREENING ADOLESCENTS AND YOUNG ADULTS FOR HIV IN THE UNITED STATES: A COST-EFFECTIVENESS ANALYSIS Neilan, A., Dunville, R., Ocfemia, M., Salomon, J., Francke, J., Wang, L., Bulteel, A., Hsu, K., DiNenno, E., Parker, R., Walensky, R., Freedberg, K., Ciaranello, A. ELSEVIER SCIENCE INC. 2017: S18

  View details for DOI 10.1016/j.jadohealth.2016.10.055

  View details for Web of Science ID 000397270700033

• Impact of a Text-Messaging Programon Adolescent Reproductive Health: A Cluster-Randomized Trial in Ghana AMERICAN JOURNAL OF PUBLIC HEALTH Rokicki, S., Cohen, J., Salomon, J. A., Fink, G. 2017; 107 (2): 298–305

  Abstract

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

  View details for PubMedID 27997236

• SCREENING ADOLESCENTS AND YOUNG ADULTS FOR HIV IN THE UNITED STATES: A COST-EFFECTIVENESS ANALYSIS Neilan, A., Dunville, R., Ocfemia, M., Salomon, J., Francke, J., Wang, L., Bulteel, A., Hsu, K., DiNenno, E., Parker, R., Walensky, R., Freedberg, K., Ciaranello, A. ELSEVIER SCIENCE INC. 2017: S18

  View details for Web of Science ID 000406846500033

• The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. The Lancet. Infectious diseases 2017

  Abstract

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

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

  View details for PubMedID 29223583

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

  Abstract

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

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

  View details for PubMedID 28919118

  View details for PubMedCentralID PMC5605707

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

  Abstract

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

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

  View details for PubMedID 28919117

  View details for PubMedCentralID PMC5605509

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

  Abstract

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

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

  View details for PubMedID 28916366

  View details for PubMedCentralID PMC5603800

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

  Abstract

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

  View details for PubMedID 27926667

  View details for PubMedCentralID PMC5147032

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

  Abstract

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

  View details for PubMedID 28226024

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

  Abstract

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

  View details for PubMedID 28480259

• ESTIMATING HEALTH IMPACT OF RAPID DIAGNOSTIC TESTS FOR MALARIA Pradhan, E., Cohen, J., Salomon, J. AMER SOC TROP MED & HYGIENE. 2017: 404

  View details for Web of Science ID 000423215204017

• Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda PLOS ONE Shrime, M. G., Sekidde, S., Linden, A., Cohen, J. L., Weinstein, M. C., Salomon, J. A. 2016; 11 (12): e0168867

  Abstract

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

  View details for PubMedID 28036357

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

  Abstract

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

  View details for PubMedID 27371184

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

  Abstract

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

  View details for DOI 10.1001/jamaoncol.2016.5688

  View details for PubMedID 27918777

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

  Abstract

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

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

  View details for PubMedID 27720689

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

  Abstract

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

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

  View details for Web of Science ID 000386811200023

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

  Abstract

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

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

  View details for PubMedID 27720688

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

  Abstract

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

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

  View details for PubMedID 27727123

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

  Abstract

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

  View details for Web of Science ID 000385285000012

  View details for PubMedCentralID PMC5224694

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

  Abstract

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

  View details for Web of Science ID 000423462600001

  View details for PubMedID 27733285

  View details for PubMedCentralID PMC5224696

• Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015 LANCET Lim, S. S., Allen, K., Bhutta, Z. A., Dandona, L., Forouzanfar, M. H., Fullman, N., Gething, P. W., Goldberg, E. M., Hay, S. I., Holmberg, M., Kinfu, Y., Kutz, M. J., Larson, H. J., Liang, X., Lopez, A. D., Lozano, R., McNellan, C. R., Mokdad, A. H., Mooney, M. D., Naghavi, M., Olsen, H. E., Pigott, D. M., Salomon, J. A., Vos, T., Wang, H., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulle, A. M., Abraham, B., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Abyu, G. Y., Achoki, T., Adebiyi, A. O., Adedeji, I. A., Afanvi, K. A., Afshin, A., Agarwal, A., Agrawal, A., Kiadaliri, A. A., Ahmadieh, H., Ahmed, K. Y., Akanda, A. S., Akinyemi, R. O., Akinyemiju, T. F., Akseer, N., Al-Aly, Z., Alam, K., Alam, U., Alasfoor, D., Albuhairan, F. S., Aldhahri, S. F., Dge, R. W., Alemu, Z. A., Ali, R., Alkerwi, A., Alkhateeb, M. A., Alla, F., Allebeck, P., Allen, C., Al-Raddadi, R., Altirkawi, K. A., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, H., Ammar, W., Amrock, S. M., Andersen, H. H., Anderson, B. O., Anderson, G. M., Antonio, C. A., Anwari, P., Arnlov, J., Artaman, A., Asayesh, H., Asghar, R. J., Atique, S., Avokpaho, E. F., Awasthi, A., Quintanilla, B. P., Azzopardi, P., Bacha, U., Badawi, A., Balakrishnan, K., Banerjee, A., Barac, A., Barber, R., Barker-Collo, S. L., Barnighausen, T., Barrero, L. H., Barrientos-Gutierrez, T., Basu, S., Bayou, T. A., Bazargan-Hejazi, S., Beardsley, J., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Benzian, H., Berhane, A., Bernabe, E., Bernal, O. A., Betsu, B. D., Beyene, A. S., Bhala, N., Bhatt, S., Biadgilign, S., Bienhoff, K. A., Bikbov, B., Binagwaho, A., Bisanzio, D., Bjertness, E., Blore, J., Bourne, R. R., Brainin, M., Brauer, M., Brazinova, A., Breitborde, N. J., Broday, D. M., Brugha, T. S., Buchbinder, R., Butt, Z. A., Cahill, L. E., Campos-Nonato, I. R., Campuzano, J. C., Carabin, H., Cardenas, R., Carrero, J. J., Carter, A., Casey, D., Caso, V., Castaneda-Orjuela, C. A., Rivas, J. C., Catala-Lopez, F., Cavalleri, F., Cecilio, P., Chang, H., Chang, J., Charlson, F. J., Che, X., Chen, A. Z., Chiang, P. P., Chibalabala, M., Chisumpa, V. H., Choi, J. J., Chowdhury, R., Christensen, H., Ciobanu, L. G., Cirillo, M., Coates, M. M., Coggeshall, M., Cohen, A. J., Cooke, G. S., Cooper, C., Cooper, L. T., Cowie, B. C., Crump, J. A., Damtew, S. A., Dandona, R., Dargan, P. I., das Neves, J., Davis, A. C., Davletov, K., de Castro, E. F., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Deribe, K., Derrett, S., Jarlais, D. C., Deshpande, A., deVeber, G. A., Dey, S., Dharmaratne, S. D., Dhillon, P. K., Ding, E. L., Dorsey, E. R., Doyle, K. E., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Ebrahimi, H., Endries, A. Y., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Fahimi, S., Farid, T. A., Farinha, C. S., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Felicio, M. M., Fereshtehnejad, S., Fernandes, J. G., Fernandes, J. C., Ferrari, A. J., Fischer, F., Fitchett, J. R., Fitzmaurice, C., Foigt, N., Foreman, K., Fowkes, F. G., Franca, E. B., Franklin, R. C., Fraser, M., Friedman, J., Frostad, J., Furst, T., Gabbe, B., Garcia-Basteiro, A. L., Gebre, T., Gebrehiwot, T. T., Gebremedhin, A. T., Gebru, A. A., Gessner, B. D., Gillum, R. F., Ginawi, I. A., Giref, A. Z., Giroud, M., Gishu, M. D., Godwin, W., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Graetz, N., Greenwell, K. F., Griswold, M., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Gyawali, B., Haagsma, J. A., Haakenstad, A., Hafezi-Nejad, N., Haile, D., Hailu, G. B., Halasa, Y. A., Hamadeh, R. R., Hamidi, S., Hammami, M., Hankey, G. J., Harb, H. L., Haro, J. M., Hassanvand, M. S., Havmoeller, R., Heredia-Pi, I. B., Hoek, H. W., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Htet, A. S., Hu, G., Huang, H., Iburg, K. M., Idrisov, B. T., Inoue, M., Islami, F., Jacobs, T. A., Jacobsen, K. H., Jahanmehr, N., Jakovljevic, M. B., James, P., Jansen, H. A., Javanbakht, M., Jayatilleke, A. U., Jee, S. H., Jeemon, P., Jha, V., Jiang, Y., Jibat, T., Jin, Y., Jonas, J. B., Kabir, Z., Kalkonde, Y., Kamal, R., Kan, H., Kandel, A., Karch, A., Karema, C. K., KarimIchani, C., Karunapema, P., Kasaeian, A., Kassebaum, N. J., Kaul, A., Kawakami, N., Kayibanda, J. F., Keiyoro, P. N., Kemmer, L., Kemp, A. H., Kengne, A. P., Keren, A., Kesavachandran, C. N., Khader, Y. S., Khan, A. R., Khan, E. A., Khan, G., Khang, Y., Khoja, T. A., Khosravi, A., Khubchandani, J., Kieling, C., Kim, C., Kim, D., Kim, S., Kim, Y. J., Kimokoti, R. W., Kissoon, N., Kivipelto, M., Knibbs, L. D., Kokubo, Y., Kolte, D., Kosen, S., Kotsakis, G. A., Koul, P. A., Koyanagi, A., Kravchenko, M., Krueger, H., Defo, B. K., Kuchenbecker, R. S., Kuipers, E. J., Kulikoff, X. R., Kulkarni, V. S., Kumar, G. A., Kwan, G. F., Kyu, H. H., Lal, A., Lal, D. K., Lalloo, R., Lam, H., Lan, Q., Langan, S. M., Larsson, A., Laryea, D. O., Latif, A. A., Leasher, J. L., Leigh, J., Leinsalu, M., Leung, J., Leung, R., Levi, M., Li, Y., Li, Y., Lind, M., Linn, S., Lipshultz, S. E., Liu, P. Y., Liu, S., Liu, Y., Lloyd, B. K., Lo, L., Logroscino, G., Lotufo, P. A., Lucas, R. M., Lunevicius, R., Abd El Razek, M. M., Magis-Rodriguez, C., Mandavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Malta, D. C., Mapoma, C. C., Margolis, D. J., Martin, R. V., Martinez-Raga, J., Masiye, F., Mason-Jones, A. J., Massano, J., Matzopoulos, R., Mayosi, B. M., McGrath, J. J., McKee, M., Meaney, P. A., Mehari, A., Mekonnen, A. B., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Mensink, G. B., Meretoja, A., Meretoja, T. J., Mesfin, Y. M., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Mirarefin, M., Misganaw, A., Mitchell, P. B., Mock, C. N., Mohammadi, A., Mohammed, S., Monasta, L., Monis, J. d., Hernandez, J. C., Montico, M., Moradi-Lakeh, M., Morawska, L., Mori, R., Mueller, U. O., Murdoch, M. E., Murimira, B., Murray, J., Murthy, G. V., Murthy, S., Musa, K. I., Nachega, J. B., Nagel, G., Naidoo, K. S., Naldi, L., Nangia, V., Neal, B., Nejjari, C., Newton, C. R., Newton, J. N., Ngalesoni, F. N., Nguhiu, P., Nguyen, G., Quyen Le Nguyen, Q. L., Nisar, M. I., Pete, P. M., Nolte, S., Nomura, M., Norheim, O. F., Norrving, B., Obermeyer, C. M., Ogbo, F. A., Oh, I., Oladimeji, O., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Opio, J. N., Oren, E., Ortiz, A., Osborne, R. H., Ota, E., Owolabi, M. O., Mahesh, P. A., Park, E., Park, H., Parry, C. D., Parsaeian, M., Patel, T., Patel, V., Caicedo, A. J., Patil, S. T., Patten, S. B., Patton, G. C., Paudel, D., Pedro, J. M., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Pinho, C., Pishgar, F., Polinder, S., Poulton, R. G., Pourmalek, F., Qorbani, M., Rabiee, R. H., Radfar, A., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, R. K., Rajsic, S., Raju, M., Ram, U., Rana, S. M., Ranabhat, C. L., Ranganathan, K., Rao, P. C., Refaat, A. H., Reitsma, M. B., Remuzzi, G., Resnikoff, S., Ribeiro, A. L., Blancas, M. J., Rolm, H. S., Roberts, B., Rodriguez, M., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roth, G. A., Rothenbacher, D., Roy, A., Roy, N., Sackey, B. B., Sagar, R., Saleh, M. M., Sanabria, J. R., Santomauro, D. F., Santos, I. S., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Sawyer, S. M., Schmidhuber, J., Schmidt, M. I., Schneider, I. J., Schutte, A. E., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shackelford, K., Shaheen, A., Shaikh, M. A., Levy, T. S., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Sheth, K. N., Shey, M., Shi, P., Shibuya, K., Shigematsu, M., Shin, M., Shiri, R., Shishani, K., Shiue, I., Sigfusdottir, I. D., Silpakit, N., Silva, D. A., Silverberg, J. I., Simard, E. P., Sindi, S., Singh, A., Singh, G. M., Singh, J. A., Singh, O. P., Singh, P. K., Skirbekk, V., Sligar, A., Soneji, S., Soreide, K., Sorensen, R. J., Soriano, J. B., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stahl, H., Stanaway, J. D., Stathopoulou, V., Steckling, N., Steel, N., Stein, D. J., Steiner, C., Stockl, H., Stranges, S., Strong, M., Sun, J., Sunguya, B. F., Sur, P., Swaminathan, S., Sykes, B. L., Szoeke, C. E., Tabares-Seisdedos, R., Tabb, K. M., Talongwa, R. T., Tarawneh, M. R., Tavakkoli, M., Taye, B., Taylor, H. R., Tedla, B. A., Tefera, W., Tegegne, T. K., Tekle, D. Y., Shifa, G. T., Terkawi, A. S., Tessema, G. A., Thakur, J. S., Thomson, A. J., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tobe-Gai, R., Tonelli, M., Topor-Madry, R., Topouzis, F., Tran, B. X., Dimbuene, Z. T., Tura, A. K., Tuzcu, E. M., Tyrovolas, S., Ukwaja, K. N., Undurraga, E. A., Uneke, C. J., Uthman, O. A., van Donkelaar, A., Varakin, Y. Y., Vasankari, T., Vasconcelos, A. M., Veerman, J. L., Venketasubramanian, N., Verma, R. K., Violante, F. S., Vlassov, V. V., Volkow, P., Vollset, S. E., Wagner, G. R., Wallin, M. T., Wang, L., Wanga, V., Watkins, D. A., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Weiss, D. J., Werdecker, A., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Wiysonge, C. S., Wolfe, C. D., Wolfe, I., Won, S., Woolf, A. D., Workie, S. B., Wubshet, M., Xu, G., Yadav, A. K., Yakob, B., Yalew, A. Z., Yan, L. L., Yano, Y., Yaseri, M., Ye, P., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Yu, C., Zaidi, Z., Zaki, M. E., Zambrana-Torrelio, C., Zapata, T., Zegeye, E. A., Zhao, Y., Zhou, M., Zodpey, S., Zonies, D., Murray, C. J. 2016; 388 (10053): 1813-1850

  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.

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  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

  View details for Web of Science ID 000385493804084

• 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

  View details for Web of Science ID 000390695900224

• 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

  View details for Web of Science ID 000390695900324

• Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA Sanders, G. D., Neumann, P. J., Basu, A., Brock, D. W., Feeny, D., Krahn, M., Kuntz, K. M., Meltzer, D. O., Owens, D. K., Prosser, L. A., Salomon, J. A., Sculpher, M. J., Trikalinos, T. A., Russell, L. B., Siegel, J. E., Ganiats, T. G. 2016; 316 (10): 1093-1103

  Abstract

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

  View details for DOI 10.1001/jama.2016.12195

  View details for PubMedID 27623463

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

  Abstract

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

  View details for PubMedID 27552195

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

  Abstract

  Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health.

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

  View details for Web of Science ID 000380842400010

  View details for PubMedID 27470028

  View details for PubMedCentralID PMC5056319

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

  Abstract

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

  View details for PubMedID 27351744

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

  Abstract

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

  View details for PubMedID 26345320

  View details for PubMedCentralID PMC5007601

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

  Abstract

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

  View details for PubMedID 27025969

• Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Forouzanfar, M. H., Alexander, L., Anderson, H. R., Bachman, V. F., Biryukov, S., Brauer, M., Burnett, R., Casey, D., Coates, M. M., Cohen, A., Delwiche, K., Estep, K., Frostad, J. J., Astha, K. C., Kyu, H. H., Moradi-Lakeh, M., Ng, M., Slepak, E. L., Thomas, B. A., Wagner, J., Aasvang, G. M., Abbafati, C., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Aboyans, V., Abraham, B., Abraham, J. P., Abubakar, I., Abu-Rmeileh, N. M., Aburto, T. C., Achoki, T., Adelekan, A., Adofo, K., Adou, A. K., Adsuar, J. C., Afshin, A., Agardh, E. E., Al Khabouri, M. J., Al Lami, F. H., Alam, S. S., Alasfoor, D., Albittar, M. I., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Ali, M. K., Alla, F., Allebeck, P., Allen, P. J., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Ameh, E. A., Ameli, O., Amini, H., Ammar, W., Anderson, B. O., Antonio, C. A., Anwari, P., Cunningham, S. A., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Atkinson, C., Avila, M. A., Awuah, B., Badawi, A., Bahit, M. C., Bakfalouni, T., Balakrishnan, K., Balalla, S., Balu, R. K., Banerjee, A., Barber, R. M., Barker-Collo, S. L., Barquera, S., Barregard, L., Barrero, L. H., Barrientos-Gutierrez, T., Basto-Abreu, A. C., Basu, A., Basu, S., Basulaiman, M. O., Ruvalcaba, C. B., Beardsley, J., Bedi, N., Bekele, T., Bell, M. L., Benjet, C., Bennett, D. A., Benzian, H., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. Q., Bikbov, B., Bin Abdulhak, A. A., Blore, J. D., Blyth, F. M., Bohensky, M. A., Basara, B. B., Borges, G., Bornstein, N. M., Bose, D., Boufous, S., Bourne, R. R., Brainin, M., Brazinova, A., Breitborde, N. 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P., Deribe, K., Derrett, S., Jarlais, D. C., Dessalegn, M., deVeber, G. A., Devries, K. M., Dharmaratne, S. D., Dherani, M. K., Dicker, D., Ding, E. L., Dokova, K., Dorsey, E. R., Driscoll, T. R., Duan, L., Durrani, A. M., Ebel, B. E., Ellenbogen, R. G., Elshrek, Y. M., Endres, M., Ermakov, S. P., Erskine, H. E., Eshrati, B., Esteghamati, A., Fahimi, S., Faraon, E. J., Farzadfar, F., Fay, D. F., Feigin, V. L., Feigl, A. B., Fereshtehnejad, S., Ferrari, A. J., Ferri, C. P., Flaxman, A. D., Fleming, T. D., Foigt, N., Foreman, K. J., Paleo, U. F., Franklin, R. C., Gabbe, B., Gaffikin, L., Gakidou, E., Gamkrelidze, A., Gankpe, F. G., Gansevoort, R. T., Garcia-Guerra, F. A., Gasana, E., Geleijnse, J. M., Gessner, B. D., Gething, P., Gibney, K. B., Gillum, R. F., Ginawi, I. A., Giroud, M., Giussani, G., Goenka, S., Goginashvili, K., Dantes, H. G., Gona, P., de Cosio, T. G., Gonzalez-Castell, D., Gotay, C. C., Goto, A., Gouda, H. N., Guerrant, R. L., Gugnani, H. 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E., Khan, E. A., Khang, Y., Khatibzadeh, S., Khonelidze, I., Kieling, C., Kim, D., Kim, S., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kinge, J. M., Kissela, B. M., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kose, M. R., Kosen, S., Kraemer, A., Kravchenko, M., Krishnaswami, S., Kromhout, H., Ku, T., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kwan, G. F., Lai, T., Balaji, A. L., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Laryea, D. O., Lavados, P. M., Lawrynowicz, A. E., Leasher, J. L., Lee, J., Leigh, J., Leung, R., Levi, M., Li, Y., Li, Y., Liang, J., Liang, X., Lim, S. S., Lindsay, M. P., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Logroscino, G., London, S. J., Lopez, N., Lortet-Tieulent, J., Lotufo, P. A., Lozano, R., Lunevicius, R., Ma, J., Ma, S., Machado, V. M., MacIntyre, M. F., Magis-Rodriguez, C., Mahdi, A. A., Majdan, M., Malekzadeh, R., Mangalam, S., Mapoma, C. C., Marape, M., Marcenes, W., Margolis, D. J., Margono, C., Marks, G. B., Martin, R. V., Marzan, M. B., Mashal, M. T., Masiye, F., Mason-Jones, A. J., Matsushita, K., Matzopoulos, R., Mayosi, B. M., Mazorodze, T. T., Mckay, A. C., McKee, M., McLain, A., Meaney, P. A., Medina, C., Mehndiratta, M. M., Mejia-Rodriguez, F., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Misganaw, A., Mishra, S., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Hernandez, J. C., Montico, M., Moore, A. R., Morawska, L., Mori, R., Moschandreas, J., Moturi, W. N., Arian, D. M., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murthy, K. S., Naghavi, M., Nahas, Z., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nash, D., Neal, B., Nejjari, C., Neupane, S. P., Newton, C. R., Ngalesoni, F. N., Ngirabega, J. d., Nguyen, G., Nguyen, N. T., Nieuwenhuijsen, M. J., Nisar, M. I., Nogueira, J. R., Nolla, J. M., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orozco, R., Pagcatipunan, R. S., Pain, A. W., Pandian, J. D., Panelo, C. I., Papachristou, C., Park, E., Parry, C. D., Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pedraza, L. S., Pedroza, A., Stokic, L. P., Pekericli, A., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Perry, S. A., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phua, H. P., Plass, D., Poenaru, D., Polanczyk, G. V., Polinder, S., Pond, C. D., Pope, C. A., Pope, D., Popova, S., Pourmalek, F., Powles, J., Prabhakaran, D., Prasad, N. M., Qato, D. M., Quezada, A. D., Quistberg, D. A., Racape, L., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rakovac, I., Rana, S. M., Rao, M., Razavi, H., Reddy, K. S., Refaat, A. 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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 PubMedID 26515678

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

  Abstract

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

  View details for PubMedID 26668435

  View details for PubMedCentralID PMC4669723

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

  Abstract

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

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

  View details for Web of Science ID 000365992600030

  View details for PubMedCentralID PMC5388903

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

  Abstract

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

  View details for PubMedID 26582970

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

  Abstract

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

  View details for PubMedID 26475018

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

  Abstract

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

  View details for PubMedID 26355058

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

  Abstract

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

  View details for PubMedID 25894707

  View details for PubMedCentralID PMC5729585

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

  Abstract

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

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

  View details for Web of Science ID 000360287900025

  View details for PubMedCentralID PMC4561509

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

  Abstract

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

  View details for PubMedID 26135810

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

  Abstract

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

  View details for PubMedID 26181261

  View details for PubMedCentralID PMC4500822

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

  Abstract

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

  View details for PubMedID 26170504

  View details for PubMedCentralID PMC4490811

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

  Abstract

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

  View details for PubMedID 25878131

  View details for PubMedCentralID PMC4424692

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

  Abstract

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

  View details for DOI 10.7326/M14-1313

  View details for Web of Science ID 000354119100006

  View details for PubMedID 25820703

  View details for PubMedCentralID PMC4420667

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

  Abstract

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

  View details for PubMedID 25819778

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

  Abstract

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

  View details for PubMedID 25768060

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

  Abstract

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

  View details for PubMedID 26778920

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

  Abstract

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

  View details for PubMedID 25656226

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

  Abstract

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

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

  View details for Web of Science ID 000347715900024

  View details for PubMedCentralID PMC4340604

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

  View details for PubMedID 25541164

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

  Abstract

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

  View details for PubMedID 25203158

  View details for PubMedCentralID PMC4247262

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

  Abstract

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

  View details for PubMedID 25303078

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

  Abstract

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

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

  View details for PubMedID 25059949

• Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England) Wang, H., 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., Blore, J. D., Basara, B. B., Boufous, S., Breitborde, N., Bruce, N. G., Bui, L. N., Carapetis, J. R., Cárdenas, R., Carpenter, D. O., Caso, V., Castro, R. E., Catalá-Lopéz, F., Cavlin, A., Che, X., Chiang, P. P., Chowdhury, R., Christophi, C. A., Chuang, T. W., Cirillo, M., da Costa Leite, I., 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. M., 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. H., 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. T., 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., 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., 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., El Sayed Zaki, M., Zhu, S., Vos, T., Lopez, A. D., Murray, C. J. 2014; 384 (9947): 957-79

  Abstract

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

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

  View details for PubMedID 24797572

  View details for PubMedCentralID PMC4165626

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

  Abstract

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

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

  View details for PubMedID 24797575

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

  Abstract

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

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

  View details for Web of Science ID 000341679700030

  View details for PubMedCentralID PMC4165626

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

  Abstract

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

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

  View details for Web of Science ID 000341679700032

  View details for PubMedCentralID PMC4202387

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

  Abstract

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

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

  View details for Web of Science ID 000341679700031

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

  Abstract

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

  View details for DOI 10.1002/hep.26934

  View details for Web of Science ID 000337969000010

  View details for PubMedID 24990105

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

  Abstract

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

  View details for PubMedID 24842841

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

  Abstract

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

  View details for PubMedID 24670522

  View details for PubMedCentralID PMC4045405

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

  Abstract

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

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

  View details for Web of Science ID 000336423900015

  View details for PubMedID 25104632

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

  Abstract

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

  View details for DOI 10.1161/CIRCOUTCOMES.113.000397

  View details for Web of Science ID 000331071200007

  View details for PubMedID 24425701

  View details for PubMedCentralID PMC3971865

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

  Abstract

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

  View details for PubMedID 24468944

• Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models. The 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., Bärnighausen, T., Bershteyn, A., Bloom, D. E., Boily, M. C., 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. 2013; 2 (1): 23-34

  Abstract

  New WHO guidelines recommend ART initiation for HIV-positive persons with CD4 cell counts ≤500 cells/µL, a higher threshold than was previously recommended. Country decision makers must consider whether to further expand ART eligibility accordingly.We used multiple independent mathematical models in four settings-South Africa, Zambia, India, and Vietnam-to evaluate the potential health impact, costs, and cost-effectiveness of different adult ART eligibility criteria under scenarios of current and expanded treatment coverage, with results projected over 20 years. Analyses considered extending eligibility to include individuals with CD4 ≤500 cells/µL or all HIV-positive adults, compared to the previous recommendation of initiation with CD4 ≤350 cells/µL. We assessed costs from a health system perspective, and calculated the incremental cost per DALY averted ($/DALY) to compare competing strategies. Strategies were considered 'very cost-effective' if the $/DALY was less than the country's per capita gross domestic product (GDP; South Africa: $8040, Zambia: $1425, India: $1489, Vietnam: $1407) and 'cost-effective' if $/DALY was less than three times per capita GDP.In South Africa, the cost per DALY averted of extending ART eligibility to CD4 ≤500 cells/µL ranged from $237 to $1691/DALY compared to 2010 guidelines; in Zambia, expanded eligibility ranged from improving health outcomes while reducing costs (i.e. dominating current guidelines) to $749/DALY. Results were similar in scenarios with substantially expanded treatment access and for expanding eligibility to all HIV-positive adults. Expanding treatment coverage in the general population was therefore found to be cost-effective. In India, eligibility for all HIV-positive persons ranged from $131 to $241/DALY and in Vietnam eligibility for CD4 ≤500 cells/µL cost $290/DALY. In concentrated epidemics, expanded access among key populations was also cost-effective.Earlier ART eligibility is estimated to be very cost-effective in low- and middle-income settings, although these questions should be revisited as further information becomes available. Scaling-up ART should be considered among other high-priority health interventions competing for health budgets.The Bill and Melinda Gates Foundation and World Health Organization.

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

  View details for PubMedID 25083415

  View details for PubMedCentralID PMC4114402

• Cost-effectiveness of monitoring inactive chronic hepatitis B and treating eligible patients in Shanghai, China Toy, M., Salomon, J. WILEY-BLACKWELL. 2013: 641–42

  View details for Web of Science ID 000325017803463

• 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

  View details for DOI 10.1016/S0140-6736(13)61519-6

  View details for Web of Science ID 000321347000016

  View details for PubMedID 23830332

• 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

  View details for DOI 10.1016/S0140-6736(12)62131-X

  View details for Web of Science ID 000313044300013

  View details for PubMedID 23266228

• 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 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 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

  View details for DOI 10.1016/S0140-6736(12)61899-6

  View details for Web of Science ID 000312387000009

  View details for PubMedID 23245602

• 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

  View details for DOI 10.1016/S0140-6736(12)62134-5

  View details for Web of Science ID 000312387000005

  View details for PubMedID 23245598

• 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

• 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 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 PubMedID 23172342

• 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 PubMedID 23172346

• 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 PubMedID 23185139

• 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 PubMedID 21914713

• 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 PubMedID 22802743

• 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 PubMedID 22389335

• 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

  View details for Web of Science ID 000315514700020

• 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 PubMedID 22025393

• 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 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 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 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 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 PubMedID 19564169

• 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 PubMedID 19159483

• 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 PubMedID 18848905

• Progress and challenges in modelling country-level HIV/AIDS epidemics: the UNAIDS Estimation and Projection Package 2007. Sexually transmitted infections Brown, T., Salomon, J. A., Alkema, L., Raftery, A. E., Gouws, E. 2008; 84 Suppl 1: i5-i10

  Abstract

  The UNAIDS Estimation and Projection Package (EPP) was developed to aid in country-level estimation and short-term projection of HIV/AIDS epidemics. This paper describes advances reflected in the most recent update of this tool (EPP 2007), and identifies key issues that remain to be addressed in future versions. The major change to EPP 2007 is the addition of uncertainty estimation for generalised epidemics using the technique of Bayesian melding, but many additional changes have been made to improve the user interface and efficiency of the package. This paper describes the interface for uncertainty analysis, changes to the user interface for calibration procedures and other user interface changes to improve EPP's utility in different settings. While formal uncertainty assessment remains an unresolved challenge in low-level and concentrated epidemics, the Bayesian melding approach has been applied to provide analysts in these settings with a visual depiction of the range of models that may be consistent with their data. In fitting the model to countries with longer-running epidemics in sub-Saharan Africa, a number of limitations have been identified in the current model with respect to accommodating behaviour change and accurately replicating certain observed epidemic patterns. This paper discusses these issues along with their implications for future changes to EPP and to the underlying UNAIDS Reference Group model.

  View details for DOI 10.1136/sti.2008.030437

  View details for PubMedID 18647867

  View details for PubMedCentralID PMC2569145

• 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 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 PubMedID 18001145

• Economic evaluation of hepatitis B vaccination in low-income countries: using cost-effectiveness affordability curves. Bulletin of the World Health Organization Kim, S. Y., Salomon, J. A., Goldie, S. J. 2007; 85 (11): 833-42

  Abstract

  We sought to describe a method that explicitly considers both a health-care programmes cost-effectiveness and its affordability. For illustration, we apply the method to the programme to vaccinate infants against hepatitis B in the Gambia.We synthesized selected data and developed a computer-based model from the societal and payer perspectives to evaluate the cost-effectiveness of routine infant vaccination against hepatitis B in the Gambia compared with no vaccination. The primary outcome measure was cost per averted disability-adjusted life year (DALY), which was expressed in 2002 US dollars. We used Monte Carlo methods for uncertainty analysis to examine the affordability of the programme from the payers perspective, and we derived an affordability curve and cost-effectiveness affordability curves for the programme.In the Gambia, vaccinating infants against hepatitis B is highly cost-effective. Compared with offering no intervention, the vaccination programme would cost US$ 28 per DALY averted from the societal perspective or US$ 47 per DALY averted from the payers perspective. The programme also has the potential to be affordable, starting at a relatively low budget of US$ 160,000 per year. Combining the two dimensions of the outcome measure, the probability that vaccinating infants would be both cost-effective and affordable is 40% at an annual programme budget of US$ 182,000 (the estimated total programme cost from the payers perspective), given a threshold cost-effectiveness value of US$ 47 per DALY averted.In the face of uncertainties about both the health and economic consequences of a vaccine programme, as well as the availability and magnitude of resources needed to fund the programme, cost-effectiveness affordability curves can provide information to decision-makers about the probability that a programme will be both cost-effective and affordable: these are distinct but equally relevant considerations in resource-poor settings.

  View details for PubMedID 18038073

  View details for PubMedCentralID PMC2636252

• Cost-effectiveness of HPV 16, 18 vaccination in Brazil VACCINE Goldie, S. J., Kim, J. J., Kobus, K., Goldhaber-Fiebert, J. D., Salomon, J., O'Shea, M. K., Xavier Bosch, F., de Sanjose, S., Franco, E. L. 2007; 25 (33): 6257-6270

  Abstract

  We use an empirically calibrated model to estimate the cost-effectiveness of cervical cancer prevention in Brazil, a country with a high cervical cancer burden. Assuming 70% coverage, HPV 16, 18 vaccination of adolescent girls is expected to reduce the lifetime risk of cancer by approximately 42.7% (range, 33.2-53.5%); screening three times per lifetime is expected to reduce risk by 21.9-30.7% depending on the screening test, and a combined approach of vaccination and screening is expected to reduce cancer risk by a mean of 60.8% (range, 52.8-70.1%). In Brazil; provided the cost per vaccinated woman is less than I$ 25, implying a per dose cost of approximately I$ 5, vaccination before age 12, followed by screening three times per lifetime between ages 35 and 45, would be considered very cost-effective using the country's per capita gross domestic product as a cost-effectiveness threshold. Assuming a coverage rate of 70%, this strategy would be expected to prevent approximately 100,000 cases of invasive cervical cancer over a 5-year period. Vaccination strategies identified as cost-effective may be unaffordable in countries with similar socioeconomic profiles as Brazil without assistance; these results can provide guidance to the global community by identifying health investments of highest priority and with the greatest promise.

  View details for DOI 10.1016/j.vaccine.2007.05.058

  View details for PubMedID 17606315

• Global burden of disease 2005: call for collaborators. Lancet (London, England) Murray, C. J., Lopez, A. D., Black, R., Mathers, C. D., Shibuya, K., Ezzati, M., Salomon, J. A., Michaud, C. M., Walker, N., Vos, T. 2007; 370 (9582): 109-110

  View details for DOI 10.1016/S0140-6736(07)61064-2

  View details for PubMedID 17630021

• Cost-effectiveness of treatment for hepatitis C in an urban cohort co-infected with HIV. The American journal of medicine Campos, N. G., Salomon, J. A., Servoss, J. C., Nunes, D. P., Samet, J. H., Freedberg, K. A., Goldie, S. J. 2007; 120 (3): 272-9

  Abstract

  Recent clinical trials have evaluated treatment strategies for chronic infection with hepatitis C virus (HCV) in patients co-infected with human immunodeficiency virus (HIV). Our objective was to use these data to examine the cost-effectiveness of treating HCV in an urban cohort of co-infected patients.A computer-based model, together with available published data, was used to estimate lifetime costs (2004 US dollars), life expectancy, and incremental cost per year of life saved (YLS) associated with 3 treatment strategies: (1) interferon-alfa and ribavirin; (2) pegylated interferon-alfa; and (3) pegylated interferon-alfa and ribavirin. The target population included treatment-eligible patients, based on an actual urban cohort of HIV-HCV co-infected subjects, with a mean age of 44 years, of whom 66% had genotype 1 HCV, 16% had cirrhosis, and 98% had CD4 cell counts >200 cells/mm3.Pegylated interferon-alfa and ribavirin was consistently more effective and cost-effective than other treatment strategies, particularly in patients with non-genotype 1 HCV. For patients with CD4 counts between 200 and 500 cells/mm3, survival benefits ranged from 5 to 11 months, and incremental cost-effectiveness ratios were consistently less than $75,000 per YLS for men and women of both genotypes. Due to better treatment efficacy in non-genotype 1 HCV patients, this group experienced greater life expectancy gains and lower incremental cost-effectiveness ratios.Combination therapy with pegylated interferon-alfa and ribavirin for HCV in eligible co-infected patients with stable HIV disease provides substantial life-expectancy benefits and appears to be cost-effective. Overcoming barriers to HCV treatment eligibility among urban co-infected patients remains a critical priority.

  View details for DOI 10.1016/j.amjmed.2006.06.036

  View details for PubMedID 17349451

  View details for PubMedCentralID PMC2034752

• A risk-based method for modeling traffic fatalities. Risk analysis : an official publication of the Society for Risk Analysis Bhalla, K., Ezzati, M., Mahal, A., Salomon, J., Reich, M. 2007; 27 (1): 125-36

  Abstract

  We describe a risk-based analytical framework for estimating traffic fatalities that combines the probability of a crash and the probability of fatality in the event of a crash. As an illustrative application, we use the methodology to explore the role of vehicle mix and vehicle prevalence on long-run fatality trends for a range of transportation growth scenarios that may be relevant to developing societies. We assume crash rates between different road users are proportional to their roadway use and estimate case fatality ratios (CFRs) for the different vehicle-vehicle and vehicle-pedestrian combinations. We find that in the absence of road safety interventions, the historical trend of initially rising and then falling fatalities observed in industrialized nations occurred only if motorization was through car ownership. In all other cases studied (scenarios dominated by scooter use, bus use, and mixed use), traffic fatalities rose monotonically. Fatalities per vehicle had a falling trend similar to that observed in historical data from industrialized nations. Regional adaptations of the model validated with local data can be used to evaluate the impacts of transportation planning and safety interventions, such as helmets, seat belts, and enforcement of traffic laws, on traffic fatalities.

  View details for DOI 10.1111/j.1539-6924.2006.00864.x

  View details for PubMedID 17362405

• Modeling human papillomavirus and cervical cancer in the United States for analyses of screening and vaccination. Population health metrics Goldhaber-Fiebert, J. D., Stout, N. K., Ortendahl, J., Kuntz, K. M., Goldie, S. J., Salomon, J. A. 2007; 5: 11-?

  Abstract

  To provide quantitative insight into current U.S. policy choices for cervical cancer prevention, we developed a model of human papillomavirus (HPV) and cervical cancer, explicitly incorporating uncertainty about the natural history of disease.We developed a stochastic microsimulation of cervical cancer that distinguishes different HPV types by their incidence, clearance, persistence, and progression. Input parameter sets were sampled randomly from uniform distributions, and simulations undertaken with each set. Through systematic reviews and formal data synthesis, we established multiple epidemiologic targets for model calibration, including age-specific prevalence of HPV by type, age-specific prevalence of cervical intraepithelial neoplasia (CIN), HPV type distribution within CIN and cancer, and age-specific cancer incidence. For each set of sampled input parameters, likelihood-based goodness-of-fit (GOF) scores were computed based on comparisons between model-predicted outcomes and calibration targets. Using 50 randomly resampled, good-fitting parameter sets, we assessed the external consistency and face validity of the model, comparing predicted screening outcomes to independent data. To illustrate the advantage of this approach in reflecting parameter uncertainty, we used the 50 sets to project the distribution of health outcomes in U.S. women under different cervical cancer prevention strategies.Approximately 200 good-fitting parameter sets were identified from 1,000,000 simulated sets. Modeled screening outcomes were externally consistent with results from multiple independent data sources. Based on 50 good-fitting parameter sets, the expected reductions in lifetime risk of cancer with annual or biennial screening were 76% (range across 50 sets: 69-82%) and 69% (60-77%), respectively. The reduction from vaccination alone was 75%, although it ranged from 60% to 88%, reflecting considerable parameter uncertainty about the natural history of type-specific HPV infection. The uncertainty surrounding the model-predicted reduction in cervical cancer incidence narrowed substantially when vaccination was combined with every-5-year screening, with a mean reduction of 89% and range of 83% to 95%.We demonstrate an approach to parameterization, calibration and performance evaluation for a U.S. cervical cancer microsimulation model intended to provide qualitative and quantitative inputs into decisions that must be taken before long-term data on vaccination outcomes become available. This approach allows for a rigorous and comprehensive description of policy-relevant uncertainty about health outcomes under alternative cancer prevention strategies. The model provides a tool that can accommodate new information, and can be modified as needed, to iteratively assess the expected benefits, costs, and cost-effectiveness of different policies in the U.S.

  View details for PubMedID 17967185

• Priority setting for health interventions in Mexico's System of Social Protection in Health. Lancet (London, England) González-Pier, E., Gutiérrez-Delgado, C., Stevens, G., Barraza-Lloréns, M., Porras-Condey, R., Carvalho, N., Loncich, K., Dias, R. H., Kulkarni, S., Casey, A., Murakami, Y., Ezzati, M., Salomon, J. A. 2006; 368 (9547): 1608-18

  Abstract

  Explicit priority setting presents Mexico with the opportunity to match the pressure and complexity of an advancing epidemiological transition with evidence-based policies driven by a fundamental concern for how to make the best use of scarce resources to improve population health. The Mexican priority-setting experience describes how standardised analytical approaches to decision making, mainly burden of disease and cost-effectiveness analyses, combine with other criteria--eg, being responsive to the legitimate non-health expectations of patients and ensuring fair financing across households--to design and implement a set of three differentiated health intervention packages. This process is a key element of a wider set of reform components aimed at extending health insurance, especially to the poor. The most relevant policy implications include lessons on the use of available and proven analytical tools to set national health priorities, the usefulness of priority-setting results to guide long-term capacity development, the importance of favouring an institutionalised approach to cost-effectiveness analysis, and the need for local technical capacity strengthening as an essential step to balance health-maximising arguments and other non-health criteria in a transparent and systematic process.

  View details for DOI 10.1016/S0140-6736(06)69567-6

  View details for PubMedID 17084761

• 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 PubMedID 17105337

• The burden of disease and injury in the United States 1996. Population health metrics Michaud, C. M., McKenna, M. T., Begg, S., Tomijima, N., Majmudar, M., Bulzacchelli, M. T., Ebrahim, S., Ezzati, M., Salomon, J. A., Kreiser, J. G., Hogan, M., Murray, C. J. 2006; 4: 11

  Abstract

  Burden of disease studies have been implemented in many countries using the Disability-Adjusted Life Year (DALY) to assess major health problems. Important objectives of the study were to quantify intra-country differentials in health outcomes and to place the United States situation in the international context.We applied methods developed for the Global Burden of Disease (GBD) to data specific to the United States to compute Disability-Adjusted Life Years. Estimates are provided by age and gender for the general population of the United States and for each of the four official race groups: White; Black; American Indian or Alaskan Native; and Asian or Pacific Islander. Several adjustments of GBD methods were made: the inclusion of race; a revised list of causes; and a revised algorithm to allocate cardiovascular disease garbage codes to ischaemic heart disease. We compared the results of this analysis to international estimates published by the World Health Organization for developed and developing regions of the world.In the mid-1990s the leading sources of premature death and disability in the United States, as measured by DALYs, were: cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the US population, particularly among racial minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries.Estimating DALYs specifically for the United States provides a comprehensive assessment of health problems for this country compared to what is available using mortality data alone.

  View details for DOI 10.1186/1478-7954-4-11

  View details for PubMedID 17049081

  View details for PubMedCentralID PMC1635736

• 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 PubMedID 16866578

• 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 PubMedID 16796403

• Health impacts of macroeconomic crises and policies: determinants of variation in childhood malnutrition trends in Cameroon. International journal of epidemiology Pongou, R., Salomon, J. A., Ezzati, M. 2006; 35 (3): 648-56

  Abstract

  It is generally hypothesized that macro economic shocks worsen child health by lowering household economic status and limiting access to health care, but this proposition seldom has been tested empirically. We examined the effects of economic crises and adjustment programmes during the 1990s in Cameroon on childhood malnutrition in population subgroups and evaluated the household and health system mediators of these effects.We used pooled cross-sectional data from two Demographic and Health Surveys conducted in 1991 and 1998. In multivariate analysis, we stratified data on child sex and age, maternal education, and place and region of residence. We used a linear regression model to estimate the net effects of changes in average household economic status and maternal health seeking behaviour (MHSB) on changes in the prevalence of malnutrition for each stratum, adjusting for all other variables.The prevalence of malnutrition in children younger than 3 years increased from 16 to 23% (P < 0.001) between 1991 and 1998. The increase in urban areas, from 13 to 15% (P = 0.391), mostly occurred in children of low-educated mothers. The increase in rural areas, from 19 to 25% (P < 0.001), mostly occurred in boys, children older than 6 months of age, those born to low-educated mothers, and those of low economic status. In urban areas, the advantage associated with higher maternal education was robust to all controls, and declines in economic status and MHSB were the mediators of increasing malnutrition. In rural areas, increase in malnutrition was higher in children with lower baseline economic status; decline in MHSB was a significant mediator of worsening nutritional status.The negative nutritional effects during economic crises and adjustment programmes of the 1990s in Cameroon were largest among children of low socioeconomic status. Declines in household economic status and access to health care were the mediators of increasing malnutrition.

  View details for DOI 10.1093/ije/dyl016

  View details for PubMedID 16567342

• Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon. BMC public health Pongou, R., Ezzati, M., Salomon, J. A. 2006; 6: 98

  Abstract

  Undernutrition is a leading cause of child mortality in developing countries, especially in sub-Saharan Africa. We examine the household and community level socioeconomic and environmental factors associated with child nutritional status in Cameroon, and changes in the effects of these factors during the 1990s economic crisis. We further consider age-specific effects of household economic status on child nutrition.Child nutritional status was measured by weight-for-age (WAZ) and height-for-age (HAZ) z-scores. Data were from Demographic and Health Surveys conducted in 1991 and 1998. We used analysis of variance to assess the bivariate association between the explanatory factors and nutritional status. Multivariate, multilevel analyses were undertaken to estimate the net effects of both household and community factors.Average WAZ and HAZ declined respectively from -0.70 standard deviations (SD), i.e. 0.70 SD below the reference median, to -0.83 SD (p = 0.006) and from -1.03 SD to -1.14 SD (p = 0.026) between 1991 and 1998. These declines occurred mostly among boys, children over 12 months of age, and those of low socioeconomic status. Maternal education and maternal health seeking behavior were associated with better child nutrition. Household economic status had an overall positive effect that increased during the crisis, but it had little effect in children under 6 months of age. Improved household (water, sanitation and cooking fuel) and community environment had positive effects. Children living in the driest regions of the country were consistently worst off, and those in the largest cities were best off.Both household and community factors have significant impact on child health in Cameroon. Understanding these relationships can facilitate design of age- and community-specific intervention programs.

  View details for DOI 10.1186/1471-2458-6-98

  View details for PubMedID 16618370

  View details for PubMedCentralID PMC1523206

• The global impact of scaling up HIV/AIDS prevention programs in low- and middle-income countries. Science (New York, N.Y.) Stover, J., Bertozzi, S., Gutierrez, J. P., Walker, N., Stanecki, K. A., Greener, R., Gouws, E., Hankins, C., Garnett, G. P., Salomon, J. A., Boerma, J. T., De Lay, P., Ghys, P. D. 2006; 311 (5766): 1474-6

  Abstract

  A strong, global commitment to expanded prevention programs targeted at sexual transmission and transmission among injecting drug users, started now, could avert 28 million new HIV infections between 2005 and 2015. This figure is more than half of the new infections that might otherwise occur during that period in 125 low- and middle-income countries. Although preventing these new infections would require investing about U.S.$122 billion over this period, it would reduce future needs for treatment and care. Our analysis suggests that it will cost about U.S.$3900 to prevent each new infection, but that this will produce a savings of U.S.$4700 in forgone treatment and care costs. Thus, greater spending on prevention now would not only prevent more than half the new infections that would occur from 2005 to 2015 but would actually produce a net financial saving as future costs for treatment and care are averted.

  View details for DOI 10.1126/science.1121176

  View details for PubMedID 16456039

• Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries. BMJ (Clinical research ed.) Hogan, D. R., Baltussen, R., Hayashi, C., Lauer, J. A., Salomon, J. A. 2005; 331 (7530): 1431-7

  Abstract

  To assess the costs and health effects of a range of interventions for preventing the spread of HIV and for treating people with HIV/AIDS in the context of the millennium development goal for combating HIV/AIDS.Cost effectiveness analysis based on an epidemiological model.Analyses undertaken for two regions classified using the WHO epidemiological grouping-Afr-E, countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, countries in South East Asia with high adult and high child mortality.Biological and behavioural parameters from clinical and observational studies and population based surveys. Intervention effects and resource inputs based on published reports, expert opinion, and the WHO-CHOICE database.Costs per disability adjusted life year (DALY) averted in 2000 international dollars (Int dollars).In both regions interventions focused on mass media, education and treatment of sexually transmitted infections for female sex workers, and treatment of sexually transmitted infections in the general population cost < Int150 dollars per DALY averted. Voluntary counselling and testing costs < Int350 dollars per DALY averted in both regions, while prevention of mother to child transmission costs < Int50 dollars per DALY averted in Afr-E but around Int850 dollars per DALY in Sear-D. School based education strategies and various antiretroviral treatment strategies cost between Int500 dollars and Int5000 dollars per DALY averted.Reducing HIV transmission could be done most efficiently through mass media campaigns, interventions for sex workers and treatment of sexually transmitted infections where resources are most scarce. However, prevention of mother to child transmission, voluntary counselling and testing, and school based education would yield further health gains at higher budget levels and would be regarded as cost effective or highly cost effective based on standard international benchmarks. Antiretroviral therapy is at least as cost effective in improving population health as some of these interventions.

  View details for DOI 10.1136/bmj.38643.368692.68

  View details for PubMedID 16282380

  View details for PubMedCentralID PMC1315644

• Enlightened self-interest and the control of tuberculosis. The New England journal of medicine Bloom, B. R., Salomon, J. A. 2005; 353 (10): 1057-9

  View details for DOI 10.1056/NEJMe058153

  View details for PubMedID 16148293

• Illness transmission in the home: A possible role for alcohol-based hand gels PEDIATRICS Lee, G. M., Salomon, J. A., Friedman, J. F., Hibberd, P. L., Ross-Degnan, D., Zasloff, E., Bediako, S., GOLDMANN, D. A. 2005; 115 (4): 852-860

  Abstract

  The widespread use of child care has altered the epidemiology of respiratory and gastrointestinal (GI) infection in the community. Our primary objective was to measure transmission of respiratory and GI illnesses among families with children enrolled in child care. We also sought to examine potential predictors of reduced illness transmission in the home in a secondary analysis.We performed an observational, prospective cohort study to determine transmission rates for respiratory and GI illnesses within families with at least 1 child between 6 months and 5 years of age enrolled in child care. A survey about family beliefs and practices was mailed at the beginning of the study. Symptom diaries were provided for families to record the timing and duration of respiratory and GI illnesses. To ensure the accuracy of symptom diaries, biweekly telephone calls were performed to review illnesses recorded by participants. Families with > or =4 weeks of data recorded were included in the analysis. Families were recruited from 5 pediatric practices in the metropolitan Boston area. Of 261 families who agreed to participate in the study, 208 were available for analysis. Secondary transmission rates for respiratory and GI illnesses were measured as illnesses per susceptible person-month.We observed 1545 respiratory and 360 GI illnesses in 208 families from November 2000 to May 2001. Of these, 1099 (71%) respiratory and 297 (83%) GI illnesses were considered primary illnesses introduced into the home. The secondary transmission rates for respiratory and GI illnesses were 0.63 and 0.35 illnesses per susceptible person-month, respectively. Only two thirds of respondents correctly believed that contact transmission was important in the spread of colds, and fewer than half believed that it was important in the spread of stomach flus. Twenty-two percent of respondents reported use of alcohol-based hand gels all, most, or some of the time; 33% reported always washing their hands after blowing or wiping a nose. In multivariate models, use of alcohol-based hand gels had a protective effect against respiratory illness transmission in the home.In homes with young children enrolled in child care, illness transmission to family members occurs frequently. Alcohol-based hand gel use was associated with reduced respiratory illness transmission in the home.

  View details for DOI 10.1542/peds.2004-0856

  View details for PubMedID 15805355

• Health-state valuations for pertussis: methods for valuing short-term health states. Health and quality of life outcomes Lee, G. M., Salomon, J. A., LeBaron, C. W., Lieu, T. A. 2005; 3: 17-?

  Abstract

  The incidence of reported adolescent and adult pertussis continues to rise in the United States. Acellular pertussis vaccines for adolescents and adults have been developed and may be available soon for use in the U.S. Our objectives were: (1) to describe patient valuations of pertussis disease and vaccination; and (2) to compare valuations for short-term and long-term health states associated with pertussis.We conducted telephone surveys with 515 adult patients and parents of adolescent patients with pertussis in Massachusetts to determine valuations of pertussis-related health states for disease and vaccination using time trade-off (TTO) and contingent valuation (CV) techniques. Respondents were randomized to complete either a short-term or long-term TTO exercise. Discrimination between health states for each valuation technique was assessed using Tukey's method, and valuations for short-term vs. long-term health states were compared using the Wilcoxon rank-sum test.Three hundred three (59%) and 309 (60%) respondents completed and understood the TTO and CV exercises, respectively. Overall, respondents gave lower valuations (lower TTO and higher CV values) to avoid a given state for adolescent/adult disease compared to vaccine adverse events. Infant complications due to pertussis were considered worse than adolescent/adult disease, regardless of the method of valuation. The short-term TTO resulted in lower mean valuations and larger mean differences between health states than the long-term TTO exercise.Pertussis was considered worse than adverse events due to vaccination. Short-term health-state valuation is better able to discriminate among health states, which is useful for cost-utility analysis.

  View details for PubMedID 15780145

• Prevention and treatment of human immunodeficiency virus/acquired immunodeficiency syndrome in resource-limited settings. Bulletin of the World Health Organization Hogan, D. R., Salomon, J. A. 2005; 83 (2): 135-43

  Abstract

  Strategies for confronting the epidemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have included a range of different approaches that focus on prevention and treatment. However, debate persists over what levels of emphasis are appropriate for the different components of the global response. This paper presents an overview of this debate and briefly summarizes the evidence on a range of interventions designed to prevent the spread of HIV infection, paying particular attention to voluntary counselling and testing, treatment for sexually transmitted infections and prevention of mother-to-child transmission. We also review the experience with antiretroviral therapy to date in terms of response rates and survival rates, adherence, drug resistance, behavioural change and epidemiological impact. Although various studies have identified strategies with proven effectiveness in reducing the risks of HIV infection and AIDS mortality, considerable uncertainties remain. Successful integration of treatment and prevention of HIV/AIDS will require a balanced approach and rigorous monitoring of the impact of programmes in terms of both individual and population outcomes.

  View details for DOI /S0042-96862005000200014

  View details for PubMedID 15744406

  View details for PubMedCentralID PMC2623810

• Estimating the net effect of HIV on child mortality in African populations affected by generalized HIV epidemics. Journal of acquired immune deficiency syndromes (1999) Marston, M., Zaba, B., Salomon, J. A., Brahmbhatt, H., Bagenda, D. 2005; 38 (2): 219-27

  Abstract

  For a given prevalence, HIV has a relatively higher impact on child mortality when mortality from other causes is low. To project the effect of the epidemic on child mortality, it is necessary to estimate a realistic schedule of "net" age-specific mortality rates that would operate if HIV were the only cause of child death observable. We assume that this net pattern would be independent of mortality from other causes. We used African studies that measured the survival of HIV-infected children (direct data) or survival of children of HIV-infected mothers (indirect data). We developed a mathematic procedure to estimate the mortality of infected children from indirect data sources and obtained net HIV mortality patterns for each study population. The net age-specific HIV mortality pattern for infected children can be described by a double Weibull curve fitted to empiric data; this gives a functional representation of age-specific mortality rates that decline after infancy and rise in the preteens. The fitted curve that we would expect if HIV were the only effective cause of death shows 67% net survival at 1 year and 39% at 5 years. The curve also predicts 13% net survival at 10 years using constraints based on survival of infected adults.

  View details for PubMedID 15671809

• 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 PubMedID 15647780

• Global patterns of healthy life expectancy in the year 2002. BMC public health Mathers, C. D., Iburg, K. M., Salomon, J. A., Tandon, A., Chatterji, S., Ustün, B., Murray, C. J. 2004; 4: 66

  Abstract

  Healthy life expectancy--sometimes called health-adjusted life expectancy (HALE)--is a form of health expectancy indicator that extends measures of life expectancy to account for the distribution of health states in the population. The World Health Organization reports on healthy life expectancy for 192 WHO Member States. This paper describes variation in average levels of population health across these countries and by sex for the year 2002.Mortality was analysed for 192 countries and disability from 135 causes assessed for 17 regions of the world. Health surveys in 61 countries were analyzed using new methods to improve the comparability of self-report data.Healthy life expectancy at birth ranged from 40 years for males in Africa to over 70 years for females in developed countries in 2002. The equivalent "lost" healthy years ranged from 15% of total life expectancy at birth in Africa to 8-9% in developed countries.People living in poor countries not only face lower life expectancies than those in richer countries but also live a higher proportion of their lives in poor health.

  View details for DOI 10.1186/1471-2458-4-66

  View details for PubMedID 15619327

  View details for PubMedCentralID PMC547900

• Taking account of future technology in cost effectiveness analysis. BMJ (Clinical research ed.) Salomon, J. A., Weinstein, M. C., Goldie, S. J. 2004; 329 (7468): 733-6

  View details for DOI 10.1136/bmj.329.7468.733

  View details for PubMedID 15388618

  View details for PubMedCentralID PMC518904

• A multi-method approach to measuring health-state valuations. Health economics Salomon, J. A., Murray, C. J. 2004; 13 (3): 281-90

  Abstract

  Existing techniques for eliciting health-state valuations incorporate both strength of preferences for health states and other values such as risk aversion or time preference. This paper presents a new methodological approach that allows estimation of a set of core underlying health-state values based on responses elicited through multiple measurement techniques. A study was undertaken in which respondents completed the visual analogue (VAS) scale, time trade-off (TTO), standard gamble (SG) and person trade-off (PTO) for a range of states. By specifying flexible parametric functions to explain responses on each measurement technique, we estimated both the underlying strength of preference values for the health states in the study and the values for a set of auxiliary parameters characterising risk attitudes, discount rates, distributional concerns and scale distortion effects in the group of respondents. This study demonstrates that it is possible to understand responses on these four different measurement techniques based on a consistent set of core values. The approach presented here can provide insights into different sources of observed variation in VAS, TTO, SG and PTO responses and facilitate appropriate adjustment of valuations elicited through different methods for use in summary health measures and economic analyses.

  View details for DOI 10.1002/hec.834

  View details for PubMedID 14981652

• Comparability of self rated health: cross sectional multi-country survey using anchoring vignettes. BMJ (Clinical research ed.) Salomon, J. A., Tandon, A., Murray, C. J. 2004; 328 (7434): 258

  Abstract

  To examine differences in expectations for health using anchoring vignettes, which describe fixed levels of health on dimensions such as mobility.Cross sectional survey of adults living in the community.China, Myanmar, Sri Lanka, Pakistan, Turkey, and United Arab Emirates.3012 men and women aged 18 years and older (self ratings); subsample of 406 (vignette ratings).Self rated mobility levels and ratings of hypothetical vignettes using the same questions and response categories.Consistent rankings of vignettes are evidence that vignettes are understood in similar ways in different settings, and internal consistency of orderings on two mobility questions indicates good comprehension. Variation in vignette ratings across age groups suggests that expectations for mobility decline with age. Comparison of responses to two different mobility questions supports the assumption that individual ratings of hypothetical vignettes relate to expectations for health in similar ways as self assessments.Anchoring vignettes could provide a powerful tool for understanding and adjusting for the influence of different health expectations on self ratings of health. Incorporating anchoring vignettes in surveys can improve the comparability of self reported measures.

  View details for DOI 10.1136/bmj.37963.691632.44

  View details for PubMedID 14742348

  View details for PubMedCentralID PMC324453

• Reconsidering the use of rankings in the valuation of health states: a model for estimating cardinal values from ordinal data. Population health metrics Salomon, J. A. 2003; 1 (1): 12

  Abstract

  BACKGROUND: In survey studies on health-state valuations, ordinal ranking exercises often are used as precursors to other elicitation methods such as the time trade-off (TTO) or standard gamble, but the ranking data have not been used in deriving cardinal valuations. This study reconsiders the role of ordinal ranks in valuing health and introduces a new approach to estimate interval-scaled valuations based on aggregate ranking data. METHODS: Analyses were undertaken on data from a previously published general population survey study in the United Kingdom that included rankings and TTO values for hypothetical states described using the EQ-5D classification system. The EQ-5D includes five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) with three possible levels on each. Rank data were analysed using a random utility model, operationalized through conditional logit regression. In the statistical model, probabilities of observed rankings were related to the latent utilities of different health states, modeled as a linear function of EQ-5D domain scores, as in previously reported EQ-5D valuation functions. Predicted valuations based on the conditional logit model were compared to observed TTO values for the 42 states in the study and to predictions based on a model estimated directly from the TTO values. Models were evaluated using the intraclass correlation coefficient (ICC) between predictions and mean observations, and the root mean squared error of predictions at the individual level. RESULTS: Agreement between predicted valuations from the rank model and observed TTO values was very high, with an ICC of 0.97, only marginally lower than for predictions based on the model estimated directly from TTO values (ICC = 0.99). Individual-level errors were also comparable in the two models, with root mean squared errors of 0.503 and 0.496 for the rank-based and TTO-based predictions, respectively. CONCLUSIONS: Modeling health-state valuations based on ordinal ranks can provide results that are similar to those obtained from more widely analyzed valuation techniques such as the TTO. The information content in aggregate ranking data is not currently exploited to full advantage. The possibility of estimating cardinal valuations from ordinal ranks could also simplify future data collection dramatically and facilitate wider empirical study of health-state valuations in diverse settings and population groups.

  View details for DOI 10.1186/1478-7954-1-12

  View details for PubMedID 14687419

  View details for PubMedCentralID PMC344742

• Cost-effectiveness of treatment for chronic hepatitis C infection in an evolving patient population. JAMA Salomon, J. A., Weinstein, M. C., Hammitt, J. K., Goldie, S. J. 2003; 290 (2): 228-37

  Abstract

  Approximately 2.7 million US individuals are chronically infected with the hepatitis C virus (HCV). As public health campaigns are pursued, a growing number of treatment candidates are likely to have minimal evidence of liver damage.To examine the clinical benefits and cost-effectiveness of newer treatments for chronic hepatitis C infection in a population of asymptomatic, HCV sero-positive but otherwise healthy individuals.Cost-effectiveness analysis using a Markov model of the natural history of HCV infection and impact of treatment. We used an epidemiologic model to derive a range of natural history parameters that were empirically calibrated to provide a good fit to observed data on both prevalence of HCV seropositivity and time trends in outcomes related to HCV infection.Cohorts of 40-year-old men and women with elevated levels of alanine aminotransferase, positive results on quantitative HCV RNA assays and serologic tests for antibody to HCV, and no histological evidence of fibrosis on liver biopsy.Monotherapy with standard or pegylated interferon alfa-2b; combination therapy with standard or pegylated interferon plus ribavirin.Lifetime costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.The probability of patients with chronic HCV developing cirrhosis over a 30-year period ranged from 13% to 46% for men and from 1% to 29% for women. The incremental cost-effectiveness of combination therapy with pegylated interferon for men ranged from 26 000 dollars to 64 000 dollars per QALY for genotype 1 and from 10 000 dollars to 28 000 dollars per QALY for other genotypes; and for women ranged from 32 000 dollars to 90 000 dollars for genotype 1 and from 12 000 dollars to 42 000 dollars for other genotypes. Because the benefits of treatment were realized largely in the form of improvements in health-related quality of life, rather than prolonged survivorship, cost-effectiveness ratios expressed as dollars per year of life were substantially higher. Results were most sensitive to assumptions about the gains and decrements in health-related quality of life associated with treatment.While newer treatment options for hepatitis C appear to be reasonably cost-effective on average, these results vary widely across different patient subgroups and depend critically on quality-of-life assumptions. As the pool of persons eligible for treatment for HCV infection expands to the more general population, it will be imperative for patients and their physicians to consider these assumptions in making individual-level treatment decisions.

  View details for DOI 10.1001/jama.290.2.228

  View details for PubMedID 12851278

• Infant mortality is not an adequate summary measure of population health. Journal of epidemiology and community health Mathers, C. D., Salomon, J. A., Murray, C. J. 2003; 57 (5): 319

  View details for PubMedID 12700211

  View details for PubMedCentralID PMC1732459

• Healthy life expectancy: comparison of OECD countries in 2001. Australian and New Zealand journal of public health Mathers, C. D., Murray, C. J., Salomon, J. A., Sadana, R., Tandon, A., Lopez, A. D., Ustün, B., Chatterji, S. 2003; 27 (1): 5-11

  Abstract

  To compare average levels of population health for Australia and other OECD countries in 2001.Healthy life expectancies (HALE) for OECD countries for 2001 are based on analysis of mortality data for OECD countries, country-specific estimates of health state prevalences for 135 causes from the Global Burden of Disease 2000 study, and an analysis of 34 health surveys in 28 OECD countries, using novel methods to improve the comparability of self-report data.HALE at birth ranges from a low of 59.8 years for Turkey to a high of 73.6 years in Japan in 2001. Australia ranks fourth among OECD countries at 71.6 years with a 95% uncertainty interval of 70.9 to 72.8 years, ahead of New Zealand in 13th place at 70.3 years. The equivalent 'lost' healthy years at birth range from around 10 years in OECD countries with lowest life expectancies to around eight years in those with high life expectancies at birth. There is a statistically significant association between higher levels of health expenditure and higher healthy life expectancy across OECD countries, although causal inferences require more sophisticated analyses of the health system and non-health system determinants of levels of health.The new methods used in the WHO Multi-Country Household Survey Study have increased the comparability of self-report data across OECD countries, a major step forward in the use of self-reported data on health. Building on this experience, WHO is developing improved health status measurement techniques for a World Health Survey to be carried out in 2002/03.

  View details for PubMedID 14705260

• Empirically calibrated model of hepatitis C virus infection in the United States. American journal of epidemiology Salomon, J. A., Weinstein, M. C., Hammitt, J. K., Goldie, S. J. 2002; 156 (8): 761-73

  Abstract

  This study presents a comprehensive epidemiologic model of hepatitis C in the United States. Through empirical calibration of model parameter values, the objectives were to gain insights into uncertain aspects of the natural history of hepatitis C and to improve the basis for projecting the future course of the epidemic. A systematic review of the published literature was conducted to define plausible ranges around model parameters, and multiple simulations of the model were undertaken using sampled values from these ranges. Model predictions produced by each set of sampled values were compared with available epidemiologic data on infection prevalence and mortality from liver cancer, and various goodness-of-fit criteria were used to identify the range of parameter values that were consistent with these data. The results of the study indicate that rates of progression to advanced liver disease may be lower than previously assumed. The authors also found that a wide range of plausible assumptions about heterogeneity in these rates, beyond that explained by age and sex, is consistent with observed epidemiologic trends. These findings have important implications both for individual clinical decisions and for broader public health policy.

  View details for PubMedID 12370165

• Can we reverse the HIV/AIDS pandemic with an expanded response? Lancet (London, England) Stover, J., Walker, N., Garnett, G. P., Salomon, J. A., Stanecki, K. A., Ghys, P. D., Grassly, N. C., Anderson, R. M., Schwartländer, B. 2002; 360 (9326): 73-7

  Abstract

  HIV/AIDS has reached pandemic proportions, and is one of the leading causes of death worldwide. In 2001, the Declaration of Commitment on HIV/AIDS set out several aims with respect to reducing the effect and spread of HIV/AIDS, and an expanded response in low-income and middle-income countries was initiated. Here we examine the potential effect of the expanded global response based on analyses of epidemiological data, of mathematical models of HIV-1 transmission, and a review of the impact of prevention interventions on risk behaviours. Analyses suggest that if the successes achieved in some countries in prevention of transmission can be expanded to a global scale by 2005, about 29 million new infections could be prevented by 2010.

  View details for DOI 10.1016/S0140-6736(02)09339-X

  View details for PubMedID 12114060

• Global patterns of healthy life expectancy for older women. Journal of women & aging Mathers, C. D., Murray, C. J., Lopez, A. D., Sadana, R., Salomon, J. A. 2002; 14 (1-2): 99-117

  Abstract

  This paper focuses on patterns of healthy life expectancy for older women around the globe in the year 2000, and on the determinants of differences in disease and injury for older ages. Our study uses data from the World Health Organization for women and men in 191 countries. These data include a summary measure of population health, healthy life expectancy (HALE), which measures the number of years of life expected to be lived in good health, and a complementary measure of the loss of health (disability-adjusted life years or DALYs) due to a comprehensive set of disease and injury causes. We examine two topics in detail: (1) cross-national patterns of female-male differences in healthy life expectancy at age 60; and (2) identification of the major injury and disability causes of disability in women at older ages. Globally, the male-female gap is lower for HALE than for total life expectancy. The sex gap is highest for Russia (10.0 years) and lowest in North Africa and the Middle East, where males and females have similar levels of healthy life expectancy, and in some cases, females have lower levels of healthy life expectancy. We discuss the implications of the findings for international health policy.

  View details for DOI 10.1300/J074v14n01_07

  View details for PubMedID 12537282

• Modelling HIV/AIDS epidemics in sub-Saharan Africa using seroprevalence data from antenatal clinics. Bulletin of the World Health Organization Salomon, J. A., Murray, C. J. 2001; 79 (7): 596-607

  Abstract

  To improve the methodological basis for modelling the HIV/AIDS epidemics in adults in sub-Saharan Africa, with examples from Botswana, Central African Republic, Ethiopia, and Zimbabwe. Understanding the magnitude and trajectory of the HIV/AIDS epidemic is essential for planning and evaluating control strategies.Previous mathematical models were developed to estimate epidemic trends based on sentinel surveillance data from pregnant women. In this project, we have extended these models in order to take full advantage of the available data. We developed a maximum likelihood approach for the estimation of model parameters and used numerical simulation methods to compute uncertainty intervals around the estimates.In the four countries analysed, there were an estimated half a million new adult HIV infections in 1999 (range: 260 to 960 thousand), 4.7 million prevalent infections (range: 3.0 to 6.6 million), and 370 thousand adult deaths from AIDS (range: 266 to 492 thousand).While this project addresses some of the limitations of previous modelling efforts, an important research agenda remains, including the need to clarify the relationship between sentinel data from pregnant women and the epidemiology of HIV and AIDS in the general population.

  View details for PubMedID 11477962

  View details for PubMedCentralID PMC2566469

• Healthy life expectancy in 191 countries, 1999. Lancet (London, England) Mathers, C. D., Sadana, R., Salomon, J. A., Murray, C. J., Lopez, A. D. 2001; 357 (9269): 1685-91

  Abstract

  We describe here the methods used to produce the first estimates of healthy life expectancy (DALE) for 191 countries in 1999. These were based on estimates of the incidence, prevalence, and disability distributions for 109 disease and injury causes by age group, sex, and region of the world, and an analysis of 60 representative health surveys across the world. We used Sullivan's method to compute healthy life expectancy for men and women in each WHO member country. Japan had the highest average healthy life expectancy of 74.5 years at birth in 1999. The bottom ten countries are all in sub-Saharan Africa, where the HIV-AIDS epidemic is most prevalent, resulting in DALE at birth of less than 35 years. Years of healthy life lost due to disability represent 18% of total life expectancy in the bottom countries, and decreases to around 8% in the countries with the highest healthy life expectancies. Globally, the male-female gap is lower for DALE than for total life expectancy. Healthy life expectancy increases across countries at a faster rate than total life expectancy, suggesting that reductions in mortality are accompanied by reductions in disability. Although women live longer, they spend a greater amount of time with disability. As average levels of health expenditure per capita increase, healthy life expectancy increases at a greater rate than total life expectancy.

  View details for DOI 10.1016/S0140-6736(00)04824-8

  View details for PubMedID 11425392

• A critical examination of summary measures of population health. Bulletin of the World Health Organization Murray, C. J., Salomon, J. A., Mathers, C. 2000; 78 (8): 981-94

  Abstract

  In the past decade, interest has been rising in the development, calculation and use of summary measures of population health, which combine information on mortality and non-fatal health outcomes. This paper reviews the issues and challenges in the design and application of summary measures and presents a framework for evaluating different alternatives. Summary measures have a variety of uses, including comparisons of health in different populations and assessments of the relative contributions of different diseases, injuries and risk factors to the total disease burden in a population. Summary measures may be divided into two broad families: health expectancies and health gaps. Within each family, there are many different possible measures, but they share a number of inputs, including information on mortality, non-fatal health outcomes, and health state valuations. Other critical points include calculation methods and a range of conceptual and methodological issues regarding the definition, measurement and valuation of health states. This paper considers a set of basic criteria and desirable properties that may lead to rejection of certain summary measures and the development of new ones. Despite the extensive developmental agenda that remains, applications of summary measures cannot await the final resolution of all methodological issues, so they should focus on those measures that satisfy as many basic criteria and desirable properties as possible.

  View details for PubMedID 10994282

  View details for PubMedCentralID PMC2560826

• Modeling the impact of global tuberculosis control strategies. Proceedings of the National Academy of Sciences of the United States of America Murray, C. J., Salomon, J. A. 1998; 95 (23): 13881-6

  Abstract

  An epidemiological model of tuberculosis has been developed and applied to five regions of the world. Globally, 6.7 million new cases of tuberculosis and 2.4 million deaths from tuberculosis are estimated for 1998. Based on current trends in uptake of the World Health Organization's strategy of directly observed treatment, short-course, we expect a total of 225 million new cases and 79 million deaths from tuberculosis between 1998 and 2030. Active case-finding by using mass miniature radiography could save 23 million lives over this period. A single contact treatment for tuberculosis could avert 24 million cases and 11 million deaths; combined with active screening, it could reduce mortality by nearly 40%. A new vaccine with 50% efficacy could lower incidence by 36 million cases and mortality by 9 million deaths. Support for major extensions to global tuberculosis control strategies will occur only if the size of the problem and the potential for action are recognized more widely.

  View details for PubMedID 9811895

  View details for PubMedCentralID PMC24946

• Expanding the WHO tuberculosis control strategy: rethinking the role of active case-finding. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease Murray, C. J., Salomon, J. A. 1998; 2 (9 Suppl 1): S9-15

  View details for PubMedID 9755959

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

  View details for DOI 10.1177/0033354920912710

  View details for PubMedID 32735183