Clinical Focus


  • Internal Medicine

Academic Appointments


Administrative Appointments


  • Faculty Fellow, Stanford Center for Population Health Sciences (2017 - Present)
  • Faculty Fellow, Center for Innovation in Global Health (2015 - Present)
  • Co-Director, Health Disparities Group, Stanford Center for Population Health Sciences (2015 - Present)
  • Director, Analytics and Modeling Core, Stanford Precision Health for Ethnic and Racial Equity (SPHERE) Collaborative Center (2016 - Present)

Honors & Awards


  • Rhodes Scholar, State of Massachusetts, Oxford University (2002)
  • Dasey Award for Character and Integrity in Medicine, Yale University (2008)
  • Top 100 Global Thinkers List, Foreign Policy Magazine (2013)
  • New Innovator Award, National Institutes of Health, Office of the Director (2015)
  • Inducted Member, The American Society for Clinical Investigation (2016)

Professional Education


  • Medical Education:Yale School Of Medicine Office of Student Affairs (2009) CT
  • MD, PhD, Yale University (2009)
  • MSc, Oxford University (2003)
  • SB, Massachusetts Institute of Technology (2002)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2012)
  • Residency:UCSF-Internal Medicine (2012) CA
  • Internship:UCSF-Internal Medicine (2010) CA

Current Research and Scholarly Interests


https://sites.google.com/stanford.edu/basulab/home

The mission of The Basu Lab is to improve the ability of public health and healthcare systems to reduce the burden of preventable chronic diseases worldwide.
We advance public health and healthcare delivery through community-based research, large-scale data analysis, and simulation modeling.

Clinical Trials


  • Fruit and Vegetable Vouchers With and Without an SSB Tax Recruiting

    We aim to examine whether a purchasing incentive for healthy foods has the same effect on dietary intake in a community with and a community without a purchasing penalty for unhealthy foods. We will perform a randomized non-inferiority trial in two locations, San Francisco (SF) and Los Angeles (LA) to test whether a voucher for purchasing fresh fruits and vegetables has a similar effect in LA and in SF, where the former does not but the latter does have a tax on sugar-sweetened beverages. Participants will be recruited from 4 neighborhoods (N=312) with 2 SF neighborhoods (exposed to the SSB tax) and 2 LA neighborhoods (not exposed to the SSB tax).

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  • Designing Food Voucher Programs to Reduce Disparities in Healthy Diets Not Recruiting

    Improving diets through increased food and vegetable (F&V) consumption significantly reduces the risk of cardiovascular disease (CVD). Programs increasing the accessibility and affordability of F&Vs among low-income Americans have been hindered by the food consumption cycle associated with poverty: the tendency to over-consume calories shortly after receiving funds at the beginning of each month, draining the budget for F&V purchases, or for all food purchases, by month's end. An emerging theory about dietary behavior suggests that providing funds for food in smaller installments distributed throughout the month will smooth the consumption cycle and improve healthy eating—counteracting the tendency to respond to lump sum, once-monthly funding installments by purchasing calorie-dense foods immediately after funds are received. The theory also suggests that funds targeted toward specific healthy foods (e.g., F&Vs) will improve diets more than untargeted funds, despite the inconvenience of utilizing targeted funds. We will rigorously test both hypotheses in a real-world setting by comparing alternative approaches for delivering food purchasing vouchers. We have established and tested the infrastructure to provide vouchers accepted by numerous food sellers (e.g., supermarkets, corner shops) in low-income neighborhoods. Leveraging this infrastructure, we will conduct a randomized trial with a two-by-two factorial design, comparing $20 of vouchers valid for one month to four $5 vouchers each valid for a sequential week of the month (lump sum versus distributed funding), and comparing vouchers restricted to F&V purchases to vouchers redeemable for any food (targeted versus untargeted funding). Low-income adults (N=288) recruited through our community partners will be randomized to one of four 6-month interventions: monthly targeted, monthly untargeted, weekly targeted, or weekly untargeted vouchers. Participants will be assessed through efficient verbal 24-hour dietary recalls validated among low-literacy populations, to determine daily consumption of F&Vs and metrics of overall dietary quality at months 0, 6 and 12 (6 months after vouchers end). Additional surveys will identify moderators and mediators of dietary improvement.

    Stanford is currently not accepting patients for this trial. For more information, please contact Sanjay Basu, (415) 881 - 7030.

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  • The EARN-Health Trial of Financial Savings and Health Not Recruiting

    The current literature in social epidemiology and public health suggests that low financial savings has an unsurprising negative relationship with subjective well-being, and increases the odds of making visits to a healthcare provider, receiving a chronic disease diagnosis, and experiencing medical disability. Earn.org is a community-based non-profit based in San Francisco with a mission to help low-income workers build lifelong savings habits and financial capability. The organization is one of the largest providers of "goal-based savings accounts" or "matched savings accounts" in the US. The investigators propose to conduct a randomized controlled trial to determine the health effects of Earn's savings program. Through this trial, the investigators will test three principal hypotheses: (1) Participants in the Earn account, as compared to a control group, are hypothesized to demonstrate improved scores on mental health scales assessing depression and anxiety. (2) Participants in the Earn account, as compared to a control group, are hypothesized to experience lower odds of harmful behaviors associated with stress, specifically tobacco and alcohol abuse. The investigators hypothesize that the effect on behaviors will be of smaller effect size, and more delayed, than the effect on mental health outcomes, judging from similar effects observed in the micro-credit literature. (3) The mediating variables between Earn account participation and beneficial health outcomes will include increased optimism and internal locus of control.

    Stanford is currently not accepting patients for this trial. For more information, please contact Sanjay Basu, (415) 881 - 7030.

    View full details

2017-18 Courses


Stanford Advisees


All Publications


  • A New Tool for Case Studies in Epidemiology-the Synthetic Control Method. Epidemiology (Cambridge, Mass.) Rehkopf, D. H., Basu, S. 2018; 29 (4): 503–5

    View details for DOI 10.1097/EDE.0000000000000837

    View details for PubMedID 29613871

  • Anticipated burden and mitigation of carbon-dioxide-induced nutritional deficiencies and related diseases: A simulation modeling study. PLoS medicine Weyant, C., Brandeau, M. L., Burke, M., Lobell, D. B., Bendavid, E., Basu, S. 2018; 15 (7): e1002586

    Abstract

    BACKGROUND: Rising atmospheric carbon dioxide concentrations are anticipated to decrease the zinc and iron concentrations of crops. The associated disease burden and optimal mitigation strategies remain unknown. We sought to understand where and to what extent increasing carbon dioxide concentrations may increase the global burden of nutritional deficiencies through changes in crop nutrient concentrations, and the effects of potential mitigation strategies.METHODS AND FINDINGS: For each of 137 countries, we incorporated estimates of climate change, crop nutrient concentrations, dietary patterns, and disease risk into a microsimulation model of zinc and iron deficiency. These estimates were obtained from the Intergovernmental Panel on Climate Change, US Department of Agriculture, Statistics Division of the Food and Agriculture Organization of the United Nations, and Global Burden of Disease Project, respectively. In the absence of increasing carbon dioxide concentrations, we estimated that zinc and iron deficiencies would induce 1,072.9 million disability-adjusted life years (DALYs) globally over the period 2015 to 2050 (95% credible interval [CrI]: 971.1-1,167.7). In the presence of increasing carbon dioxide concentrations, we estimated that decreasing zinc and iron concentrations of crops would induce an additional 125.8 million DALYs globally over the same period (95% CrI: 113.6-138.9). This carbon-dioxide-induced disease burden is projected to disproportionately affect nations in the World Health Organization's South-East Asia and African Regions (44.0 and 28.5 million DALYs, respectively), which already have high existing disease burdens from zinc and iron deficiencies (364.3 and 299.5 million DALYs, respectively), increasing global nutritional inequalities. A climate mitigation strategy such as the Paris Agreement (an international agreement to keep global temperatures within 2°C of pre-industrial levels) would be expected to avert 48.2% of this burden (95% CrI: 47.8%-48.5%), while traditional public health interventions including nutrient supplementation and disease control programs would be expected to avert 26.6% of the burden (95% CrI: 23.8%-29.6%). Of the traditional public health interventions, zinc supplementation would be expected to avert 5.5%, iron supplementation 15.7%, malaria mitigation 3.2%, pneumonia mitigation 1.6%, and diarrhea mitigation 0.5%. The primary limitations of the analysis include uncertainty regarding how food consumption patterns may change with climate, how disease mortality rates will change over time, and how crop zinc and iron concentrations will decline from those at present to those in 2050.CONCLUSIONS: Effects of increased carbon dioxide on crop nutrient concentrations are anticipated to exacerbate inequalities in zinc and iron deficiencies by 2050. Proposed Paris Agreement strategies are expected to be more effective than traditional public health measures to avert the increased inequality.

    View details for DOI 10.1371/journal.pmed.1002586

    View details for PubMedID 29969442

  • Behavioral health integration model. Journal of general internal medicine Basu, S., Williams, J. W., Phillips, R. S. 2018

    View details for DOI 10.1007/s11606-018-4512-9

    View details for PubMedID 29916028

  • Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk. Annals of internal medicine Yadlowsky, S., Hayward, R. A., Sussman, J. B., McClelland, R. L., Min, Y., Basu, S. 2018

    Abstract

    Background: The 2013 pooled cohort equations (PCEs) are central in prevention guidelines for cardiovascular disease (CVD) but can misestimate CVD risk.Objective: To improve the clinical accuracy of CVD risk prediction by revising the 2013 PCEs using newer data and statistical methods.Design: Derivation and validation of risk equations.Setting: Population-based.Participants: 26689 adults aged 40 to 79 years without prior CVD from 6 U.S. cohorts.Measurements: Nonfatal myocardial infarction, death from coronary heart disease, or fatal or nonfatal stroke.Results: The 2013 PCEs overestimated 10-year risk for atherosclerotic CVD by an average of 20% across risk groups. Misestimation of risk was particularly prominent among black adults, of whom 3.9 million (33% of eligible black persons) had extreme risk estimates (<70% or >250% those of white adults with otherwise-identical risk factor values). Updating these equations improved accuracy among all race and sex subgroups. Approximately 11.8 million U.S. adults previously labeled high-risk (10-year risk ≥7.5%) by the 2013 PCEs would be relabeled lower-risk by the updated equations.Limitations: Updating the 2013 PCEs with data from modern cohorts reduced the number of persons considered to be at high risk. Clinicians and patients should consider the potential benefits and harms of reducing the number of persons recommended aspirin, blood pressure, or statin therapy. Our findings also indicate that risk equations will generally become outdated over time and require routine updating.Conclusion: Revised PCEs can improve the accuracy of CVD risk estimates.Primary Funding Source: National Institutes of Health.

    View details for DOI 10.7326/M17-3011

    View details for PubMedID 29868850

  • Food Insecurity and Health Care Expenditures in the United States, 2011-2013 HEALTH SERVICES RESEARCH Berkowitz, S. A., Basu, S., Meigs, J. B., Seligman, H. K. 2018; 53 (3): 1600–1620

    Abstract

    To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures.Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]).Longitudinal retrospective cohort.A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area.Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p < .0001), an extra $1,863 in health care expenditure per year, or $77.5 billion in additional health care expenditure annually.Food insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs.

    View details for DOI 10.1111/1475-6773.12730

    View details for Web of Science ID 000434112400017

    View details for PubMedID 28608473

    View details for PubMedCentralID PMC5980147

  • Matching Microsimulation Risk Factor Correlations to Cross-sectional Data: The Shortest Distance Method MEDICAL DECISION MAKING Suen, S., Goldhaber-Fiebert, J. D., Basu, S. 2018; 38 (4): 452–64

    Abstract

    Microsimulation models often compute the distribution of a simulated cohort's risk factors and medical outcomes over time using repeated waves of cross-sectional data. We sought to develop a strategy to simulate how risk factor values remain correlated over time within individuals, and compare it to available alternative methods.We developed a method using shortest-distance matching for modeling changes in risk factors in individuals over time, which preserves both the cohort distribution of each risk factor as well as the cross-sectional correlation between risk factors observed in repeated cross-sectional data. We compared the performance of the method with rank stability and regression methods, using both synthetic data and data from the Framingham Offspring Heart Study (FOHS) to simulate a cohort's atherosclerotic cardiovascular disease (ASCVD) risk.The correlation between risk factors was better preserved using the shortest distance method than with rank stability or regression (root mean squared difference = 0.077 with shortest distance, v. 0.126 with rank stability and 0.146 with regression in FOHS, and 0.052, 0.426 and 0.352, respectively, in the synthetic data). The shortest distance method generated population ASCVD risk estimate distributions indistinguishable from the true distribution in over 99.8% of cases (Kolmogorov-Smirnov, P > 0.05), outperforming some existing regression methods, which produced ASCVD distributions statistically distinguishable from the true one at the 5% level around 15% of the time.None of the methods considered could predict individual longitudinal trends without error. The shortest-distance method was not statistically inferior to rank stability or regression methods for predicting individual risk factor values over time in the FOHS.A shortest distance method may assist in preserving risk factor correlations in microsimulations informed by cross-sectional data.

    View details for DOI 10.1177/0272989X17741635

    View details for Web of Science ID 000432097700003

    View details for PubMedID 29185378

    View details for PubMedCentralID PMC5913001

  • Illustrating a "consequential" shift in the study of health inequalities: a decomposition of racial differences in the distribution of body mass ANNALS OF EPIDEMIOLOGY Siddiqi, A., Shahidi, F., Hildebrand, V., Hong, A., Basu, S. 2018; 28 (4): 236–41

    Abstract

    We present a conceptual introduction to "distributional inequalities"-differences in distributions of risk factors or other outcomes between social groups-as a consequential shift for research on health inequalities. We also review a companion analytical methodology, "distributional decomposition", which can assess the population characteristics that explain distributional inequalities.Using the 1999-2012 U.S. National Health and Nutrition Examination Survey, we apply statistical decomposition to (a) document gender-specific, black-white inequalities in the distribution of body mass index (BMI) and, (b) assess the extent to which demographic (age), socioeconomic (family income, education), and behavioral predictors (caloric intake, physical activity, smoking, alcohol consumption) are associated with broader distributional inequalities in BMI.Black people demonstrate favorable or no different caloric intake, smoking, or alcohol consumption than whites, but worse levels of physical activity. Racial inequalities extend beyond the obesity threshold to the broader BMI distribution. Demographic, socioeconomic, and behavioral characteristics jointly explain more of the distributional inequality among men than women.Black-white distributional inequalities are present both among men and women, although the mechanisms may differ by gender. The notion of "distributional inequalities" offers an additional purchase for studying social inequalities in health.

    View details for DOI 10.1016/j.annepidem.2018.02.003

    View details for Web of Science ID 000429632700005

    View details for PubMedID 29576050

    View details for PubMedCentralID PMC5875451

  • PARTICIPANTS' RESEARCH LITERACY ABOUT RETENTION AND TRUST IMPROVE AFTER ATTENDING INTERACTIVE ORIENTATION SESSIONS Farias, R., Kiernan, M., Basu, S. OXFORD UNIV PRESS INC. 2018: S388
  • Military Service, Childhood Socio-Economic Status, and Late-Life Lung Function: Korean War Era Military Service Associated with Smaller Disparities. Military medicine Vable, A. M., Kiang, M. V., Basu, S., Rudolph, K. E., Kawachi, I., Subramanian, S. V., Glymour, M. M. 2018

    Abstract

    Background: Military service is associated with smoking initiation, but U.S. veterans are also eligible for special social, financial, and healthcare benefits, which are associated with smoking cessation. A key public health question is how these offsetting pathways affect health disparities; we assessed the net effects of military service on later life pulmonary function among Korean War era veterans by childhood socio-economic status (cSES).Methods: Data came from U.S.-born male Korean War era veteran (service: 1950-1954) and non-veteran participants in the observational U.S. Health and Retirement Study who were alive in 2010 (average age = 78). Veterans (N = 203) and non-veterans (N = 195) were exactly matched using coarsened exact matching on birth year, race, coarsened height, birthplace, childhood health, and parental and childhood smoking. Results were evaluated by cSES (defined as maternal education <8 yr/unknown or ≥8 yr), in predicting lung function, as assessed by peak expiratory flow (PEF), measured in 2008 or 2010.Findings: While there was little overall association between veterans and PEF [beta = 12.8 L/min; 95% confidence interval (CI): (-12.1, 37.7); p = 0.314; average non-veteran PEF = 379 L/min], low-cSES veterans had higher PEF than similar non-veterans [beta = 81.9 L/min; 95% CI: (25.2, 138.5); p = 0.005], resulting in smaller socio-economic disparities among veterans compared to non-veterans [difference in disparities: beta = -85.0 L/min; 95% CI: (-147.9, -22.2); p = 0.008].Discussion: Korean War era military service appears to disproportionately benefit low-cSES veteran lung functioning, resulting in smaller socio-economic disparities among veterans compared with non-veterans.

    View details for DOI 10.1093/milmed/usx196

    View details for PubMedID 29509934

  • Validation of Risk Equations for Complications of Type 2 Diabetes (RECODe) Using Individual Participant Data From Diverse Longitudinal Cohorts in the U.S DIABETES CARE Basu, S., Sussman, J. B., Berkowitz, S. A., Hayward, R. A., Bertoni, A. G., Correa, A., Mwasongwe, S., Yudkin, J. S. 2018; 41 (3): 586–95

    Abstract

    We sought to validate Risk Equations for Complications of Type 2 Diabetes (RECODe) among diverse populations.We compared risk predictions from RECODe equations and from two alternative risk models (UK Prospective Diabetes Study Outcomes Model 2 [UKPDS OM2] and American College of Cardiology/American Heart Association Pooled Cohort Equations) to observed outcomes in two studies: the Multi-Ethnic Study of Atherosclerosis (MESA, n = 1,555 adults with type 2 diabetes, median follow-up 9.1 years) and the Jackson Heart Study (JHS, n = 1,746 adults with type 2 diabetes, median follow-up 8.0 years). Outcomes included nephropathy by multiple measures (microalbuminuria, macroalbuminuria, renal failure, end-stage renal disease, and reduction in glomerular filtration rate), moderate to severe diabetic retinopathy by Airlie House classification, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, congestive heart failure, and all-cause mortality.RECODe equations for microvascular and cardiovascular outcomes had C-statistics for discrimination ranging from 0.71 to 0.85 in MESA and 0.64 to 0.91 in JHS for alternative outcomes. Calibration slopes in MESA ranged from 0.62 for a composite nephropathy outcome, 0.83-1.04 for individual nephropathy outcomes, 1.07 for retinopathy, 1.00-1.05 for cardiovascular outcomes, and 1.03 for all-cause mortality. Slopes in JHS ranged from 0.47 for retinopathy, 0.97-1.16 for nephropathy, 0.72-1.05 for cardiovascular outcomes, and 1.01 for all-cause mortality. The alternative models had C-statistics 0.50-0.72 and calibration slopes 0.07-0.60.RECODe equations improved risk estimation for diverse patients with type 2 diabetes, as compared with two commonly used alternatives.

    View details for DOI 10.2337/dc17-2002

    View details for Web of Science ID 000430455900039

    View details for PubMedID 29269511

    View details for PubMedCentralID PMC5829967

  • Characteristics Associated With Decreased or Increased Mortality Risk From Glycemic Therapy Among Patients With Type 2 Diabetes and High Cardiovascular Risk: Machine Learning Analysis of the ACCORD Trial DIABETES CARE Basu, S., Raghavan, S., Wexler, D. J., Berkowitz, S. A. 2018; 41 (3): 604–12

    Abstract

    Identifying patients who may experience decreased or increased mortality risk from intensive glycemic therapy for type 2 diabetes remains an important clinical challenge. We sought to identify characteristics of patients at high cardiovascular risk with decreased or increased mortality risk from glycemic therapy for type 2 diabetes using new methods to identify complex combinations of treatment effect modifiers.The machine learning method of gradient forest analysis was applied to understand the variation in all-cause mortality within the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (N = 10,251), whose participants were 40-79 years old with type 2 diabetes, hemoglobin A1c (HbA1c) ≥7.5% (58 mmol/mol), cardiovascular disease (CVD) or multiple CVD risk factors, and randomized to target HbA1c <6.0% (42 mmol/mol; intensive) or 7.0-7.9% (53-63 mmol/mol; standard). Covariates included demographics, BMI, hemoglobin glycosylation index (HGI; observed minus expected HbA1c derived from prerandomization fasting plasma glucose), other biomarkers, history, and medications.The analysis identified four groups defined by age, BMI, and HGI with varied risk for mortality under intensive glycemic therapy. The lowest risk group (HGI <0.44, BMI <30 kg/m2, age <61 years) had an absolute mortality risk decrease of 2.3% attributable to intensive therapy (95% CI 0.2 to 4.5, P = 0.038; number needed to treat: 43), whereas the highest risk group (HGI ≥0.44) had an absolute mortality risk increase of 3.7% attributable to intensive therapy (95% CI 1.5 to 6.0; P < 0.001; number needed to harm: 27).Age, BMI, and HGI may help individualize prediction of the benefit and harm from intensive glycemic therapy.

    View details for DOI 10.2337/dc17-2252

    View details for Web of Science ID 000430455900041

    View details for PubMedID 29279299

    View details for PubMedCentralID PMC5829969

  • Hepatitis C virus treatment as prevention in an extended network of people who inject drugs in the USA: a modelling study LANCET INFECTIOUS DISEASES Zelenev, A., Li, J., Mazhnaya, A., Basu, S., Altice, F. L. 2018; 18 (2): 215–24

    Abstract

    Chronic infections with hepatitis C virus (HCV) and HIV are highly prevalent in the USA and concentrated in people who inject drugs. Treatment as prevention with highly effective new direct-acting antivirals is a prospective HCV elimination strategy. We used network-based modelling to analyse the effect of this strategy in HCV-infected people who inject drugs in a US city.Five graph models were fit using data from 1574 people who inject drugs in Hartford, CT, USA. We used a degree-corrected stochastic block model, based on goodness-of-fit, to model networks of injection drug users. We simulated transmission of HCV and HIV through this network with varying levels of HCV treatment coverage (0%, 3%, 6%, 12%, or 24%) and varying baseline HCV prevalence in people who inject drugs (30%, 60%, 75%, or 85%). We compared the effectiveness of seven treatment-as-prevention strategies on reducing HCV prevalence over 10 years and 20 years versus no treatment. The strategies consisted of treatment assigned to either a randomly chosen individual who injects drugs or to an individual with the highest number of injection partners. Additional strategies explored the effects of treating either none, half, or all of the injection partners of the selected individual, as well as a strategy based on respondent-driven recruitment into treatment.Our model estimates show that at the highest baseline HCV prevalence in people who inject drugs (85%), expansion of treatment coverage does not substantially reduce HCV prevalence for any treatment-as-prevention strategy. However, when baseline HCV prevalence is 60% or lower, treating more than 120 (12%) individuals per 1000 people who inject drugs per year would probably eliminate HCV within 10 years. On average, assigning treatment randomly to individuals who inject drugs is better than targeting individuals with the most injection partners. Treatment-as-prevention strategies that treat additional network members are among the best performing strategies and can enhance less effective strategies that target the degree (ie, the highest number of injection partners) within the network.Successful HCV treatment as prevention should incorporate the baseline HCV prevalence and will achieve the greatest benefit when coverage is sufficiently expanded.National Institute on Drug Abuse.

    View details for DOI 10.1016/S1473-3099(17)30676-X

    View details for Web of Science ID 000423814000040

    View details for PubMedID 29153265

    View details for PubMedCentralID PMC5860640

  • 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

  • Tobacco control policies and perinatal and child health: a systematic review and meta-analysis Faber, T., Kumar, A., Mackenbach, J. P., Millett, C., Basu, S., Sheikh, A., Been, J. V. EUROPEAN PUBLISHING. 2018: 58–59

    View details for DOI 10.18332/tid/83921

    View details for Web of Science ID 000431841800158

  • Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study. PLoS medicine Rasella, D., Basu, S., Hone, T., Paes-Sousa, R., Ocké-Reis, C. O., Millett, C. 2018; 15 (5): e1002570

    Abstract

    Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of long-term fiscal austerity measures that will substantially reduce expenditure on social welfare programmes as a percentage of the country's GDP over the next 20 years. The Bolsa Família Programme (BFP)-one of the largest conditional cash transfer programmes in the world-and the nationwide primary healthcare strategy (Estratégia Saúde da Família [ESF]) are affected by fiscal austerity, despite being among the policy interventions with the strongest estimated impact on child mortality in the country. We investigated how reduced coverage of the BFP and ESF-compared to an alternative scenario where the level of social protection under these programmes is maintained-may affect the under-five mortality rate (U5MR) and socioeconomic inequalities in child health in the country until 2030, the end date of the Sustainable Development Goals.We developed and validated a microsimulation model, creating a synthetic cohort of all 5,507 Brazilian municipalities for the period 2017-2030. This model was based on the longitudinal dataset and effect estimates from a previously published study that evaluated the effects of poverty, the BFP, and the ESF on child health. We forecast the economic crisis and the effect of reductions in BFP and ESF coverage due to current fiscal austerity on the U5MR, and compared this scenario with a scenario where these programmes maintain the levels of social protection by increasing or decreasing with the size of Brazil's vulnerable populations (policy response scenarios). We used fixed effects multivariate regression models including BFP and ESF coverage and accounting for secular trends, demographic and socioeconomic changes, and programme duration effects. With the maintenance of the levels of social protection provided by the BFP and ESF, in the most likely economic crisis scenario the U5MR is expected to be 8.57% (95% CI: 6.88%-10.24%) lower in 2030 than under fiscal austerity-a cumulative 19,732 (95% CI: 10,207-29,285) averted under-five deaths between 2017 and 2030. U5MRs from diarrhoea, malnutrition, and lower respiratory tract infections are projected to be 39.3% (95% CI: 36.9%-41.8%), 35.8% (95% CI: 31.5%-39.9%), and 8.5% (95% CI: 4.1%-12.0%) lower, respectively, in 2030 under the maintenance of BFP and ESF coverage, with 123,549 fewer under-five hospitalisations from all causes over the study period. Reduced coverage of the BFP and ESF will also disproportionately affect U5MR in the most vulnerable areas, with the U5MR in the poorest quintile of municipalities expected to be 11.0% (95% CI: 8.0%-13.8%) lower in 2030 under the maintenance of BFP and ESF levels of social protection than under fiscal austerity, compared to no difference in the richest quintile. Declines in health inequalities over the last decade will also stop under a fiscal austerity scenario: the U5MR concentration index is expected to remain stable over the period 2017-2030, compared to a 13.3% (95% CI: 5.6%-21.8%) reduction under the maintenance of BFP and ESF levels of protection. Limitations of our analysis are the ecological nature of the study, uncertainty around future macroeconomic scenarios, and potential changes in other factors affecting child health. A wide range of sensitivity analyses were conducted to minimise these limitations.The implementation of fiscal austerity measures in Brazil can be responsible for substantively higher childhood morbidity and mortality than expected under maintenance of social protection-threatening attainment of Sustainable Development Goals for child health and reducing inequality.

    View details for DOI 10.1371/journal.pmed.1002570

    View details for PubMedID 29787574

    View details for PubMedCentralID PMC5963760

  • Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices JOURNAL OF GENERAL INTERNAL MEDICINE Basu, S., Landon, B. E., Williams, J. W., Bitton, A., Song, Z., Phillips, R. S. 2017; 32 (12): 1330–41

    Abstract

    New payments from Medicare encourage behavioral health services to be integrated into primary care practice activities.To evaluate the financial impact for primary care practices of integrating behavioral health services.Microsimulation model.We simulated patients and providers at federally qualified health centers (FQHCs), non-FQHCs in urban and rural high-poverty areas, and practices outside of high-poverty areas surveyed by the National Association of Community Health Centers, National Ambulatory Medical Care Survey, National Health and Nutrition Examination Survey, and National Health Interview Survey.A collaborative care model (CoCM), involving telephone-based follow-up from a behaviorist care manager, or a primary care behaviorist model (PCBM), involving an in-clinic behaviorist.Net revenue change per full-time physician.When behavioral health integration services were offered only to Medicare patients, net revenue was higher under CoCM (averaging $25,026 per MD in year 1 and $28,548/year in subsequent years) than PCBM (-$7052 in year 1 and -$3706/year in subsequent years). When behavioral health integration services were offered to all patients and were reimbursed by Medicare and private payers, only practices adopting the CoCM approach consistently gained net revenues. The outcomes of the model were sensitive to rates of patient referral acceptance, presentation, and therapy completion, but the CoCM approach remained consistently financially viable whereas PCBM would not be in the long-run across practice types.New Medicare payments may offer financial viability for primary care practices to integrate behavioral health services, but this viability depends on the approach toward care integration.

    View details for DOI 10.1007/s11606-017-4177-9

    View details for Web of Science ID 000416151600012

    View details for PubMedID 28900839

    View details for PubMedCentralID PMC5698230

  • Income Volatility: A Preventable Public Health Threat AMERICAN JOURNAL OF PUBLIC HEALTH Basu, S. 2017; 107 (12): 1898–99

    View details for DOI 10.2105/AJPH.2017.304109

    View details for Web of Science ID 000419239300035

    View details for PubMedID 29116841

  • Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults JAMA INTERNAL MEDICINE Berkowitz, S. A., Seligman, H. K., Rigdon, J., Meigs, J. B., Basu, S. 2017; 177 (11): 1642–49

    Abstract

    Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown.To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures.This is a retrospective cohort study of 4447 noninstitutionalized adults with income below 200% of the federal poverty threshold who participated in the 2011 National Health Interview Survey (NHIS) and the 2012-2013 Medical Expenditure Panel Survey (MEPS).Self-reported SNAP participation in 2011.Total health care expenditures (all paid claims and out-of-pocket costs) in the 2012-2013 period. To test whether SNAP participation was associated with lower subsequent health care expenditures, we used generalized linear modeling (gamma distribution, log link, with survey design information), adjusting for demographics (age, gender, race/ethnicity), socioeconomic factors (income, education, Social Security Disability Insurance disability, urban/rural), census region, health insurance, and self-reported medical conditions. We also conducted sensitivity analyses as a robustness check for these modeling assumptions.A total of 4447 participants (2567 women and 1880 men) were enrolled in the study, mean (SE) age, 42.7 (0.5) years; 1889 were SNAP participants, and 2558 were not. Compared with other low-income adults, SNAP participants were younger (mean [SE] age, 40.3 [0.6] vs 44.1 [0.7] years), more likely to have public insurance or be uninsured (84.9% vs 67.7%), and more likely to be disabled (24.2% vs 10.6%) (P < .001 for all). In age- and gender-adjusted models, health care expenditures between those who did and did not participate in SNAP were similar (difference, $34; 95% CI, -$1097 to $1165). In fully adjusted models, SNAP was associated with lower estimated annual health care expenditures (-$1409; 95% CI, -$2694 to -$125). Sensitivity analyses were consistent with these results, also indicating that SNAP participation was associated with significantly lower estimated expenditures.SNAP enrollment is associated with reduced health care spending among low-income American adults, a finding consistent across several analytic approaches. Encouraging SNAP enrollment among eligible adults may help reduce health care costs in the United States.

    View details for DOI 10.1001/jamainternmed.2017.4841

    View details for Web of Science ID 000414525700022

    View details for PubMedID 28973507

    View details for PubMedCentralID PMC5710268

  • Targeting weight loss interventions to reduce cardiovascular complications of type 2 diabetes: a machine learning-based post-hoc analysis of heterogeneous treatment effects in the Look AHEAD trial LANCET DIABETES & ENDOCRINOLOGY Baum, A., Scarpa, J., Bruzelius, E., Tamler, R., Basu, S., Faghmous, J. 2017; 5 (10): 808–15

    Abstract

    The Action for Health in Diabetes (Look AHEAD) trial investigated whether long-term cardiovascular disease morbidity and mortality could be reduced through a weight loss intervention among people with type 2 diabetes. Despite finding no significant reduction in cardiovascular events on average, it is possible that some subpopulations might have derived benefit. In this post-hoc analysis, we test the hypothesis that the overall neutral average treatment effect in the trial masked important heterogeneous treatment effects (HTEs) from intensive weight loss interventions.We used causal forest modelling, which identifies HTEs, using a random half of the trial data (the training set). We applied Cox proportional hazards models to test the potential HTEs on the remaining half of the data (the testing set). The analysis was deemed exempt from review by the Columbia University Institutional Review Board, Protocol ID# AAAO3003.Between Aug 22, 2001, and April 30, 2004, 5145 patients with type 2 diabetes were enrolled in the Look AHEAD randomised controlled trial, of whom 4901 were included in the The National Institute of Diabetes and Digestive and Kidney Diseases Repository and included in our analyses: 2450 for model development and 2451 in the testing dataset. Baseline HbA1c and self-reported general health distinguished participants who differentially benefited from the intervention. Cox models for the primary composite cardiovascular outcome revealed a number needed to treat of 28·9 to prevent 1 event over 9·6 years among participants with HbA1c 6·8% or higher, or both HbA1c less than 6·8% and Short Form Health Survey (SF-36) general health score of 48 or more (2101 [86%] of 2451 participants in the testing dataset; 167 [16%] of 1046 primary outcome events for intervention vs 205 [19%] of 1055 for control, absolute risk reduction of 3·46%, 95% CI 0·21-6·73%, p=0·038) By contrast, participants with HbA1c less than 6·8% and baseline SF-36 general health score of less than 48 (350 [14%] of 2451 participants in the testing data; 27 [16%] of 171 primary outcome events for intervention vs 15 [8%] of 179 primary outcome events for control) had an absolute risk increase of the primary outcome of 7·41% (0·60 to 14·22, p=0·003).Look AHEAD participants with moderately or poorly controlled diabetes (HbA1c 6·8% or higher) and subjects with well controlled diabetes (HbA1c less than 6·8%) and good self-reported health (85% of the overall study population) averted cardiovascular events from a behavioural intervention aimed at weight loss. However, 15% of participants with well controlled diabetes and poor self-reported general health experienced negative effects that rendered the overall study outcome neutral. HbA1c and a short questionnaire on general health might identify people with type 2 diabetes likely to derive benefit from an intensive lifestyle intervention aimed at weight loss.None.

    View details for DOI 10.1016/S2213-8587(17)30176-6

    View details for Web of Science ID 000411128600018

    View details for PubMedID 28711469

    View details for PubMedCentralID PMC5815373

  • Benefit and harm of intensive blood pressure treatment: Derivation and validation of risk models using data from the SPRINT and ACCORD trials PLOS MEDICINE Basu, S., Sussman, J. B., Rigdon, J., Steimle, L., Denton, B. T., Hayward, R. A. 2017; 14 (10): e1002410

    Abstract

    Intensive blood pressure (BP) treatment can avert cardiovascular disease (CVD) events but can cause some serious adverse events. We sought to develop and validate risk models for predicting absolute risk difference (increased risk or decreased risk) for CVD events and serious adverse events from intensive BP therapy. A secondary aim was to test if the statistical method of elastic net regularization would improve the estimation of risk models for predicting absolute risk difference, as compared to a traditional backwards variable selection approach.Cox models were derived from SPRINT trial data and validated on ACCORD-BP trial data to estimate risk of CVD events and serious adverse events; the models included terms for intensive BP treatment and heterogeneous response to intensive treatment. The Cox models were then used to estimate the absolute reduction in probability of CVD events (benefit) and absolute increase in probability of serious adverse events (harm) for each individual from intensive treatment. We compared the method of elastic net regularization, which uses repeated internal cross-validation to select variables and estimate coefficients in the presence of collinearity, to a traditional backwards variable selection approach. Data from 9,069 SPRINT participants with complete data on covariates were utilized for model development, and data from 4,498 ACCORD-BP participants with complete data were utilized for model validation. Participants were exposed to intensive (goal systolic pressure < 120 mm Hg) versus standard (<140 mm Hg) treatment. Two composite primary outcome measures were evaluated: (i) CVD events/deaths (myocardial infarction, acute coronary syndrome, stroke, congestive heart failure, or CVD death), and (ii) serious adverse events (hypotension, syncope, electrolyte abnormalities, bradycardia, or acute kidney injury/failure). The model for CVD chosen through elastic net regularization included interaction terms suggesting that older age, black race, higher diastolic BP, and higher lipids were associated with greater CVD risk reduction benefits from intensive treatment, while current smoking was associated with fewer benefits. The model for serious adverse events chosen through elastic net regularization suggested that male sex, current smoking, statin use, elevated creatinine, and higher lipids were associated with greater risk of serious adverse events from intensive treatment. SPRINT participants in the highest predicted benefit subgroup had a number needed to treat (NNT) of 24 to prevent 1 CVD event/death over 5 years (absolute risk reduction [ARR] = 0.042, 95% CI: 0.018, 0.066; P = 0.001), those in the middle predicted benefit subgroup had a NNT of 76 (ARR = 0.013, 95% CI: -0.0001, 0.026; P = 0.053), and those in the lowest subgroup had no significant risk reduction (ARR = 0.006, 95% CI: -0.007, 0.018; P = 0.71). Those in the highest predicted harm subgroup had a number needed to harm (NNH) of 27 to induce 1 serious adverse event (absolute risk increase [ARI] = 0.038, 95% CI: 0.014, 0.061; P = 0.002), those in the middle predicted harm subgroup had a NNH of 41 (ARI = 0.025, 95% CI: 0.012, 0.038; P < 0.001), and those in the lowest subgroup had no significant risk increase (ARI = -0.007, 95% CI: -0.043, 0.030; P = 0.72). In ACCORD-BP, participants in the highest subgroup of predicted benefit had significant absolute CVD risk reduction, but the overall ACCORD-BP participant sample was skewed towards participants with less predicted benefit and more predicted risk than in SPRINT. The models chosen through traditional backwards selection had similar ability to identify absolute risk difference for CVD as the elastic net models, but poorer ability to correctly identify absolute risk difference for serious adverse events. A key limitation of the analysis is the limited sample size of the ACCORD-BP trial, which expanded confidence intervals for ARI among persons with type 2 diabetes. Additionally, it is not possible to mechanistically explain the physiological relationships explaining the heterogeneous treatment effects captured by the models, since the study was an observational secondary data analysis.We found that predictive models could help identify subgroups of participants in both SPRINT and ACCORD-BP who had lower versus higher ARRs in CVD events/deaths with intensive BP treatment, and participants who had lower versus higher ARIs in serious adverse events.

    View details for DOI 10.1371/journal.pmed.1002410

    View details for Web of Science ID 000414064100014

    View details for PubMedID 29040268

    View details for PubMedCentralID PMC5644999

  • Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis LANCET PUBLIC HEALTH Faber, T., Kumar, A., Mackenbach, J. P., Millett, C., Basu, S., Sheikh, A., Been, J. V. 2017; 2 (9): E420–E437

    Abstract

    Tobacco smoking and smoke exposure during pregnancy and childhood cause considerable childhood morbidity and mortality. We did a systematic review and meta-analysis to investigate whether implementation of WHO's recommended tobacco control policies (MPOWER) was of benefit to perinatal and child health.We searched 19 electronic databases, hand-searched references and citations, and consulted experts to identify studies assessing the association between implementation of MPOWER policies and child health. We did not apply any language restrictions, and searched the full time period available for each database, up to June 22, 2017. Our primary outcomes of interest were perinatal mortality, preterm birth, hospital attendance for asthma exacerbations, and hospital attendance for respiratory tract infections. Where possible and appropriate, we combined data from different studies in random-effects meta-analyses. This study is registered with PROSPERO, number CRD42015023448.We identified 41 eligible studies (24 from North America, 16 from Europe, and one from China) that assessed combinations of the following MPOWER policies: smoke-free legislation (n=35), tobacco taxation (n=11), and smoking cessation services (n=3). Risk of bias was low in 23 studies, moderate in 16, and high in two. Implementation of smoke-free legislation was associated with reductions in rates of preterm birth (-3·77% [95% CI -6·37 to -1·16]; ten studies, 27 530 183 individuals), rates of hospital attendance for asthma exacerbations (-9·83% [-16·62 to -3·04]; five studies, 684 826 events), and rates of hospital attendance for all respiratory tract infections (-3·45% [-4·64 to -2·25]; two studies, 1 681 020 events) and for lower respiratory tract infections (-18·48% [-32·79 to -4·17]; three studies, 887 414 events). Associations appeared to be stronger when comprehensive smoke-free laws were implemented than when partial smoke-free laws were implemented. Among two studies assessing the association between smoke-free legislation and perinatal mortality, one showed significant reductions in stillbirth and neonatal mortality but did not report the overall effect on perinatal mortality, while the other showed no change in perinatal mortality. Meta-analysis of studies on other MPOWER policies was not possible; all four studies on increasing tobacco taxation and one of two on offering disadvantaged pregnant women help to quit smoking that reported on our primary outcomes had positive findings. Assessment of publication bias was only possible for studies assessing the association between smoke-free legislation and preterm birth, showing some degree of bias.Smoke-free legislation is associated with substantial benefits to child health. The majority of studies on other MPOWER policies also indicated a positive effect. These findings provide strong support for implementation of such policies comprehensively across the world.Chief Scientist Office Scotland, Farr Institute, Netherlands Lung Foundation, Erasmus MC.

    View details for Web of Science ID 000425588900011

    View details for PubMedID 28944313

    View details for PubMedCentralID PMC5592249

  • Diabetes in sub-Saharan Africa: from clinical care to health policy LANCET DIABETES & ENDOCRINOLOGY Atun, R., Davies, J. I., Gale, E. M., Barnighausen, T., Beran, D., Kengne, A., Levitt, N. S., Mangugu, F. W., Nyirenda, M. J., Ogle, G. D., Ramaiya, K., Sewankambo, N. K., Sobngwi, E., Tesfaye, S., Yudkin, J. S., Basu, S., Bommer, C., Heesemann, E., Manne-Goehler, J., Postolovska, I., Sagalova, V., Vollmer, S., Abbas, Z. G., Ammon, B., Angamo, M., Annamreddi, A., Awasthi, A., Besancon, S., Bhadriraju, S., Binagwaho, A., Burgess, P. I., Burton, M. J., Chai, J., Chilunga, F. P., Chipendo, P., Conn, A., Joel, D. R., Eagan, A. W., Gishoma, C., Ho, J., Jong, S., Kakarmath, S. S., Khan, Y., Kharel, R., Kyle, M. A., Lee, S. C., Lichtman, A., Malm, C. P., Mbaye, M. N., Muhimpundu, M. A., Mwagomba, B. M., Mwangi, K., Nair, M., Niyonsenga, S. P., Njuguna, B., Okafor, O. O., Okunade, O., Park, P. H., Pastakia, S. D., Pekny, C., Reja, A., Rotimi, C. N., Rwunganira, S., Sando, D., Sarriera, G., Sharma, A., Sidibe, A., Siraj, E. S., Syed, A. S., Van Acker, K., Werfalli, M. 2017; 5 (8): 622–67
  • Targeting LDL Cholesterol: Beyond Absolute Goals Toward Personalized Risk CURRENT CARDIOLOGY REPORTS Leibowitz, M., Cohen-Stavi, C., Basu, S., Balicer, R. D. 2017; 19 (6)

    Abstract

    The aim of this study was to review and assess the evidence for low-density lipoprotein cholesterol (LDL-C) treatment goals as presented in current guidelines for primary and secondary prevention of cardiovascular disease.Different sets of guidelines and clinical studies for secondary prevention have centered on lower absolute LDL-C targets [<70 mg/dL (<1.8 mmol/L)], greater percent reductions of LDL-C (≥50%), or more intense treatment to achieve greater reductions in cardiovascular risk. Population-based risk models serve as the basis for statin initiation in primary prevention. Reviews of current population risk models for primary prevention show moderate ability to discriminate [with c-statistics ranging from 0.67 to 0.77 (95% CIs from 0.62 to 0.83) for men and women] with poor calibration and overestimation of risk. Individual clinical trial data are not compelling to support specific LDL-C targets and percent reductions in secondary prevention. Increasing utilization of electronic health records and data analytics will enable the development of individualized treatment goals in both primary and secondary prevention.

    View details for DOI 10.1007/s11886-017-0858-6

    View details for Web of Science ID 000401427000006

    View details for PubMedID 28432662

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

    Abstract

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

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

    View details for PubMedID 28528753

    View details for PubMedCentralID PMC5528124

  • The Monthly Cycle of Hypoglycemia: An Observational Claims-based Study of Emergency Room Visits, Hospital Admissions, and Costs in a Commercially Insured Population. Medical care Basu, S., Berkowitz, S. A., Seligman, H. 2017

    Abstract

    Multipayer initiatives have sought to address social determinants of health, such as food insecurity, by linking primary care patients to social services. It remains unclear whether such social determinants contribute to avoidable short-term health care costs.We sought to quantify costs and mitigating factors for the increased risk of hypoglycemia at the end of each month among low-income Americans, a phenomenon related to exhaustion of food budgets.We used claims data on 595,770 commercially insured American adults aged 19 through 64 years old from 2004 through 2015 to estimate the risks and costs of emergency room visits and inpatient hospitalizations for hypoglycemia during the last week of each month versus prior weeks.Although persons with household incomes greater than the national median did not experience a monthly cycle of hypoglycemia, those with incomes less than the national median had an odds ratio of 1.07 (95% confidence interval, 1.02-1.12; P=0.005) for emergency room visits or inpatient hospitalizations for hypoglycemia during the last week of each month, compared with earlier weeks. The risk of end-of-the-month hypoglycemia was mitigated to statistical insignificance during a period of increased federal nutrition program benefits from 2009 through 2013. Eliminating the monthly cycle of hypoglycemia among commercially insured nonelderly adults would be expected to avert $54.1 million per year (95% confidence interval, $0.8-$204.0) in emergency department and inpatient hospitalization costs.Addressing the end-of-the-month increase in hypoglycemia risk among lower-income populations may avert substantial costs from emergency department visits and inpatient hospitalizations.

    View details for DOI 10.1097/MLR.0000000000000728

    View details for PubMedID 28481762

    View details for PubMedCentralID PMC5695234

  • Global Cardiovascular and Renal Outcomes of Reduced GFR. Journal of the American Society of Nephrology Thomas, B., Matsushita, K., Abate, K. H., Al-Aly, Z., Ärnlöv, J., Asayama, K., Atkins, R., Badawi, A., Ballew, S. H., Banerjee, A., Barregård, L., Barrett-Connor, E., Basu, S., Bello, A. K., Bensenor, I., Bergstrom, J., Bikbov, B., Blosser, C., Brenner, H., Carrero, J., Chadban, S., Cirillo, M., Cortinovis, M., Courville, K., Dandona, L., Dandona, R., Estep, K., Fernandes, J., Fischer, F., Fox, C., Gansevoort, R. T., Gona, P. N., Gutierrez, O. M., Hamidi, S., Hanson, S. W., Himmelfarb, J., Jassal, S. K., Jee, S. H., Jha, V., Jimenez-Corona, A., Jonas, J. B., Kengne, A. P., Khader, Y., Khang, Y., Kim, Y. J., Klein, B., Klein, R., Kokubo, Y., Kolte, D., Lee, K., Levey, A. S., Li, Y., Lotufo, P., El Razek, H. M., Mendoza, W., Metoki, H., Mok, Y., Muraki, I., Muntner, P. M., Noda, H., Ohkubo, T., Ortiz, A., Perico, N., Polkinghorne, K., Al-Radaddi, R., Remuzzi, G., Roth, G., Rothenbacher, D., Satoh, M., Saum, K., Sawhney, M., Schöttker, B., Shankar, A., Shlipak, M., Silva, D. A., Toyoshima, H., Ukwaja, K., Umesawa, M., Vollset, S. E., Warnock, D. G., Werdecker, A., Yamagishi, K., Yano, Y., Yonemoto, N., Zaki, M. E., Naghavi, M., Forouzanfar, M. H., Murray, C. J., Coresh, J., Vos, T. 2017

    Abstract

    The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths.

    View details for DOI 10.1681/ASN.2016050562

    View details for PubMedID 28408440

  • Evaluating the Health Impact of Large-Scale Public Policy Changes: Classical and Novel Approaches. Annual review of public health Basu, S., Meghani, A., Siddiqi, A. 2017; 38: 351-370

    Abstract

    Large-scale public policy changes are often recommended to improve public health. Despite varying widely-from tobacco taxes to poverty-relief programs-such policies present a common dilemma to public health researchers: how to evaluate their health effects when randomized controlled trials are not possible. Here, we review the state of knowledge and experience of public health researchers who rigorously evaluate the health consequences of large-scale public policy changes. We organize our discussion by detailing approaches to address three common challenges of conducting policy evaluations: distinguishing a policy effect from time trends in health outcomes or preexisting differences between policy-affected and -unaffected communities (using difference-in-differences approaches); constructing a comparison population when a policy affects a population for whom a well-matched comparator is not immediately available (using propensity score or synthetic control approaches); and addressing unobserved confounders by utilizing quasi-random variations in policy exposure (using regression discontinuity, instrumental variables, or near-far matching approaches).

    View details for DOI 10.1146/annurev-publhealth-031816-044208

    View details for PubMedID 28384086

  • The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis GLOBALIZATION AND HEALTH Barlow, P., McKee, M., Basu, S., Stuckler, D. 2017; 13

    Abstract

    Regional trade agreements are major international policy instruments that shape macro-economic and political systems. There is widespread debate as to whether and how these agreements pose risks to public health. Here we perform a comprehensive systematic review of quantitative studies of the health impact of trade and investment agreements. We identified studies from searches in PubMed, Web of Science, EMBASE, and Global Health Online. Research articles were eligible for inclusion if they were quantitative studies of the health impacts of trade and investment agreements or policy. We systematically reviewed study findings, evaluated quality using the Quality Assessment Tool from the Effective Public Health Practice Project, and performed network citation analysis to study disciplinary siloes.Seventeen quantitative studies met our inclusion criteria. There was consistent evidence that implementing trade agreements was associated with increased consumption of processed foods and sugar-sweetened beverages. Granting import licenses for patented drugs was associated with increased access to pharmaceuticals. Implementing trade agreements and associated policies was also correlated with higher cardiovascular disease incidence and higher Body Mass Index (BMI), whilst correlations with tobacco consumption, under-five mortality, maternal mortality, and life expectancy were inconclusive. Overall, the quality of studies is weak or moderately weak, and co-citation analysis revealed a relative isolation of public health from economics.We identified limitations in existing studies which preclude definitive conclusions of the health impacts of regional trade and investment agreements. Few address unobserved confounding, and many possible consequences and mechanisms linking trade and investment agreements to health remain poorly understood. Results from our co-citation analysis suggest scope for greater interdisciplinary collaboration. Notwithstanding these limitations, our results find evidence that trade agreements pose some significant health risks. Health protections in trade and investment treaties may mitigate these impacts.

    View details for DOI 10.1186/s12992-017-0240-x

    View details for Web of Science ID 000396929000002

    View details for PubMedID 28274238

  • Detecting Heterogeneous Treatment Effects to Guide Personalized Blood Pressure Treatment ANNALS OF INTERNAL MEDICINE Basu, S., Sussman, J. B., Hayward, R. A. 2017; 166 (5): 354-U78

    Abstract

    Two recent randomized trials produced discordant results when testing the benefits and harms of treatment to reduce blood pressure (BP) in patients with cardiovascular disease (CVD).To perform a theoretical modeling study to identify whether large, clinically important differences in benefit and harm among patients (heterogeneous treatment effects [HTEs]) can be hidden in, and explain discordant results between, treat-to-target BP trials.Microsimulation.Results of 2 trials comparing standard (systolic BP target <140 mm Hg) with intensive (systolic BP target <120 mm Hg) BP treatment and data from the National Health and Nutrition Examination Survey (2013 to 2014).U.S. adults.5 years.Societal.BP treatment.CVD events and mortality.Clinically important HTEs could explain differences in outcomes between 2 trials of intensive BP treatment, particularly diminishing benefit with each additional BP agent (for example, adding a second agent reduces CVD risk [hazard ratio, 0.61], but adding a fourth agent to a third has no benefit) and increasing harm at low diastolic BP.Conventional treat-to-target trial designs had poor (<5%) statistical power to detect the HTEs, despite large samples (n > 20 000), and produced biased effect estimates. In contrast, a trial with sequential randomization to more intensive therapy achieved greater than 80% power and unbiased HTE estimates, despite small samples (n = 3500).The HTEs as a function of the number of BP agents only were explored. Simulated aggregate data from the trials were used as model inputs because individual-participant data were not available.Clinically important heterogeneity in intensive BP treatment effects remains undetectable in conventional trial designs but can be detected in sequential randomization trial designs.National Institutes of Health and U.S. Department of Veterans Affairs.

    View details for DOI 10.7326/M16-1756

    View details for Web of Science ID 000396432800008

    View details for PubMedCentralID PMC5815372

  • Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care A Cost-Benefit Analysis MEDICAL CARE Basu, S., Jack, H. E., Arabadjis, S. D., Phillips, R. S. 2017; 55 (2): 140-147

    Abstract

    Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption.To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer's perspective.Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program's expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources.CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4-5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure-approximately 3%-4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings.Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient's primary diagnosis.

    View details for Web of Science ID 000392919300012

    View details for PubMedID 27547954

  • Cost Effectiveness of Subsidizing Fruit and Vegetable Purchases Through the Supplemental Nutrition Assistance Program. American journal of preventive medicine Choi, S. E., Seligman, H., Basu, S. 2017

    Abstract

    A diet high in fruits and vegetables (FV) is associated with reduced risk of chronic disease. One strategy to incentivize FV consumption among low-income households is to make them more affordable through the Supplemental Nutrition Assistance Program (SNAP). This study aims to identify the cost effectiveness of subsidizing FV purchases among the one in seven Americans who participate in SNAP.A cost-effectiveness analysis was conducted from a societal perspective to estimate lifetime costs and health gains associated with subsidizing FV purchases. A stochastic microsimulation model of obesity, type 2 diabetes, myocardial infarction, and stroke in the 2015 U.S. population was used. Model parameters were based on nationally representative SNAP participation and dietary consumption data from the National Health and Nutrition Examination Survey (2003-2012), and data from a randomized trial of FV subsidies among SNAP users.Despite cycling of participants in and out of SNAP, expanding an FV subsidy nationwide through SNAP would be expected to reduce incidence of type 2 diabetes by 1.7% (95% CI=1.2, 2.2), myocardial infarction by 1.4% (95% CI=0.9, 1.9), stroke by 1.2% (95% CI=0.8, 1.6), and obesity by 0.2% (95% CI=0.1, 0.3), and be cost saving from a societal perspective. The saved costs would be largely attributable to long-term reductions in type 2 diabetes and cardiovascular diseases.The model suggests nationwide SNAP FV subsidies would reduce chronic disease morbidity, mortality, and costs over long time horizons that are unlikely to be observed in short-term community-based trials.

    View details for DOI 10.1016/j.amepre.2016.12.013

    View details for PubMedID 28153648

    View details for PubMedCentralID PMC5401647

  • Effectiveness and equity of sugar-sweetened beverage taxation. PLoS medicine Basu, S., Madsen, K. 2017; 14 (6): e1002327

    Abstract

    Sanjay Basu and Kristine Madsen discuss the effects of taxes on sugar-sweetened beverages in both Australia and Berkeley, USA.

    View details for DOI 10.1371/journal.pmed.1002327

    View details for PubMedID 28654690

    View details for PubMedCentralID PMC5487023

  • Dynamic treatment selection and modification for personalised blood pressure therapy using a Markov decision process model: a cost-effectiveness analysis. BMJ open Choi, S. E., Brandeau, M. L., Basu, S. 2017; 7 (11): e018374

    Abstract

    Personalised medicine seeks to select and modify treatments based on individual patient characteristics and preferences. We sought to develop an automated strategy to select and modify blood pressure treatments, incorporating the likelihood that patients with different characteristics would benefit from different types of medications and dosages and the potential severity and impact of different side effects among patients with different characteristics.We developed a Markov decision process (MDP) model to incorporate meta-analytic data and estimate the optimal treatment for maximising discounted lifetime quality-adjusted life-years (QALYs) based on individual patient characteristics, incorporating medication adjustment choices when a patient incurs side effects. We compared the MDP to current US blood pressure treatment guidelines (the Eighth Joint National Committee, JNC8) and a variant of current guidelines that incorporates results of a major recent trial of intensive treatment (Intensive JNC8). We used a microsimulation model of patient demographics, cardiovascular disease risk factors and side effect probabilities, sampling from the National Health and Nutrition Examination Survey (2003-2014), to compare the expected population outcomes from adopting the MDP versus guideline-based strategies.Costs and QALYs for the MDP-based treatment (MDPT), JNC8 and Intensive JNC8 strategies.Compared with the JNC8 guideline, the MDPT strategy would be cost-saving from a societal perspective with discounted savings of US$1187 per capita (95% CI 1178 to 1209) and an estimated discounted gain of 0.06 QALYs per capita (95% CI 0.04 to 0.08) among the US adult population. QALY gains would largely accrue from reductions in severe side effects associated with higher treatment doses later in life. The Intensive JNC8 strategy was dominated by the MDPT strategy.An MDP-based approach can aid decision-making by incorporating meta-analytic evidence to personalise blood pressure treatment and improve overall population health compared with current blood pressure treatment guidelines.

    View details for DOI 10.1136/bmjopen-2017-018374

    View details for PubMedID 29146652

    View details for PubMedCentralID PMC5695480

  • Re-evaluating associations between the Supplemental Nutrition Assistance Program participation and body mass index in the context of unmeasured confounders. Social science & medicine (1982) Rigdon, J., Berkowitz, S. A., Seligman, H. K., Basu, S. 2017; 192: 112–24

    Abstract

    To evaluate the association between participation in the Supplemental Nutrition Assistance Program (SNAP) and body mass index (BMI) in the presence of unmeasured confounding.We applied new matching methods to determine whether previous reports of associations between SNAP participation and BMI were robust to unmeasured confounders. We applied near-far matching, which strengthens standard matching by combining it with instrumental variables analysis, to the nationally-representative National Household Food Acquisition and Purchasing Survey (FoodAPS, N = 10,360, years 2012-13).In ordinary least squares regressions controlling for individual demographic and socioeconomic characteristics, SNAP was associated with increased BMI (+1.23 kg/m2, 95% CI: 0.84, 1.63). While propensity-score-based analysis replicated this finding, using instrumental variables analysis and particularly near-far matching to strengthen the instruments' discriminatory power revealed the association between SNAP and BMI was likely confounded by unmeasured covariates (+0.21 kg/m2, 95% CI: -3.88, 4.29).Previous reports of an association between SNAP and obesity should be viewed with caution, and use of near-far matching may assist similar assessments of health effects of social programs.

    View details for DOI 10.1016/j.socscimed.2017.09.020

    View details for PubMedID 28965002

    View details for PubMedCentralID PMC5815398

  • 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

  • High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care. Health affairs (Project Hope) Basu, S., Phillips, R. S., Song, Z., Bitton, A., Landon, B. E. 2017; 36 (9): 1599–1605

    Abstract

    Capitated payments in the form of fixed monthly payments to cover all of the costs associated with delivering primary care could encourage primary care practices to transform the way they deliver care. Using a microsimulation model incorporating data from 969 US practices, we sought to understand whether shifting to team- and non-visit-based care is financially sustainable for practices under traditional fee-for-service, capitated payment, or a mix of the two. Practice revenues and costs were computed for fee-for-service payments and a range of capitated payments, before and after the substitution of team- and non-visit-based services for low-complexity in-person physician visits. The substitution produced financial losses for simulated practices under fee-for-service payment of $42,398 per full-time-equivalent physician per year; however, substitution produced financial gains under capitated payment in 95 percent of cases, if more than 63 percent of annual payments were capitated. Shifting to capitated payment might create an incentive for practices to increase their delivery of team- and non-visit-based primary care, if capitated payment levels were sufficiently high.

    View details for DOI 10.1377/hlthaff.2017.0367

    View details for PubMedID 28874487

  • Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. Respiratory medicine 2017; 5 (9): 691–706

    Abstract

    Chronic obstructive pulmonary disease (COPD) and asthma are common diseases with a heterogeneous distribution worldwide. Here, we present methods and disease and risk estimates for COPD and asthma from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2015 study. The GBD study provides annual updates on estimates of deaths, prevalence, and disability-adjusted life years (DALYs), a summary measure of fatal and non-fatal disease outcomes, for over 300 diseases and injuries, for 188 countries from 1990 to the most recent year.We estimated numbers of deaths due to COPD and asthma using the GBD Cause of Death Ensemble modelling (CODEm) tool. First, we analysed data from vital registration and verbal autopsy for the aggregate category of all chronic respiratory diseases. Subsequently, models were run for asthma and COPD relying on covariates to predict rates in countries that have incomplete or no vital registration data. Disease estimates for COPD and asthma were based on systematic reviews of published papers, unpublished reports, surveys, and health service encounter data from the USA. We used the Global Initiative of Chronic Obstructive Lung Disease spirometry-based definition as the reference for COPD and a reported diagnosis of asthma with current wheeze as the definition of asthma. We used a Bayesian meta-regression tool, DisMod-MR 2.1, to derive estimates of prevalence and incidence. We estimated population-attributable fractions for risk factors for COPD and asthma from exposure data, relative risks, and a theoretical minimum exposure level. Results were stratified by Socio-demographic Index (SDI), a composite measure of income per capita, mean years of education over the age of 15 years, and total fertility rate.In 2015, 3·2 million people (95% uncertainty interval [UI] 3·1 million to 3·3 million) died from COPD worldwide, an increase of 11·6% (95% UI 5·3 to 19·8) compared with 1990. There was a decrease in age-standardised death rate of 41·9% (37·7 to 45·1) but this was counteracted by population growth and ageing of the global population. From 1990 to 2015, the prevalence of COPD increased by 44·2% (41·7 to 46·6), whereas age-standardised prevalence decreased by 14·7% (13·5 to 15·9). In 2015, 0·40 million people (0·36 million to 0·44 million) died from asthma, a decrease of 26·7% (-7·2 to 43·7) from 1990, and the age-standardised death rate decreased by 58·8% (39·0 to 69·0). The prevalence of asthma increased by 12·6% (9·0 to 16·4), whereas the age-standardised prevalence decreased by 17·7% (15·1 to 19·9). Age-standardised DALY rates due to COPD increased until the middle range of the SDI before reducing sharply. Age-standardised DALY rates due to asthma in both sexes decreased monotonically with rising SDI. The relation between with SDI and DALY rates due to asthma was attributed to variation in years of life lost (YLLs), whereas DALY rates due to COPD varied similarly for YLLs and years lived with disability across the SDI continuum. Smoking and ambient particulate matter were the main risk factors for COPD followed by household air pollution, occupational particulates, ozone, and secondhand smoke. Together, these risks explained 73·3% (95% UI 65·8 to 80·1) of DALYs due to COPD. Smoking and occupational asthmagens were the only risks quantified for asthma in GBD, accounting for 16·5% (14·6 to 18·7) of DALYs due to asthma.Asthma was the most prevalent chronic respiratory disease worldwide in 2015, with twice the number of cases of COPD. Deaths from COPD were eight times more common than deaths from asthma. In 2015, COPD caused 2·6% of global DALYs and asthma 1·1% of global DALYs. Although there are laudable international collaborative efforts to make surveys of asthma and COPD more comparable, no consensus exists on case definitions and how to measure disease severity for population health measurements like GBD. Comparisons between countries and over time are important, as much of the chronic respiratory burden is either preventable or treatable with affordable interventions.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S2213-2600(17)30293-X

    View details for PubMedID 28822787

    View details for PubMedCentralID PMC5573769

  • Development and validation of Risk Equations for Complications Of type 2 Diabetes (RECODe) using individual participant data from randomised trials. The lancet. Diabetes & endocrinology Basu, S., Sussman, J. B., Berkowitz, S. A., Hayward, R. A., Yudkin, J. S. 2017; 5 (10): 788–98

    Abstract

    In view of substantial mis-estimation of risks of diabetes complications using existing equations, we sought to develop updated Risk Equations for Complications Of type 2 Diabetes (RECODe).To develop and validate these risk equations, we used data from the Action to Control Cardiovascular Risk in Diabetes study (ACCORD, n=9635; 2001-09) and validated the equations for microvascular events using data from the Diabetes Prevention Program Outcomes Study (DPPOS, n=1018; 1996-2001), and for cardiovascular events using data from the Action for Health in Diabetes (Look AHEAD, n=4760; 2001-12). Microvascular outcomes were nephropathy, retinopathy, and neuropathy. Cardiovascular outcomes were myocardial infarction, stroke, congestive heart failure, and cardiovascular mortality. We also included all-cause mortality as an outcome. We used a cross-validating machine learning method to select predictor variables from demographic characteristics, clinical variables, comorbidities, medications, and biomarkers into Cox proportional hazards models for each outcome. The new equations were compared to older risk equations by assessing model discrimination, calibration, and the net reclassification index.All equations had moderate internal and external discrimination (C-statistics 0·55-0·84 internally, 0·57-0·79 externally) and high internal and external calibration (slopes 0·71-1·31 between observed and estimated risk). Our equations had better discrimination and calibration than the UK Prospective Diabetes Study Outcomes Model 2 (for microvascular and cardiovascular outcomes, C-statistics 0·54-0·62, slopes 0·06-1·12) and the American College of Cardiology/American Heart Association Pooled Cohort Equations (for fatal or non-fatal myocardial infarction or stroke, C-statistics 0·61-0·66, slopes 0·30-0·39).RECODe might improve estimation of risk of complications for patients with type 2 diabetes.National Institute for Diabetes and Digestive and Kidney Disease, National Heart, Lung and Blood Institute, and National Institute on Minority Health and Health Disparities, National Institutes of Health, and US Department of Veterans Affairs.

    View details for DOI 10.1016/S2213-8587(17)30221-8

    View details for PubMedID 28803840

    View details for PubMedCentralID PMC5769867

  • Health needs, access to healthcare, and perceptions of ageing in an urbanizing community in India: a qualitative study. BMC geriatrics Bhan, N., Madhira, P., Muralidharan, A., Kulkarni, B., Murthy, G., Basu, S., Kinra, S. 2017; 17 (1): 156

    Abstract

    India's elderly population is rising at an unprecedented rate, with a majority living in rural areas. Health challenges associated with ageing, changing social networks and limited public health infrastructure are issues faced by the elderly and caregivers. We examined perceptions of health needs of the elderly across local stakeholders in an urbanizing rural area.The qualitative study was conducted among participants in the Andhra Pradesh Children and Parents Study (APCAPS) site in Rangareddy district, Telangana. We collected data using focus group discussions and interviews among communities (n = 6), health providers (n = 9) and administrators (n = 6). We assessed stakeholders' views on the influence of urbanization on health issues faced and interventions for alleviating these challenges. We used a conceptual-analytical model to derive themes and used an inductive approach to organizing emerging codes as per a priori themes. These were organized as per thematic groups and ranked by different authors in order of importance. Bronfebrenner's theory was used to understand stakeholder perspectives and suggest interventions within four identified spheres of influence - individual, household, community and services.Stakeholders reported frailty, lack of transport and dependence on others as factors impacting health access of the elderly. Existing public health systems were perceived as overburdened and insensitive towards the elderly. Urbanization was viewed positively, but road accidents, crime and loneliness were significant concerns. Interventions suggested by stakeholders included health service outreach, lifestyle counseling, community monitoring of healthcare and engagement activities.We recommend integrating outreach services and lifestyle counseling within programs for care of the elderly. Community institutions can play an important role in the delivery and monitoring of health and social services for the elderly.

    View details for DOI 10.1186/s12877-017-0544-y

    View details for PubMedID 28724399

    View details for PubMedCentralID PMC5517927

  • Impact of the North American Free Trade Agreement on high-fructose corn syrup supply in Canada: a natural experiment using synthetic control methods. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne Barlow, P., McKee, M., Basu, S., Stuckler, D. 2017; 189 (26): E881–E887

    Abstract

    Critics of free trade agreements have argued that they threaten public health, as they eliminate barriers to trade in potentially harmful products, such as sugar. Here we analyze the North American Free Trade Agreement (NAFTA), testing the hypothesis that lowering tariffs on food and beverage syrups that contain high-fructose corn syrup (HFCS) increased its use in foods consumed in Canada.We used supply data from the Food and Agriculture Organization of the United Nations to assess changes in supply of caloric sweeteners including HFCS after NAFTA. We estimate the impact of NAFTA on supply of HFCS in Canada using an innovative, quasi-experimental methodology - synthetic control methods - that creates a control group with which to compare Canada's outcomes. Additional robustness tests were performed for sample, control groups and model specification.Tariff reductions in NAFTA coincided with a 41.6 (95% confidence interval 25.1 to 58.2) kilocalorie per capita daily increase in the supply of caloric sweeteners including HFCS. This change was not observed in the control groups, including Australia and the United Kingdom, as well as a composite control of 16 countries. Results were robust to placebo tests and additional sensitivity analyses.NAFTA was strongly associated with a marked rise in HFCS supply and likely consumption in Canada. Our study provides evidence that even a seemingly modest change to product tariffs in free trade agreements can substantially alter population-wide dietary behaviour and exposure to risk factors.

    View details for DOI 10.1503/cmaj.161152

    View details for PubMedID 28676578

    View details for PubMedCentralID PMC5495638

  • Ten years after the financial crisis: The long reach of austerity and its global impacts on health. Social science & medicine (1982) Basu, S., Carney, M. A., Kenworthy, N. J. 2017; 187: 203–7

    View details for DOI 10.1016/j.socscimed.2017.06.026

    View details for PubMedID 28666546

  • Comparative effectiveness and cost-effectiveness of treat-to-target versus benefit-based tailored treatment of type 2 diabetes in low-income and middle-income countries: a modelling analysis LANCET DIABETES & ENDOCRINOLOGY Basu, S., Shankar, V., Yudkin, J. S. 2016; 4 (11): 922-932

    Abstract

    Optimal prescription of blood pressure, lipid, and glycaemic control treatments for adults with type 2 diabetes remains unclear. We aimed to compare the effectiveness and cost-effectiveness of two treatment approaches for diabetes management in five low-income and middle-income countries.We developed a microsimulation model to compare a treat-to-target (TTT) strategy, aiming to achieve target levels of biomarkers (blood pressure <130/80 mm Hg, LDL <2·59 mmol/L, and HbA1c <7% [ie, 53·0 mmol/mol]), with a benefit-based tailored treatment (BTT) strategy, aiming to lower estimated risk for complications (to a 10 year cardiovascular risk <10% and lifetime microvascular risk <5%) on the basis of age, sex, and biomarker values. Data were obtained from cohorts in China, Ghana, India, Mexico, and South Africa to span a spectrum of risk profiles.The TTT strategy recommended treatment to a larger number of people-who were generally at lower risk of diabetes complications-than the BTT. The BTT strategy recommended treatment to fewer people at higher risk. Compared with the TTT strategy, the BTT strategy would be expected to avert 24·4-30·5% more complications and be more cost-effective from a societal perspective (saving US$4·0-300·0 per disability-adjusted life-year averted in the countries simulated). Alternative treatment thresholds, matched by total cost or population size treated, did not change the comparative superiority of the BTT strategy, nor did titrating treatment using fasting plasma glucose (for areas without HbA1c testing). However, if insulin were unavailable, the BTT strategy would no longer be superior for preventing microvascular events and was superior only for preventing cardiovascular events.A BTT strategy is more effective and cost-effective than a TTT strategy in low-income and middle-income countries for prevention of both cardiovascular and microvascular complications of type 2 diabetes. However, the superiority of the BTT strategy for averting microvascular complications is contingent on insulin availability.Rosenkranz Prize for Healthcare Research in Developing Countries and US National Institutes of Health (U54 MD010724, DP2 MD010478).

    View details for DOI 10.1016/S2213-8587(16)30270-4

    View details for Web of Science ID 000393025500028

    View details for PubMedID 27717768

  • Moderation of the Relation of County-Level Cost of Living to Nutrition by the Supplemental Nutrition Assistance Program AMERICAN JOURNAL OF PUBLIC HEALTH Basu, S., Wimer, C., Seligman, H. 2016; 106 (11): 2064-2070

    Abstract

    To examine the association of county-level cost of living with nutrition among low-income Americans.We used the National Household Food Acquisition and Purchase Survey (2012-2013; n = 14 313; including 5414 persons in households participating in the Supplemental Nutrition Assistance Program [SNAP]) to examine associations between county-level cost-of-living metrics and both food acquisitions and the Healthy Eating Index, with control for individual-, household-, and county-level covariates and accounting for unmeasured confounders influencing both area of living and food acquisition.Living in a higher-cost county-particularly one with high rent costs-was associated with significantly lower volume of acquired vegetables, fruits, and whole grains; greater volume of acquired refined grains, fats and oils, and added sugars; and an 11% lower Healthy Eating Index score. Participation in SNAP was associated with nutritional improvements among persons living in higher-cost counties.Living in a higher-cost county (particularly with high rent costs) is associated with poorer nutrition among low-income Americans, and SNAP may mitigate the negative nutritional impact of high cost of living.

    View details for DOI 10.2105/AJPH.2016.303439

    View details for Web of Science ID 000388090200045

    View details for PubMedID 27631742

  • 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 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. A., Wanga, V., Whiteford, H. A., Zhou, M., 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., Achoki, T., Ackerman, I. N., Adebiyi, A. O., Adedeji, I. A., Adsuar, J. C., Afanvi, K. A., Afshin, A., Agardh, E. E., Agarwal, A., Kumar, S., Ahmed, M. B., Kiadaliri, A. A., Ahmadieh, H., Akseer, N., Al-Aly, Z., Alam, K., Alam, N. K., Aldhahri, S. F., Alegretti, M. A., Aleman, A. V., Alemu, Z. A., Alexander, L. T., Raghib, A., Alkerwi, A., Alla, F., Allebeck, P., Alsharif, U., Altirkawi, K. A., Martin, E. A., Alvis-Guzman, N., Amare, A. T., Amberbir, A., Amegah, A. K., Amini, H., Ammar, W., Amrock, S. M., Anderson, G. M., Anderson, B. O., Antonio, C. A., Anwari, P., Arnlov, J., Arsenijevic, V. S., Artaman, A., Asayesh, H., Asghar, R. J., 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, S., Bayou, T. A., Beardsley, J., Bedi, N., Beghi, E., Bell, B., Bell, M. L., Benjet, C., Bennett, D. A., Bensenor, I. M., Berhane, A., Bernabe, E., Betsu, B. D., Beyene, A. S., Bhala, N., Bhansali, A., Bhatt, S., Biadgilign, S., Bienhofff, K., Bikbov, B., Bin Abdulhak, A. A., Bisanzio, D., Bjertness, E., Blore, J. D., Borschmann, R., Boufous, S., Bourne, R. R., Brainin, M., Brazinova, A., Breitborde, N. J., Brugha, T. S., Buchbinder, R., Buckle, G. C., Butt, Z. A., Calabria, B., Campos-Nonato, I. R., Campuzano, J. C., Carabin, H., Carapetis, J. R., Cardenas, R., Carrero, J. J., Castaneda-Orjuela, C. A., Rivas, J. C., Catala-Lopez, F., Cavalleri, F., Chang, J., Chiang, P. P., Chibalabala, M., Chibueze, C. E., Chisumpa, V. H., Choi, J. J., Choudhury, L., Christensen, H., Ciobanu, L. G., Colistro, V., Colomar, M., Colquhoun, S. M., Cortinovis, M., Crump, J. A., Damasceno, A., Dandona, R., Dargan, P. I., das Neves, J., Davey, G., Davis, A. C., De Leo, D., Degenhardt, L., Del Gobbo, L. C., Derrett, S., Des Jarlais, D. C., deVeber, G. A., Dharmaratne, S. D., Dhillon, P. K., Ding, E. L., Doyle, K. E., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Ebrahimi, H., Ellenbogen, R. G., Elyazar, I., Endries, A. Y., Ermakov, S. P., Eshrati, B., Esteghamati, A., Estep, K., Fahimi, S., 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., Foigt, N., Fowkes, F. G., Franklin, R. C., Friedman, J., Frostad, J., Furst, T., Futran, N. D., Gabbe, B., Gankpe, F. G., Garcia-Basteiro, A. L., Gebrehiwot, T. T., Gebremedhin, A. T., Geleijnse, J. M., Gibney, K. B., Gillum, R. F., Ginawi, I. A., Giref, A. Z., Giroud, M., Gishu, M. D., Godwin, W. W., Gomez-Dantes, H., Gona, P., Goodridge, A., Gopalani, S. V., Gotay, C. C., Goto, A., Gouda, H. N., Guo, Y., Gupta, R., Gupta, R., Gupta, V., Gutierrez, R. A., Hafezi-Nejad, N., Haile, D., Hailu, A. D., Hailu, G. B., Halasa, Y. A., Ribhi, R., Hamadeh, Hamidi, S., Hammami, M., Handal, A. J., Hankey, G. J., Harb, H. L., Harikrishnan, S., Haro, J. M., Hassanvand, M. S., Hassen, T. A., Havmoeller, R., Hay, R. J., Hedayati, M. T., Heredia-Pi, I. B., Heydarpour, P., Hoek, H. W., Hoffman, D. J., Horino, M., Horita, N., Hosgood, H. D., Hoy, D. G., Hsairi, M., Huang, H., Huang, J. J., Iburg, K. M., Idrisov, B. T., Innos, K., Inoue, M., Jacobsen, K. H., Jauregui, A., Jayatilleke, A. U., Jeemon, P., Jha, V., Jiang, G., Jiang, Y., Jibat, T., Jimenez-Corona, A., Jin, Y., Jonas, J. B., Kabir, Z., Kajungu, D. K., Kalkonde, Y., Kamal, R., Kan, H., Kandel, A., Karch, A., Karema, C. K., Karimkhani, C., Kasaeian, A., Katibeh, M., 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., Khang, Y., Khoja, T. A., Khubchandani, J., Kieling, C., Kim, C., Kim, D., Kim, Y. J., Kissoon, N., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kolte, D., Kopec, J. A., Koul, P. A., Koyanagi, A., Defo, B. K., Kuchenbecker, R. S., Bicer, B. K., Kuipers, E. J., Kumar, G. A., Kwan, G. F., Lalloo, R., Lallukka, T., Larsson, A., Latif, A. A., Lavados, P. M., Lawrynowicz, A. E., Leasher, J. L., Leigh, J., Leung, R., Li, Y., Li, Y., Lipshultz, S. E., Liu, P. Y., Liu, Y., Lloyd, B. K., Logroscino, G., Looker, K. J., Lotufo, P. A., Lucas, R. M., Lunevicius, R., Lyons, R. A., El Razek, H. M., Mandavi, M., Majdan, M., Majeed, A., Malekzadeh, R., Malta, D. C., Marcenes, W., Martinez-Raga, J., Masiye, F., Mason-Jones, A. J., Matzopoulos, R., Mayosi, B. M., McGrath, J. J., McKee, M., Meaney, P. A., Mehari, A., Melaku, Y. A., Memiah, P., Memish, Z. A., Mendoza, W., Meretoja, A., Meretoja, T. J., Mesfin, Y. M., Mhimbira, F. A., Miller, T. R., Mills, E. J., Mirarefin, M., Mirrakhimov, E. M., Mitchell, P. B., Mock, C. N., Mohammad, K. A., Mohammadi, A., Mohammed, S., Monasta, L., Montanez Hernandez, J. C., Montico, M., Moradi-Lakeh, M., Mori, R., Mueller, U. O., Mumford, J. E., Murdoch, M. E., Murthy, G. V., Nachega, J. B., Naheed, A., Naldi, L., Nangia, V., Newton, J. N., Ng, M., Ngalesoni, F. N., Le Nguyen, Q., Nisar, M. I., Pete, P. M., Nolla, J. M., Norheim, O. F., Norman, R. E., Norrving, B., Obermeyer, C. M., Ogbo, F. A., Oh, I., Oladimeji, O., Olivares, P. R., Olusanya, B. O., Olusanya, J. O., Oren, E., Ortiz, A., Ota, E., Oyekale, A. S., Pa, M., Park, E., Parsaeian, M., Patten, S. B., Patton, G. C., Pedro, J. M., Pereira, D. M., Perico, N., Pesudovs, K., Petzold, M., Phillips, M. R., Piel, F. B., Pillay, J. D., Pishgar, F., Plass, D., Polinder, S., Popova, S., Poulton, R. G., Pourmalek, F., Prasad, N. M., Qorbani, M., Rabiee, R. H., Radfar, A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, M., Rahman, M. H., Rahman, S. u., Rai, D., Rai, R. K., Rajsic, S., Raju, M., Ram, U., Ranganathan, K., Refaat, A. H., Reitsma, M. B., Remuzzi, G., Resnikoff, S., Reynolds, A., Ribeiro, A. L., Ricci, S., Roba, H. S., Rojas-Rueda, D., Ronfani, L., Roshandel, G., Roth, G. A., Roy, A., Sackey, B. B., Sagar, R., Sanabria, J. R., Dolores Sanchez-Nino, M., Santos, I. S., Santos, J. V., Sarmiento-Suarez, R., Sartorius, B., Satpathy, M., Savic, M., Sawhney, M., Schmidt, M. I., Schneider, I. J., Schutte, A. E., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Shahraz, S., Shaikh, M. A., Sharma, R., She, J., Sheikhbahaei, S., Shen, J., Sheth, K. N., Shibuya, K., Shigematsu, M., Shin, M., Shin, R., Sigfusdottir, I. D., Santos Silva, D. A., Silverberg, J. I., Simard, E. P., Singh, A., Singh, J. A., Singh, P. K., Skirbekk, V., Skogen, J. C., Soljak, M., Soreide, K., Sorensen, R. J., Sreeramareddy, C. T., Stathopoulou, V., Steel, N., Stein, D. J., Stein, M. B., Steiner, T. J., Stovner, L. J., Stranges, S., Stroumpoulis, K., Sunguya, B. F., Sur, P. J., Swaminathan, S., Sykes, B. L., Szoeke, C. E., Tabares-Seisdedos, R., Landon, N., Tanne, D., Tavakkoli, M., Taye, B., Taylor, H. R., Ao, B. J., Tegegne, T. K., Tekle, D. Y., Terkawi, A. S., Tessema, G. A., Thakur, J. S., Thomson, A. J., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tobe-Gai, R., Tonelli, M., Topor-Madry, R., Topouzis, F., Tran, B. X., Dimbuene, Z. T., Tsilimbaris, M., Tura, A. K., Tuzcu, E. M., Tyrovolas, S., Ukwaja, K. N., Undurraga, E. A., Uneke, C. J., Uthman, O. A., van Gool, C. H., van Os, J., Vasankari, T., Vasconcelos, A. M., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Wallin, M. T., Wang, L., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., WestermaM, R., Wijeratne, T., Wilkinson, J. D., Williams, H. C., Wiysonge, C. S., Woldeyohannes, S. M., Wolfe, C. D., Won, S., Xu, G., Yadav, A. K., Yakob, B., Yan, L. 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. 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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. 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    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.

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    View details for PubMedCentralID PMC5388903

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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

  • 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

  • Risk of self-reported symptoms or diagnosis of active tuberculosis in relationship to low body mass index, diabetes and their co-occurrence. Tropical medicine & international health Prince, L., Andrews, J. R., Basu, S., Goldhaber-Fiebert, J. D. 2016; 21 (10): 1272-1281

    Abstract

    Globally, tuberculosis prevalence has declined, but its risk factors have varied across place and time - low body mass index (BMI) has persisted while diabetes has increased. Using India's National Family Health Survey (NFHS), wave 3 and World Health Survey (WHS) data, we examined their relationships to support projection of future trends and targeted control efforts.Multivariate logistic regressions at the individual level with and without diabetes/BMI interactions assessed the relationship between tuberculosis, diabetes and low BMI and the importance of risk factor co-occurrence. Population-level analyses examined how tuberculosis incidence and prevalence varied with diabetes/low BMI co-occurrence.In NFHS, diabetic individuals had higher predicted tuberculosis risks (diabetic vs. non-diabetic: 2.50% vs. 0.63% at low BMI; 0.81% vs. 0.20% at normal BMI; 0.37% vs. 0.09% at high BMI), which were not significantly different when modelled independently or allowing for risk modification with diabetes/low BMI co-occurrence. WHS findings were generally consistent. Population-level analysis found that diabetes/low BMI co-occurrence may be associated with elevated tuberculosis risk, although its predicted effect on tuberculosis incidence/prevalence was generally ≤0.2 percentage points and not robustly statistically significant.Concerns about the additional elevation of tuberculosis risk from diabetes/low BMI co-occurrence and hence the need to coordinate tuberculosis control efforts around the nexus of co-occurring diabetes and low BMI may be premature. However, study findings robustly support the importance of individually targeting low BMI and diabetes as part of ongoing tuberculosis control efforts.

    View details for DOI 10.1111/tmi.12763

    View details for PubMedID 27495971

  • Reduced Emergency Department Utilization after Increased Access to Primary Care. PLoS medicine Basu, S., Phillips, R. S. 2016; 13 (9)

    Abstract

    Sanjay Basu and Russell Phillips discuss the findings from Whittaker and colleagues on the link between extending primary care hours and emergency department utilization.

    View details for DOI 10.1371/journal.pmed.1002114

    View details for PubMedID 27598299

  • Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model. Annals of family medicine Basu, S., Phillips, R. S., Song, Z., Landon, B. E., Bitton, A. 2016; 14 (5): 404-414

    Abstract

    We assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives.We estimated practices' changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys. Simulated practices reflecting the national range of practice size, location, and patient population were examined under several potential changes in clinical services: investments in patient tracking, communications, and quality improvement; increased support staff; altered visit templates to accommodate longer visits, telephone visits or electronic visits; and extended service delivery hours.Under the status quo of traditional FFS payments, clinics operate near their maximum estimated possible net revenue levels, suggesting they respond strongly to existing financial incentives. Practices gained substantial additional net annual revenue per full-time physician under PMPM or PMPM plus P4P payments ($113,300 per year, 95% CI, $28,500 to $198,200) but not under increased FFS payments (-$53,500, 95% CI, -$69,700 to -$37,200), after accounting for costs of meeting PCMH funding requirements. Expanding services beyond minimum required levels decreased net revenue, because traditional FFS revenues decreased.PCMH funding through PMPM payments could substantially improve practice finances but will not offer sufficient financial incentives to expand services beyond minimum requirements for PCMH funding.

    View details for DOI 10.1370/afm.1960

    View details for PubMedID 27621156

  • Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden LANCET DIABETES & ENDOCRINOLOGY White, J. S., Hamad, R., Li, X., Basu, S., Ohlsson, H., Sundquist, J., Sundquist, K. 2016; 4 (6): 517-524

    Abstract

    Although studies have shown associations between neighbourhood quality and chronic disease outcomes, such associations are potentially confounded by the selection of different types of people into different neighbourhood environments. We sought to identify the causal effects of neighbourhood deprivation on type 2 diabetes risk, by comparing refugees in Sweden who were actively dispersed by government policy to low-deprivation, moderate-deprivation, or high-deprivation neighbourhoods.In this quasi-experimental study, we analysed national register data for refugees who arrived in Sweden aged 25-50 years, at a time when the government policy involved quasi-random dispersal of refugees to neighbourhoods with different levels of poverty and unemployment, schooling, and social welfare participation. Individuals in our sample were assigned to a neighbourhood categorised as high deprivation (≥1 SD above the mean), moderate deprivation (within 1 SD of the mean), or low deprivation (≥1 SD below the mean). The primary outcome was new diagnosis of type 2 diabetes between Jan 1, 2002, and Dec 31, 2010. We used multivariate logistic and linear regressions to assess the effects of neighbourhood deprivation on diabetes risk, controlling for potential confounders affecting neighbourhood assignment and assessing effects of cumulative exposure to different neighbourhood conditions.We included data for 61 386 refugees who arrived in Sweden during 1987-91 and who were assigned to one of 4833 neighbourhoods. Being assigned to an area deemed high deprivation versus low deprivation was associated with an increased risk of diabetes (odds ratio [OR] 1·22, 95% CI 1·07-1·38; p=0·001). In analyses that included fixed effects for assigned municipality, the increased diabetes risk was estimated to be 0·85 percentage points (95% CI -0·030 to 1·728; p=0·058). Neighbourhood effects grew over time such that 5 years of additional exposure to high-deprivation versus low-deprivation neighbourhoods was associated with a 9% increase in diabetes risk.This study makes use of a pre-existing governmental natural experiment to show that neighbourhood deprivation increased the risk of diabetes in refugees in Sweden. This finding has heightened importance in the context of the current refugee crisis in Europe.US National Heart, Lung, and Blood Institute, US National Center for Advancing Translational Sciences, US National Institute on Minority Health and Health Disparities, Swedish Research Council.

    View details for DOI 10.1016/S2213-8587(16)30009-2

    View details for Web of Science ID 000376462800017

    View details for PubMedID 27131930

    View details for PubMedCentralID PMC4875844

  • Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s AMERICAN JOURNAL OF EPIDEMIOLOGY Basu, S., Rehkopf, D. H., Siddiqi, A., Glymour, M. M., Kawachi, I. 2016; 183 (6): 531-538

    View details for DOI 10.1093/aje/kwv249

    View details for Web of Science ID 000372579500003

  • Alternative Strategies to Achieve Cardiovascular Mortality Goals in China and India A Microsimulation of Target- Versus Risk-Based Blood Pressure Treatment CIRCULATION Basu, S., Yudkin, J. S., Sussman, J. B., Millett, C., Hayward, R. A. 2016; 133 (9): 840-848

    Abstract

    The World Health Organization aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure is a leading CVD risk factor. We sought to compare 3 strategies for treating blood pressure in China and India: a treat-to-target (TTT) strategy emphasizing lowering blood pressure to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the World Health Organization.We developed a microsimulation model of adults aged 30 to 70 years in China and in India to compare the 2 treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk of ≥10% used similar financial resources but averted ≈5 million more disability-adjusted life-years in both China and India than a TTT approach based on current US guidelines. The hybrid strategy in the current World Health Organization guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205 to $272/disability-adjusted life-year averted, which was $142 to $182 less per disability-adjusted life-year than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation and to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy.In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality.

    View details for DOI 10.1161/CIRCULATIONAHA.115.019985

    View details for Web of Science ID 000371348900003

    View details for PubMedID 26762520

  • Expansion of the National Salt Reduction Initiative: A Mathematical Model of Benefits and Risks of Population-Level Sodium Reduction MEDICAL DECISION MAKING Choi, S. E., Brandeau, M. L., Basu, S. 2016; 36 (1): 72-85

    Abstract

    . The National Salt Reduction Initiative, in which food producers agree to lower sodium to levels deemed feasible for different foods, is expected to significantly reduce sodium intake if expanded to a large sector of food manufacturers.. Given recent data on the relationship between sodium intake, hypertension, and associated cardiovascular disease at a population level, we sought to examine risks and benefits of the program.. To estimate the impact of further expanding the initiative on hypertension, myocardial infarction (MI) and stroke incidence, and related mortality, given food consumption patterns across the United States, we developed and validated a stochastic microsimulation model of hypertension, MI, and stroke morbidity and mortality, using data from food producers on sodium reduction among foods, linked to 24-hour dietary recalls, blood pressure, and cardiovascular histories from the National Health and Nutrition Examination Survey.. Expansion of the initiative to ensure all restaurants and manufacturers reach agreed-upon sodium targets would be expected to avert from 0.9 to 3.0 MIs (a 1.6%-5.4% reduction) and 0.5 to 2.8 strokes (a 1.1%-6.2% reduction) per 10,000 Americans per year over the next decade, after incorporating consumption patterns and variations in the effect of sodium reduction on blood pressure among different demographic groups. Even high levels of consumer addition of table salt or substitution among food categories would be unlikely to neutralize this benefit. However, if recent epidemiological associations between very low sodium and increased mortality are causal, then older women may be at risk of increased mortality from excessively low sodium intake.An expanded National Salt Reduction Initiative is likely to significantly reduce hypertension and hypertension-related cardiovascular morbidity but may be accompanied by potential risks to older women.

    View details for DOI 10.1177/0272989X15583846

    View details for Web of Science ID 000366910300008

    View details for PubMedID 25926284

  • A Simulation Modeling Framework to Optimize Programs Using Financial Incentives to Motivate Health Behavior Change MEDICAL DECISION MAKING Basu, S., Kiernan, M. 2016; 36 (1): 48-58

    View details for DOI 10.1177/0272989X15585984

    View details for Web of Science ID 000366910300006

    View details for PubMedID 25977362

  • 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. J., Brenner, H., Briggs, A. D., Broday, D. M., Brooks, P. M., Bruce, N. G., Brugha, T. S., Brunekreef, B., Buchbinder, R., Bui, L. N., Bukhman, G., Bulloch, A. G., Burch, M., Burney, P. G., Campos-Nonato, I. R., Campuzano, J. C., Cantoral, A. J., Caravanos, J., Cardenas, R., Cardis, E., 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., Chen, Z., Chiang, P. P., Chimed-Ochir, O., Chowdhury, R., Christophi, C. A., Chuang, T., Chugh, S. S., Cirillo, M., Classen, T. K., Colistro, V., Colomar, M., Colquhoun, S. M., Contreras, A. G., Cooper, C., Cooperrider, K., Cooper, L. T., Coresh, J., Courville, K. J., Criqui, M. H., Cuevas-Nasu, L., Damsere-Derry, J., Danawi, H., Dandona, L., Dandona, R., Dargan, P. I., Davis, A., Davitoiu, D. V., Dayama, A., de Castro, E. F., De la Cruz-Gongora, V., De Leo, D., de Lima, G., Degenhardt, L., Del Pozo-Cruz, B., Dellavalle, R. 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. C., Guillemin, F., Gunnell, D., Gupta, R., Gupta, R., Gutierrez, R. A., Hafezi-Nejad, N., Hagan, H., Hagstromer, M., Halasa, Y. A., Hamadeh, R. R., Hammami, M., Hankey, G. J., Hao, Y., Harb, H. L., Haregu, T. N., Haro, J. M., Havmoeller, R., Hay, S. I., Hedayati, M. T., Heredia-Pi, I. B., Hernandez, L., Heuton, K. R., Heydarpour, P., Hijar, M., Hoek, H. W., Man, H. J., Hornberger, J. C., Hosgood, H. D., Hoy, D. G., Hsairi, M., Hu, G., Hu, H., Huang, C., Huang, J. J., Hubbell, B. J., Huiart, L., Husseini, A., Iannarone, M. L., Iburg, K. M., Idrisov, B. T., Ikeda, N., Innos, K., Inoue, M., Islami, F., Ismayilova, S., Jacobsen, K. H., Jansen, H. A., Jarvis, D. L., Jassal, S. K., Jauregui, A., Jayaraman, S., Jeemon, P., Jensen, P. N., Jha, V., Jiang, F., Jiang, G., Jiang, Y., Jonas, J. B., Juel, K., Kan, H., Roseline, S. S., Karam, N. E., Karch, A., Karema, C. K., Karthikeyan, G., Kaul, A., Kawakami, N., Kazi, D. S., Kemp, A. H., Kengne, A. P., Keren, A., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Khatibzadeh, S., Khonelidze, I., Kieling, C., Kim, D., Kim, S., Kim, Y., Kimokoti, R. W., Kinfu, Y., Kinge, J. M., Kissela, B. M., Kivipelto, M., Knibbs, L. D., Knudsen, A. K., Kokubo, Y., Kose, M. R., Kosen, S., Kraemer, A., Kravchenko, M., Krishnaswami, S., Kromhout, H., Ku, T., Defo, B. K., Bicer, B. K., Kuipers, E. J., Kulkarni, C., Kulkarni, V. S., Kumar, G. A., Kwan, G. F., Lai, T., Balaji, A. L., Lalloo, R., Lallukka, T., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Laryea, D. O., Lavados, P. M., Lawrynowicz, A. E., Leasher, J. L., Lee, J., Leigh, J., Leung, R., Levi, M., Li, Y., Li, Y., Liang, J., Liang, X., Lim, S. S., Lindsay, M. P., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Logroscino, G., London, S. J., Lopez, N., Lortet-Tieulent, J., Lotufo, P. A., Lozano, R., Lunevicius, R., Ma, J., Ma, S., Machado, V. M., MacIntyre, M. F., Magis-Rodriguez, C., Mahdi, A. A., Majdan, M., Malekzadeh, R., Mangalam, S., Mapoma, C. C., Marape, M., Marcenes, W., Margolis, D. J., Margono, C., Marks, G. B., Martin, R. V., Marzan, M. B., Mashal, M. T., Masiye, F., Mason-Jones, A. J., Matsushita, K., Matzopoulos, R., Mayosi, B. M., Mazorodze, T. T., Mckay, A. C., McKee, M., McLain, A., Meaney, P. A., Medina, C., Mehndiratta, M. M., Mejia-Rodriguez, F., Mekonnen, W., Melaku, Y. A., Meltzer, M., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Mhimbira, F. A., Micha, R., Miller, T. R., Mills, E. J., Misganaw, A., Mishra, S., Ibrahim, N. M., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Hernandez, J. C., Montico, M., Moore, A. R., Morawska, L., Mori, R., Moschandreas, J., Moturi, W. N., Arian, D. M., Mueller, U. O., Mukaigawara, M., Mullany, E. C., Murthy, K. S., Naghavi, M., Nahas, Z., Naheed, A., Naidoo, K. S., Naldi, L., Nand, D., Nangia, V., Narayan, K. M., Nash, D., Neal, B., Nejjari, C., Neupane, S. P., Newton, C. R., Ngalesoni, F. N., Ngirabega, J. d., Nguyen, G., Nguyen, N. T., Nieuwenhuijsen, M. J., Nisar, M. I., Nogueira, J. R., Nolla, J. M., Nolte, S., Norheim, O. F., Norman, R. E., Norrving, B., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orozco, R., Pagcatipunan, R. S., Pain, A. W., Pandian, J. D., Panelo, C. I., Papachristou, C., Park, E., Parry, C. D., Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pedraza, L. S., Pedroza, A., Stokic, L. P., Pekericli, A., Pereira, D. M., Perez-Padilla, R., Perez-Ruiz, F., Perico, N., Perry, S. A., Pervaiz, A., Pesudovs, K., Peterson, C. B., Petzold, M., Phillips, M. R., Phua, H. P., Plass, D., Poenaru, D., Polanczyk, G. V., Polinder, S., Pond, C. D., Pope, C. A., Pope, D., Popova, S., Pourmalek, F., Powles, J., Prabhakaran, D., Prasad, N. M., Qato, D. M., Quezada, A. D., Quistberg, D. A., Racape, L., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Rahman, S. u., Raju, M., Rakovac, I., Rana, S. M., Rao, M., Razavi, H., Reddy, K. S., Refaat, A. H., Rehm, J., Remuzzi, G., Ribeiro, A. L., Riccio, P. M., Richardson, L., Riederer, A., Robinson, M., Roca, A., Rodriguez, A., Rojas-Rueda, D., Romieu, I., Ronfani, L., Room, R., Roy, N., Ruhago, G. M., Rushton, L., Sabin, N., Sacco, R. L., Saha, S., Sahathevan, R., Sahraian, M. A., Salomon, J. A., Salvo, D., Sampson, U. K., Sanabria, J. R., Sanchez, L. M., Sanchez-Pimienta, T. G., Sanchez-Riera, L., Sandar, L., Santos, I. S., Sapkota, A., Satpathy, M., Saunders, J. E., Sawhney, M., Saylan, M. I., Scarborough, P., Schmidt, J. C., Schneider, I. J., Schoettker, B., Schwebel, D. C., Scott, J. G., Seedat, S., Sepanlou, S. G., Serdar, B., Servan-Mori, E. E., Shaddick, G., Shahraz, S., Levy, T. S., Shangguan, S., She, J., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shinohara, Y., Shiri, R., Shishani, K., Shiue, I., Sigfusdottir, I. D., Silberberg, D. H., Simard, E. P., Sindi, S., Singh, A., Singh, G. M., Singh, J. A., Skirbekk, V., Sliwa, K., Soljak, M., Soneji, S., Soreide, K., Soshnikov, S., Sposato, L. A., Sreeramareddy, C. T., Stapelberg, N. J., Stathopoulou, V., Steckling, N., Stein, D. J., Stein, M. B., Stephens, N., Stoeckl, H., Straif, K., Stroumpoulis, K., Sturua, L., Sunguya, B. F., Swaminathan, S., Swaroop, M., Sykes, B. L., Tabb, K. M., Takahashi, K., Talongwa, R. T., Tandon, N., Tanne, D., Tanner, M., Tavakkoli, M., Ao, B. J., Teixeira, C. M., Rojo, M. M., Terkawi, A. S., Texcalac-Sangrador, J. L., Thackway, S. V., Thomson, B., Thorne-Lyman, A. L., Thrift, A. G., Thurston, G. D., Tillmann, T., Tobollik, M., Tonelli, M., Topouzis, F., Towbin, J. R., Toyoshima, H., Traebert, J. E., Tran, B. X., Trasande, L., Trillini, M., Trujillo, U., Dimbuene, Z. T., Tsilimbaris, M., Tuzcu, E. M., Uchendu, U. S., Ukwaja, K. N., Uzun, S. B., van de Vijver, S., Van Dingenen, R., van Gool, C. H., van Os, J., Varakin, Y. Y., Vasankari, T. J., Vasconcelos, A. M., Vavilala, M. S., Veerman, L. J., Velasquez-Melendez, G., Venketasubramanian, N., Vijayakumar, L., Villalpando, S., Violante, F. S., Vlassov, V. V., Vollset, S. E., Wagner, G. R., Waller, S. G., Wallin, M. T., Wan, X., Wang, H., Wang, J., Wang, L., Wang, W., Wang, Y., Warouw, T. S., Watts, C. H., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wessells, K. R., Westerman, R., Whiteford, H. A., Wilkinson, J. D., Williams, H. C., Williams, T. N., Woldeyohannes, S. M., Wolfe, C. D., Wong, J. Q., Woolf, A. D., Wright, J. L., Wurtz, B., Xu, G., Yan, L. L., Yang, G., Yano, Y., Ye, P., Yenesew, M., Yentuer, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M. Z., Younoussi, Z., Yu, C., Zaki, M. E., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zhu, S., Zou, X., Zunt, J. R., Lopez, A. D., Vos, T., Murray, C. J. 2015; 386 (10010): 2287-2323

    Abstract

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

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

    View details for Web of Science ID 000365993200031

    View details for PubMedCentralID PMC4685753

  • Health and Economic Implications of National Treatment Coverage for Cardiovascular Disease in India Cost-Effectiveness Analysis CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES Basu, S., Bendavid, E., Sood, N. 2015; 8 (6): 541-551

    Abstract

    Whether to cover cardiovascular disease costs is an increasingly pressing question for low- and middle-income countries. We sought to identify the impact of expanding national insurance to cover primary prevention, secondary prevention, and tertiary treatment for cardiovascular disease in India.We incorporated data from coverage experiments into a validated microsimulation model of myocardial infarction and stroke in India to evaluate the cost-effectiveness of alternate coverage strategies. Coverage of primary prevention alone saved 3.6 million disability-adjusted life-years (DALY) per annum at an incremental cost-effectiveness ratio of $469 per DALY averted when compared with the status quo of no coverage. Coverage of primary and secondary preventions was dominated by a strategy of covering primary prevention and tertiary treatment, which prevented 6.6 million DALYs at an incremental cost-effectiveness ratio of $2241 per DALY averted, when compared with that of primary prevention alone. The combination of all 3 categories yielded the greatest impact at an incremental cost per DALY averted of $5588 when compared with coverage of primary prevention plus tertiary treatment. When compared with the status quo of no coverage, coverage of all 3 categories of prevention/treatment yielded an incremental cost-effectiveness ratio of $1331 per DALY averted. In sensitivity analyses, coverage of primary preventive treatments remained cost-effective even if adherence and access to therapy were low, but tertiary coverage would require avoiding unnecessary procedures to remain cost-effective.Coverage of all 3 major types of cardiovascular treatment would be expected to have high impact and reasonable cost-effectiveness in India across a broad spectrum of access and adherence levels.

    View details for DOI 10.1161/CIRCOUTCOMES.115.001994

    View details for Web of Science ID 000364791200004

    View details for PubMedID 26555122

    View details for PubMedCentralID PMC4801228

  • 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. 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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

  • Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices A Modeling Study ANNALS OF INTERNAL MEDICINE Basu, S., Phillips, R. S., Bitton, A., Song, Z., Landon, B. E. 2015; 163 (8): 580-?

    View details for DOI 10.7326/M14-2677

    View details for Web of Science ID 000363737400016

    View details for PubMedID 26389533

  • The epidemiological advantage of preferential targeting of tuberculosis control at the poor REVISTA PANAMERICANA DE SALUD PUBLICA-PAN AMERICAN JOURNAL OF PUBLIC HEALTH Andrews, J. R., Basu, S., Dowdy, D. W., Murray, M. B. 2015; 38 (3): 186-194
  • A Review Of Innovative International Financing Mechanisms To Address Noncommunicable Diseases HEALTH AFFAIRS Meghani, A., Basu, S. 2015; 34 (9): 1546-1553

    View details for DOI 10.1377/hlthaff.2015.0352

    View details for Web of Science ID 000361142100015

    View details for PubMedID 26355057

  • 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

  • Using Decomposition Analysis to Identify Modifiable Racial Disparities in the Distribution of Blood Pressure in the United States AMERICAN JOURNAL OF EPIDEMIOLOGY Basu, S., Hong, A., Siddiqi, A. 2015; 182 (4): 345-353

    Abstract

    To lower the prevalence of hypertension and racial disparities in hypertension, public health agencies have attempted to reduce modifiable risk factors for high blood pressure, such as excess sodium intake or high body mass index. In the present study, we used decomposition methods to identify how population-level reductions in key risk factors for hypertension could reshape entire population distributions of blood pressure and associated disparities among racial/ethnic groups. We compared blood pressure distributions among non-Hispanic white, non-Hispanic black, and Mexican-American persons using data from the US National Health and Nutrition Examination Survey (2003-2010). When using standard adjusted logistic regression analysis, we found that differences in body mass index were the only significant explanatory correlate to racial disparities in blood pressure. By contrast, our decomposition approach provided more nuanced revelations; we found that disparities in hypertension related to tobacco use might be masked by differences in body mass index that significantly increase the disparities between black and white participants. Analysis of disparities between white and Mexican-American participants also reveal hidden relationships between tobacco use, body mass index, and blood pressure. Decomposition offers an approach to understand how modifying risk factors might alter population-level health disparities in overall outcome distributions that can be obscured by standard regression analyses.

    View details for DOI 10.1093/aje/kwv079

    View details for Web of Science ID 000359665600009

    View details for PubMedID 26199379

    View details for PubMedCentralID PMC4528957

  • Quantifying demographic and socioeconomic transitions for computational epidemiology: an open-source modeling approach applied to India POPULATION HEALTH METRICS Basu, S., Goldhaber-Fiebert, J. D. 2015; 13
  • Food Price Spikes Are Associated with Increased Malnutrition among Children in Andhra Pradesh, India JOURNAL OF NUTRITION Vellakkal, S., Fledderjohann, J., Basu, S., Agrawal, S., Ebrahim, S., Campbell, O., Doyle, P., Stuckler, D. 2015; 145 (8): 1942-1949

    Abstract

    Global food prices have risen sharply since 2007. The impact of food price spikes on the risk of malnutrition in children is not well understood.We investigated the associations between food price spikes and childhood malnutrition in Andhra Pradesh, one of India's largest states, with >85 million people. Because wasting (thinness) indicates in most cases a recent and severe process of weight loss that is often associated with acute food shortage, we tested the hypothesis that the escalating prices of rice, legumes, eggs, and other staples of Indian diets significantly increased the risk of wasting (weight-for-height z scores) in children.We studied periods before (2006) and directly after (2009) India's food price spikes with the use of the Young Lives longitudinal cohort of 1918 children in Andhra Pradesh linked to food price data from the National Sample Survey Office. Two-stage least squares instrumental variable models assessed the relation of food price changes to food consumption and wasting prevalence (weight-for-height z scores).Before the 2007 food price spike, wasting prevalence fell from 19.4% in 2002 to 18.8% in 2006. Coinciding with India's escalating food prices, wasting increased significantly to 28.0% in 2009. These increases were concentrated among low- (χ(2): 21.6, P < 0.001) and middle- (χ(2): 25.9, P < 0.001) income groups, but not among high-income groups (χ(2): 3.08, P = 0.079). Each 10.0 rupee ($0.170) increase in the price of rice/kg was associated with a drop in child-level rice consumption of 73.0 g/d (β: -7.30; 95% CI: -10.5, -3.90). Correspondingly, lower rice consumption was significantly associated with lower weight-for-height z scores (i.e., wasting) by 0.005 (95% CI: 0.001, 0.008), as seen with most other food categories.Rising food prices were associated with an increased risk of malnutrition among children in India. Policies to help ensure the affordability of food in the context of economic growth are likely critical for promoting children's nutrition.

    View details for DOI 10.3945/jn.115.211250

    View details for Web of Science ID 000359037500034

    View details for PubMedID 26136589

    View details for PubMedCentralID PMC4516769

  • Financing universal health coverage-effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries LANCET Reeves, A., Gourtsoyannis, Y., Basu, S., McCoy, D., McKee, M., Stuckler, D. 2015; 386 (9990): 274-280
  • What do Indian children drink when they do not receive water? Statistical analysis of water and alternative beverage consumption from the 2005-2006 Indian National Family Health Survey BMC PUBLIC HEALTH Fledderjohann, J., Doyle, P., Campbell, O., Ebrahim, S., Basu, S., Stuckler, D. 2015; 15

    Abstract

    Over 1.2 billion people lack access to clean water. However, little is known about what children drink when there is no clean water. We investigated the prevalence of receiving no water and what Indian children drink instead.We analysed children's beverage consumption using representative data from India's National Family and Health Survey (NFHS-3, 2005-2006). Consumption was based on mothers' reports (n = 22,668) for children aged 6-59 months (n = 30,656).About 10 % of Indian children had no water in the last 24 h, corresponding to 12,700,000 children nationally, (95 % CI: 12,260,000 to 13,200,000). Among children who received no water, 23 % received breast or fresh milk and 24 % consumed formula, "other liquid", juice, or two or more beverages. Children over 2 were more likely to consume non-milk beverages, including tea, coffee, and juice than those under 2 years. Those in the lowest two wealth quintiles were 16 % less likely to have received water (OR = 0.84; 95 % CI: 0.74 to 0.96). Compared to those living in households with bottled, piped, or tanker water, children were significantly less likely to receive water in households using well water (OR = 0.75; 95 % CI: 0.64 to 0.89) or river, spring, or rain water (OR = 0.70; 95 % CI: 0.53 to 0.92) in the last 24 h.About 13 million Indian children aged 6-59 months received no water in the last 24 h. Further research is needed to assess the risks potentially arising from insufficient water, caffeinated beverages, and high sugar drinks at early stages of life.

    View details for DOI 10.1186/s12889-015-1946-4

    View details for Web of Science ID 000357309600002

    View details for PubMedID 26143185

  • Economic shocks, resilience, and male suicides in the Great Recession: cross-national analysis of 20 EU countries EUROPEAN JOURNAL OF PUBLIC HEALTH Reeves, A., McKee, M., Gunnell, D., Chang, S., Basu, S., Barr, B., Stuckler, D. 2015; 25 (3): 404-409

    Abstract

    During the 2007-11 recessions in Europe, suicide increases were concentrated in men. Substantial differences across countries and over time remain unexplained. We investigated whether increases in unaffordable housing, household indebtedness or job loss can account for these population differences, as well as potential mitigating effects of alternative forms of social protection.Multivariate statistical models were used to evaluate changes in suicide rates in 20 EU countries from 1981-2011. Models adjusted for pre-existing time trends and country-fixed effects. Interaction terms were used to evaluate modifying effects.Changes in levels of unaffordable housing had no effect on suicide rates (P = 0.32); in contrast, male suicide increases were significantly associated with each percentage point rise in male unemployment, by 0.94% (95% CI: 0.51-1.36%), and indebtedness, by 0.54% (95% CI: 0.02-1.06%). Spending on active labour market programmes (ALMP) (-0.26%, 95% CI: -0.08 to -0.45%) and high levels of social capital (-0.048%, 95% CI: -0.0096 to -0.087) moderated the unemployment-suicide association. There was no interaction of the volume of anti-depressant prescriptions (P = 0.51), monetary benefits to unemployed persons (P = 0.77) or total social protection spending per capita (P = 0.37). Active labour market programmes and social capital were estimated to have prevented ∼ 540 and ∼ 210 male suicides, respectively, arising from unemployment in the countries studied.Job losses were a critical determinant of variations in male suicide risks in Europe's recessions. Greater spending on ALMP and levels of social capital appeared to mitigate suicide risks.

    View details for DOI 10.1093/eurpub/cku168

    View details for Web of Science ID 000355838000014

    View details for PubMedID 25287115

  • Tuberculosis Control and economic recession: longitudinal study of data from 21 European countries, 1991-2012 BULLETIN OF THE WORLD HEALTH ORGANIZATION Reeves, A., Basu, S., McKee, M., Sandgren, A., Stuckler, D., Semenza, J. C. 2015; 93 (6): 369-379
  • The transitional dynamics of caloric ecosystems: changes in the food supply around the world CRITICAL PUBLIC HEALTH Basu, S. 2015; 25 (3): 248-264
  • The Health System and Population Health Implications of Large-Scale Diabetes Screening in India: A Microsimulation Model of Alternative Approaches PLOS MEDICINE Basu, S., Millett, C., Vijan, S., Hayward, R. A., Kinra, S., Ahuja, R., Yudkin, J. S. 2015; 12 (5)

    Abstract

    Like a growing number of rapidly developing countries, India has begun to develop a system for large-scale community-based screening for diabetes. We sought to identify the implications of using alternative screening instruments to detect people with undiagnosed type 2 diabetes among diverse populations across India.We developed and validated a microsimulation model that incorporated data from 58 studies from across the country into a nationally representative sample of Indians aged 25-65 y old. We estimated the diagnostic and health system implications of three major survey-based screening instruments and random glucometer-based screening. Of the 567 million Indians eligible for screening, depending on which of four screening approaches is utilized, between 158 and 306 million would be expected to screen as "high risk" for type 2 diabetes, and be referred for confirmatory testing. Between 26 million and 37 million of these people would be expected to meet international diagnostic criteria for diabetes, but between 126 million and 273 million would be "false positives." The ratio of false positives to true positives varied from 3.9 (when using random glucose screening) to 8.2 (when using a survey-based screening instrument) in our model. The cost per case found would be expected to be from US$5.28 (when using random glucose screening) to US$17.06 (when using a survey-based screening instrument), presenting a total cost of between US$169 and US$567 million. The major limitation of our analysis is its dependence on published cohort studies that are unlikely fully to capture the poorest and most rural areas of the country. Because these areas are thought to have the lowest diabetes prevalence, this may result in overestimation of the efficacy and health benefits of screening.Large-scale community-based screening is anticipated to produce a large number of false-positive results, particularly if using currently available survey-based screening instruments. Resource allocators should consider the health system burden of screening and confirmatory testing when instituting large-scale community-based screening for diabetes.

    View details for DOI 10.1371/journal.pmed.1001827

    View details for Web of Science ID 000355304100005

    View details for PubMedID 25992895

  • The epidemiological advantage of preferential targeting of tuberculosis control at the poor INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE Andrews, J. R., Basu, S., Dowdy, D. W., Murray, M. B. 2015; 19 (4): 375-380

    Abstract

    Tuberculosis (TB) remains disproportionately concentrated among the poor, yet known determinants of TB reactivation may fail to explain observed disparities in disease rates according to wealth. Reviewing data on TB disparities in India and the wealth distribution of known TB risk factors, we describe how social mixing patterns could be contributing to TB disparities. Wealth-assortative mixing, whereby individuals are more likely to be in contact with others from similar socio-economic backgrounds, amplifies smaller differences in risk of TB, resulting in large population-level disparities. As disparities and assortativeness increase, TB becomes more difficult to control, an effect that is obscured by looking at population averages of epidemiological parameters, such as case detection rates. We illustrate how TB control efforts may benefit from preferential targeting toward the poor. In India, an equivalent-scale intervention could have a substantially greater impact if targeted at those living below the poverty line than with a population-wide strategy. In addition to potential efficiencies in targeting higher-risk populations, TB control efforts would lead to a greater reduction in secondary TB cases per primary case diagnosed if they were preferentially targeted at the poor. We highlight the need to collect programmatic data on TB disparities and explicitly incorporate equity considerations into TB control plans.

    View details for DOI 10.5588/ijtld.14.0423

    View details for Web of Science ID 000351967800004

    View details for PubMedID 25859990

  • Tackling China's Noncommunicable Diseases: Shared Origins, Costly Consequences and the Need for Action CHINESE MEDICAL JOURNAL Min, Y., Jiang, L., Yan, L. L., Wang, L., Basu, S., Wu, Y., Stafford, R. S. 2015; 128 (6): 839-843
  • Are estimates of socioeconomic inequalities in chronic disease artefactually narrowed by self-reported measures of prevalence in low-income and middle-income countries? Findings from the WHO-SAGE survey. Journal of epidemiology and community health Vellakkal, S., Millett, C., Basu, S., Khan, Z., Aitsi-Selmi, A., Stuckler, D., Ebrahim, S. 2015; 69 (3): 218-225

    Abstract

    The use of self-reported measures of chronic disease may substantially underestimate prevalence in low-income and middle-income country settings, especially in groups with lower socioeconomic status (SES). We sought to determine whether socioeconomic inequalities in the prevalence of non-communicable chronic diseases (NCDs) differ if estimated by using symptom-based or criterion-based measures compared with self-reported physician diagnoses.Using population-representative data sets of the WHO Study of Global Ageing and Adult Health (SAGE), 2007-2010 (n=42 464), we calculated wealth-related and education-related concentration indices of self-reported diagnoses and symptom-based measures of angina, hypertension, asthma/chronic lung disease, visual impairment and depression in three 'low-income and lower middle-income countries'-China, Ghana and India-and three 'upper-middle-income countries'-Mexico, Russia and South Africa.SES gradients in NCD prevalence tended to be positive for self-reported diagnoses compared with symptom-based/criterion-based measures. In China, Ghana and India, SES gradients were positive for hypertension, angina, visual impairment and depression when using self-reported diagnoses, but were attenuated or became negative when using symptom-based/criterion-based measures. In Mexico, Russia and South Africa, this distinction was not observed consistently. For example, concentration index of self-reported versus symptom-based angina were: in China: 0.07 vs -0.11, Ghana: 0.04 vs -0.21, India: 0.02 vs -0.16, Mexico: 0.19 vs -0.22, Russia: -0.01 vs -0.02 and South Africa: 0.37 vs 0.02.Socioeconomic inequalities in NCD prevalence tend to be artefactually positive when using self-report compared with symptom-based or criterion-based diagnostic criteria, with greater bias occurring in low-income countries. Using standardised, symptom-based measures would provide more valid estimates of NCD inequalities.

    View details for DOI 10.1136/jech-2014-204621

    View details for PubMedID 25550454

  • Large-scale automated analysis of news media: A novel computational method for obesity policy research. Obesity Hamad, R., Pomeranz, J. L., Siddiqi, A., Basu, S. 2015; 23 (2): 296-300

    Abstract

    Analyzing news media allows obesity policy researchers to understand popular conceptions about obesity, which is important for targeting health education and policies. A persistent dilemma is that investigators have to read and manually classify thousands of individual news articles to identify how obesity and obesity-related policy proposals may be described to the public in the media. A machine learning method called "automated content analysis" that permits researchers to train computers to "read" and classify massive volumes of documents was demonstrated.14,302 newspaper articles that mentioned the word "obesity" during 2011-2012 were identified. Four states that vary in obesity prevalence and policy (Alabama, California, New Jersey, and North Carolina) were examined. The reliability of an automated program to categorize the media's framing of obesity as an individual-level problem (e.g., diet) and/or an environmental-level problem (e.g., obesogenic environment) was tested.The automated program performed similarly to human coders. The proportion of articles with individual-level framing (27.7-31.0%) was higher than the proportion with neutral (18.0-22.1%) or environmental-level framing (16.0-16.4%) across all states and over the entire study period (P<0.05).A novel approach to the study of how obesity concepts are communicated and propagated in news media was demonstrated.

    View details for DOI 10.1002/oby.20955

    View details for PubMedID 25522013

    View details for PubMedCentralID PMC4449277

  • The inverse equity hypothesis: Does it apply to coverage of cancer screening in middle-income countries? JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Lee, J. T., Huang, Z., Basu, S., Millett, C. 2015; 69 (2): 149-155

    Abstract

    It is uncertain whether the inverse equity hypothesis-the idea that new health interventions are initially primarily accessed by the rich, but that inequalities narrow with diffusion to the poor-holds true for cancer screening in low and middle income countries (LMICs).This study examines the relationship between overall coverage and economic inequalities in coverage of cancer screening in four middle-income countries.Secondary analyses of cross-sectional data from the WHO study on Global Ageing and Adult Health in China, Mexico, Russia and South Africa (2007-2010). Three regression-based methods were used to measure economic inequalities: (1) Adjusted OR; (2) Relative Index of Inequality (RII); and (3) Slope Index of Inequality.Coverage for breast cancer screening was 10.5% in South Africa, 19.3% in China, 33.8% in Russia and 43% in Mexico, and coverage for cervical cancer screening was 24% in South Africa, 27.2% in China, 63.7% in Mexico and 81.5% in Russia. Economic inequalities in screening participation were substantially lower or non-existent in countries with higher aggregate coverage, for both breast cancer screening (RII: 14.57 in South Africa, 4.90 in China, 2.01 in Mexico, 1.04 in Russia) and cervical cancer screening (RII: 3.60 in China, 2.47 in South Africa, 1.39 in Mexico, 1.12 in Russia).Economic inequalities in breast and cervical cancer screening are low in LMICs with high screening coverage. These findings are consistent with the inverse equity hypothesis and indicate that high levels of equity in cancer screening are feasible even in countries with high income inequality.

    View details for DOI 10.1136/jech-2014-204355

    View details for Web of Science ID 000347967000010

    View details for PubMedID 25311479

  • Implications of Workforce and Financing Changes for Primary Care Practice Utilization, Revenue, and Cost A Generalizable Mathematical Model for Practice Management MEDICAL CARE Basu, S., Landon, B. E., Song, Z., Bitton, A., Phillips, R. S. 2015; 53 (2): 125-132

    Abstract

    Primary care practice transformations require tools for policymakers and practice managers to understand the financial implications of workforce and reimbursement changes.To create a simulation model to understand how practice utilization, revenues, and expenses may change in the context of workforce and financing changes.We created a simulation model estimating clinic-level utilization, revenues, and expenses using user-specified or public input data detailing practice staffing levels, salaries and overhead expenditures, patient characteristics, clinic workload, and reimbursements. We assessed whether the model could accurately estimate clinic utilization, revenues, and expenses across the nation using labor compensation, medical expenditure, and reimbursements databases, as well as cost and revenue data from independent practices of varying size. We demonstrated the model's utility in a simulation of how utilization, revenue, and expenses would change after hiring a nurse practitioner (NP) compared with hiring a part-time physician.Modeled practice utilization and revenue closely matched independent national utilization and reimbursement data, disaggregated by patient age, sex, race/ethnicity, insurance status, and ICD diagnostic group; the model was able to estimate independent revenue and cost estimates, with highest accuracy among larger practices. A demonstration analysis revealed that hiring an NP to work independently with a subset of patients diagnosed with diabetes or hypertension could increase net revenues, if NP visits involve limited MD consultation or if NP reimbursement rates increase.A model of utilization, revenue, and expenses in primary care practices may help policymakers and managers understand the implications of workforce and financing changes.

    View details for Web of Science ID 000349775000006

    View details for PubMedID 25517074

  • 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

  • Quantifying demographic and socioeconomic transitions for computational epidemiology: an open-source modeling approach applied to India. Population health metrics Basu, S., Goldhaber-Fiebert, J. D. 2015; 13: 19-?

    Abstract

    Demographic and socioeconomic changes such as increasing urbanization, migration, and female education shape population health in many low- and middle-income countries. These changes are rarely reflected in computational epidemiological models, which are commonly used to understand population health trends and evaluate policy interventions. Our goal was to create a "backbone" simulation modeling approach to allow computational epidemiologists to explicitly reflect changing demographic and socioeconomic conditions in population health models.We developed, evaluated, and "open-sourced" a generalized approach to incorporate longitudinal, commonly available demographic and socioeconomic data into epidemiological simulations, illustrating the feasibility and utility of our approach with data from India. We constructed a series of nested microsimulations of increasing complexity, calibrating each model to longitudinal sociodemographic and vital registration data. We then selected the model that was most consistent with the data (i.e., greater accuracy) while containing the fewest parameters (i.e., greater parsimony). We validated the selected model against additional data sources not used for calibration.We found that standard computational epidemiology models that do not incorporate demographic and socioeconomic trends quickly diverged from past mortality and population size estimates, while our approach remained consistent with observed data over decadal time courses. Our approach additionally enabled the examination of complex relations between demographic, socioeconomic and health parameters, such as the relationship between changes in educational attainment or urbanization and changes in fertility, mortality, and migration rates.Incorporating demographic and socioeconomic trends in computational epidemiology is feasible through the "open source" approach, and could critically alter population health projections and model-based evaluations of health policy interventions in unintuitive ways.

    View details for DOI 10.1186/s12963-015-0053-1

    View details for PubMedID 26236157

  • Tobacco control policies and perinatal and child health: a systematic review and meta-analysis protocol BMJ OPEN Been, J. V., Mackenbach, J. P., Millett, C., Basu, S., Sheikh, A. 2015; 5 (9)

    View details for DOI 10.1136/bmjopen-2015-008398

    View details for Web of Science ID 000363484000051

    View details for PubMedID 26399572

  • The EARN-Health Trial: protocol for a randomised controlled trial to identify health effects of a financial savings programme among low-income US adults. BMJ open Basu, S., Hamad, R., White, J. S., Modrek, S., Rehkopf, D. H., Cullen, M. R. 2015; 5 (10)

    View details for DOI 10.1136/bmjopen-2015-009366

    View details for PubMedID 26443663

  • The EARN-Health Trial: protocol for a randomised controlled trial to identify health effects of a financial savings programme among low-income US adults. BMJ open Basu, S., Hamad, R., White, J. S., Modrek, S., Rehkopf, D. H., Cullen, M. R. 2015; 5 (10)

    Abstract

    A theory within the social epidemiology field is that financial stress related to having inadequate financial savings may contribute to psychological stress, poor mental health and poor health-related behaviours among low-income US adults. Our objective is to test whether an intervention that encourages financial savings among low-income US adults improves health behaviours and mental health.A parallel group two-arm controlled superiority trial will be performed in which 700 participants will be randomised to the intervention or a wait list. The intervention arm will be provided an online Individual Development Account (IDA) for 6 months, during which participants receive a $5 incentive (£3.2, €4.5) for every month they save $20 in their account (£12.8, €18), and an additional $5 if they save $20 for two consecutive months. Both groups will be provided links to standard online financial counselling materials. Online surveys in months 0 (prior to randomisation), 6 and 12 (6 months postintervention) will assess self-reported health behaviours and mental health among participants in both arms. The surveys items were tested previously in the US Centers for Disease Control and Prevention national health interviews and related health studies, including self-reported overall health, health-related quality of life, alcohol and tobacco use, depression symptoms, financial stress, optimism and locus of control, and spending and savings behaviours. Trial data will be analysed on an intent-to-treat basis.This protocol was approved by the Institutional Review Board of Stanford University (Protocol ID: 30641). The findings of the trial will be disseminated through peer-reviewed publication.Identifier NCT02185612; Pre-results.

    View details for DOI 10.1136/bmjopen-2015-009366

    View details for PubMedID 26443663

    View details for PubMedCentralID PMC4606428

  • Reducing Added Sugars in the Food Supply Through a Cap-and-Trade Approach AMERICAN JOURNAL OF PUBLIC HEALTH Basu, S., Lewis, K. 2014; 104 (12): 2432-2438

    Abstract

    We estimated the effect of a simulated cap-and-trade policy to reduce added sugar in the food supply.Using nationally representative data on added-sugar content and consumption, we constructed a mathematical model of a cap-and-trade policy and compared its health implications to those of proposals to tax sugar sweetened beverages or added sugars.Capping added-sugar emissions into the food supply by food manufacturers at a rate of 1% per year would be expected to reduce the prevalence of obesity by 1.7 percentage points (95% confidence interval [CI] = 0.9, 2.4; a 4.6% decline) and the incidence of type 2 diabetes by 21.7 cases per 100 000 people (95% CI = 12.9, 30.6; a 4.2% decline) over 20 years, averting approximately $9.7 billion in health care spending. Racial and ethnic minorities would be expected to experience the largest declines. By comparison, equivalent price penalties through excise taxes would be expected to generate smaller health benefits.A cap-and-trade policy to reduce added-sugar intake may reduce obesity and type 2 diabetes to a greater extent than currently-proposed excise taxes.

    View details for DOI 10.2105/AJPH.2014.302170

    View details for Web of Science ID 000347210500053

    View details for PubMedID 25365146

  • Social protection and tuberculosis control in 21 European countries, 1995-2012: a cross-national statistical modelling analysis LANCET INFECTIOUS DISEASES Reeves, A., Basu, S., McKee, M., Stuckler, D., Sandgren, A., Semenza, J. 2014; 14 (11): 1105-1112
  • Comparing Decisions for Malaria Testing and Presumptive Treatment: A Net Health Benefit Analysis MEDICAL DECISION MAKING Basu, S., Modrek, S., Bendavid, E. 2014; 34 (8): 996-1005

    Abstract

    Rapid tests for malaria are being distributed through vendors to individual patients, presenting the dilemma of determining how individuals are incentivized to pursue testing for malaria, versus the traditional approach of presumptively treating fevers with antimalarial drugs.We incorporated testing and treatment data from 6 African countries into a dynamic model of malaria transmission and nonmalarial causes of fever to investigate how variations in the epidemiologic risk of malaria and the prices of rapid diagnostic tests (RDTs) and treatments affect testing and treatment choices from the perspective of febrile patients, public health officials, and drug shop owners. In environments falling below a critical threshold infection rate (entomological inoculation rate) of 282 for patients older than 5 years (95% confidence interval [CI]: 275-289) or 300 for 0- to 5-year-olds (95% CI: 203-307), testing was more beneficial than presumptive therapy in terms of health and financial costs to patients. Infection and cost conditions generally aligned the best patient-level strategy with the best public health strategy to minimize an overall population's morbidity and mortality from both malaria and nonmalarial causes of fever. However, the infection and cost conditions of very high malaria transmission settings did not align patient interests or public health interests with the interests of private drug shop owners. In such settings, a further lowering of testing prices may realign the interests of all 3 parties.A threshold transmission rate exists under which malaria testing confers more health and financial benefits to patients than presumptive treatment. Studying local transmission rates and testing and treatment costs may facilitate an approach to align the interests of individual patients, public health officials, and distributors of tests and therapies.

    View details for DOI 10.1177/0272989X14533609

    View details for Web of Science ID 000344064400008

  • Job loss, wealth and depression during the Great Recession in the USA and Europe INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Riumallo-Herl, C., Basu, S., Stuckler, D., Courtin, E., Avendano, M. 2014; 43 (5): 1508-1517

    Abstract

    To examine whether late-career job loss increased depression among older workers approaching retirement in the USA and Europe.Longitudinal data came from the Health and Retirement Survey and the Survey of Health, Ageing, and Retirement in Europe. Workers aged 50 to 64 years in 13 European countries and the USA were assessed biennially from 2006 to 2010. Individual fixed effects models were used to test the effect of job loss on depressive symptoms, controlling for age, sex, physical health, initial wealth and socio-demographic factors.Job loss was associated with a 4.78% [95% confidence interval (CI): 0.823% to 8.74%] increase in depressive symptoms in the USA compared with a 3.35% (95% CI: 0.486% to 6.22%) increase in Europe. Job loss due to a worker's unexpected firm closure increased depression scores in both the USA (beta=28.2%, 95% CI: 8.55% to 47.8%) and Europe (beta=7.50%, 95% CI: 1.25% to 13.70%), but pooled models suggested significantly stronger effects for US workers (P<0.001). American workers who were poorer before the recession experienced significantly larger increases in depressive symptoms compared with wealthier US workers (beta for interaction=-0.054, 95% CI: -0.082 to -0.025), whereas pre-existing wealth did not moderate the impact of job loss among European workers.Job loss is associated with increased depressive symptoms in the USA and Europe, but effects of job loss due to plant closure are stronger for American workers. Wealth mitigates the impact of job loss on depression in the USA more than in Europe.

    View details for DOI 10.1093/ije/dyu048

    View details for Web of Science ID 000343972200024

    View details for PubMedID 24942142

  • Do Girls Have a Nutritional Disadvantage Compared with Boys? Statistical Models of Breastfeeding and Food Consumption Inequalities among Indian Siblings PLOS ONE Fledderjohann, J., Agrawal, S., Vellakkal, S., Basu, S., Campbell, O., Doyle, P., Ebrahim, S., Stuckler, D. 2014; 9 (9)
  • 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
  • Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Murray, C. J., Ortblad, K. F., Guinovart, C., Lim, S. S., Wolock, T. M., Roberts, D. A., Dansereau, E. A., Graetz, N., Barber, R. M., Brown, J. C., Wang, H., Duber, H. C., Naghavi, M., Dicker, D., Dandona, L., Salomon, J. A., Heuton, K. R., Foreman, K., Phillips, D. E., Fleming, T. D., Flaxman, A. D., Phillips, B. K., Johnson, E. K., Coggeshall, M. S., Abd-Allah, F., Abera, S. F., Abraham, J. P., Abubakar, I., Abu-Raddad, L. J., Abu-Rmeileh, N. M., Achoki, T., Adeyemo, A. O., Adou, A. K., Adsuar, J. C., Agardh, E. E., Akena, D., Al Kahbouri, M. J., Alasfoor, D., Albittar, M. I., Alcalá-Cerra, G., Alegretti, M. A., Alemu, Z. A., Alfonso-Cristancho, R., Alhabib, S., Ali, R., Alla, F., Allen, P. J., Alsharif, U., Alvarez, E., Alvis-Guzman, N., Amankwaa, A. A., Amare, A. T., Amini, H., Ammar, W., Anderson, B. O., Antonio, C. A., Anwari, P., Arnlöv, J., Arsenijevic, V. S., Artaman, A., Asghar, R. J., Assadi, R., Atkins, L. S., Badawi, A., Balakrishnan, K., Banerjee, A., Basu, S., Beardsley, J., Bekele, T., Bell, M. L., Bernabe, E., Beyene, T. J., Bhala, N., Bhalla, A., Bhutta, Z. A., Abdulhak, A. B., Binagwaho, A., Blore, J. D., Basara, B. B., Bose, D., Brainin, M., Breitborde, N., Castañeda-Orjuela, C. A., Catalá-López, F., Chadha, V. K., Chang, J., Chiang, P. P., Chuang, T., Colomar, M., Cooper, L. T., Cooper, C., Courville, K. J., Cowie, B. C., Criqui, M. H., Dandona, R., Dayama, A., De Leo, D., Degenhardt, L., Del Pozo-Cruz, B., Deribe, K., Des Jarlais, D. C., Dessalegn, M., Dharmaratne, S. D., Dilmen, U., Ding, E. L., Driscoll, T. R., Durrani, A. M., Ellenbogen, R. G., Ermakov, S. P., Esteghamati, A., Faraon, E. J., Farzadfar, F., Fereshtehnejad, S., Fijabi, D. O., Forouzanfar, M. H., Fra Paleo, U., Gaffikin, L., Gamkrelidze, A., Gankpé, F. G., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Ginawi, I. A., Glaser, E. L., Gona, P., Goto, A., Gouda, H. N., Gugnani, H. C., Gupta, R., Gupta, R., Hafezi-Nejad, N., Hamadeh, R. R., Hammami, M., Hankey, G. J., Harb, H. L., Haro, J. M., Havmoeller, R., Hay, S. I., Hedayati, M. T., Pi, I. B., Hoek, H. W., Hornberger, J. C., Hosgood, H. D., Hotez, P. J., Hoy, D. G., Huang, J. J., Iburg, K. M., Idrisov, B. T., Innos, K., Jacobsen, K. H., Jeemon, P., Jensen, P. N., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kan, H., Kankindi, I., Karam, N. E., Karch, A., Karema, C. K., Kaul, A., Kawakami, N., Kazi, D. S., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khan, E. A., Khang, Y., Khonelidze, I., Kinfu, Y., Kinge, J. M., Knibbs, L., Kokubo, Y., Kosen, S., Defo, B. K., Kulkarni, V. S., Kulkarni, C., Kumar, K., Kumar, R. B., Kumar, G. A., Kwan, G. F., Lai, T., Balaji, A. L., Lam, H., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Lee, J., Leigh, J., Leinsalu, M., Leung, R., Li, Y., Li, Y., de Lima, G. M., Lin, H., Lipshultz, S. E., Liu, S., Liu, Y., Lloyd, B. K., Lotufo, P. A., Machado, V. M., Maclachlan, J. H., Magis-Rodriguez, C., Majdan, M., Mapoma, C. C., Marcenes, W., Marzan, M. B., Masci, J. R., Mashal, M. T., Mason-Jones, A. J., Mayosi, B. M., Mazorodze, T. T., Mckay, A. C., Meaney, P. A., Mehndiratta, M. M., Mejia-Rodriguez, F., Melaku, Y. A., Memish, Z. A., Mendoza, W., Miller, T. R., Mills, E. J., Mohammad, K. A., Mokdad, A. H., Mola, G. L., Monasta, L., Montico, M., Moore, A. R., Mori, R., Moturi, W. N., Mukaigawara, M., Murthy, K. S., Naheed, A., Naidoo, K. S., Naldi, L., Nangia, V., Narayan, K. M., Nash, D., Nejjari, C., Nelson, R. G., Neupane, S. P., Newton, C. R., Ng, M., Nisar, M. I., Nolte, S., Norheim, O. F., Nowaseb, V., Nyakarahuka, L., Oh, I., Ohkubo, T., Olusanya, B. O., Omer, S. B., Opio, J. N., Orisakwe, O. E., Pandian, J. D., Papachristou, C., Caicedo, A. J., Patten, S. B., Paul, V. K., Pavlin, B. I., Pearce, N., Pereira, D. M., Pervaiz, A., Pesudovs, K., Petzold, M., Pourmalek, F., Qato, D., Quezada, A. D., Quistberg, D. A., Rafay, A., Rahimi, K., Rahimi-Movaghar, V., Ur Rahman, S., Raju, M., Rana, S. M., Razavi, H., Reilly, R. Q., Remuzzi, G., Richardus, J. H., Ronfani, L., Roy, N., Sabin, N., Saeedi, M. Y., Sahraian, M. A., Samonte, G. M., Sawhney, M., Schneider, I. J., Schwebel, D. C., Seedat, S., Sepanlou, S. G., Servan-Mori, E. E., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shiue, I., Shivakoti, R., Sigfusdottir, I. D., Silberberg, D. H., Silva, A. P., Simard, E. P., Singh, J. A., Skirbekk, V., Sliwa, K., Soneji, S., Soshnikov, S. S., Sreeramareddy, C. T., Stathopoulou, V. K., Stroumpoulis, K., Swaminathan, S., Sykes, B. L., Tabb, K. M., Talongwa, R. T., Tenkorang, E. Y., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Towbin, J. A., Traebert, J., Tran, B. X., Dimbuene, Z. T., Tsilimbaris, M., Uchendu, U. S., Ukwaja, K. N., Uzun, S. B., Vallely, A. J., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V. V., Vollset, S. E., Waller, S., Wallin, M. T., Wang, L., Wang, X., Wang, Y., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., White, R. A., Wilkinson, J. D., Williams, T. N., Woldeyohannes, S. M., Wong, J. Q., Xu, G., Yang, Y. C., Yano, Y., Yentur, G. K., Yip, P., Yonemoto, N., Yoon, S., Younis, M., Yu, C., Jin, K. Y., El Sayed Zaki, M., Zhao, Y., Zheng, Y., Zhou, M., Zhu, J., Zou, X. N., Lopez, A. D., Vos, T. 2014; 384 (9947): 1005-1070

    Abstract

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

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

    View details for PubMedID 25059949

    View details for PubMedCentralID PMC4202387

  • Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 LANCET Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., Apfel, H., Iannarone, M., Phillips, B., Lofgren, K. T., Sandar, L., Dorrington, R. E., Rakovac, I., Jacobs, T. A., Liang, X., Zhou, M., Zhu, J., Yang, G., Wang, Y., Liu, S., Li, Y., Ozgoren, A. A., Abera, S. F., Abubakar, I., Achoki, T., Adelekan, A., Ademi, Z., Alemu, Z. A., Allen, P. J., AlMazroa, M. A., Alvarez, E., Amankwaa, A. A., Amare, A. T., Ammar, W., Anwari, P., Cunningham, S. A., Asad, M. M., Assadi, R., Banerjee, A., Basu, S., Bedi, N., Bekele, T., Bell, M. L., Bhutta, Z. Q., Blore, J. D., Basara, B. B., Boufous, S., Breitborde, N., Bruce, N. G., Linh Ngoc Bui, L. N., Carapetis, J. R., Cardenas, R., Carpenter, D. O., Caso, V., Estanislao Castro, R., Catala-Lopez, F., Cavlin, A., Che, X., Chiang, P. P., Chowdhury, R., Christophi, C. A., Chuang, T., Cirillo, M., Leite, I. d., Courville, K. J., Dandona, L., Dandona, R., Davis, A., Dayama, A., Deribe, K., Dharmaratne, S. D., Dherani, M. K., Dilmen, U., Ding, E. L., Edmond, K. M., Ermakov, S. P., Farzadfar, F., Fereshtehnejad, S., Fijabi, D. O., Foigt, N., Forouzanfar, M. H., Garcia, A. C., Geleijnse, J. M., Gessner, B. D., Goginashvili, K., Gona, P., Goto, A., Gouda, H. N., Green, M. A., Greenwell, K. F., Gugnani, H. C., Gupta, R., Hamadeh, R. R., Hammami, M., Harb, H. L., Hay, S., Hedayati, M. T., Hosgood, H. D., Hoy, D. G., Idrisov, B. T., Islami, F., Ismayilova, S., Jha, V., Jiang, G., Jonas, J. B., Juel, K., Kabagambe, E. K., Kazi, D. S., Kengne, A. P., Kereselidze, M., Khader, Y. S., Khalifa, S. E., Khang, Y., Kim, D., Kinfu, Y., Kinge, J. M., Kokubo, Y., Kosen, S., Defo, B. K., Kumar, G. A., Kumar, K., Kumar, R. B., Lai, T., Lan, Q., Larsson, A., Lee, J., Leinsalu, M., Lim, S. S., Lipshultz, S. E., Logroscino, G., Lotufo, P. A., Lunevicius, R., Lyons, R. A., Ma, S., Mahdi, A. A., Marzan, M. B., Mashal, M. T., Mazorodze, T. T., McGrath, J. J., Memish, Z. A., Mendoza, W., Mensah, G. A., Meretoja, A., Miller, T. R., Mills, E. J., Mohammad, K. A., Mokdad, A. H., Monasta, L., Montico, M., Moore, A. R., Moschandreas, J., Msemburi, W. T., Mueller, U. O., Muszynska, M. M., Naghavi, M., Naidoo, K. S., Narayan, K. M., Nejjari, C., Ng, M., de Dieu Ngirabega, J., Nieuwenhuijsen, M. J., Nyakarahuka, L., Ohkubo, T., Omer, S. B., Paternina Caicedo, A. J., Pillay-Van Wyk, V., Pope, D., Pourmalek, F., Prabhakaran, D., Rahman, S. u., Rana, S. M., Reilly, R. Q., Rojas-Rueda, D., Ronfani, L., Rushton, L., Saeedi, M. Y., Salomon, J. A., Sampson, U., Santos, I. S., Sawhney, M., Schmidt, J. C., Shakh-Nazarova, M., She, J., Sheikhbahaei, S., Shibuya, K., Shin, H. H., Shishani, K., Shiue, I., Sigfusdottir, I. D., Singh, J. A., Skirbekk, V., Sliwa, K., Soshnikov, S. S., Sposato, L. A., Stathopoulou, V. K., Stroumpoulis, K., Tabb, K. M., Talongwa, R. T., Teixeira, C. M., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Toyoshima, H., Dimbuene, Z. T., Uwaliraye, P., Uzun, S. B., Vasankari, T. J., Nogales Vasconcelos, A. M., Vlassov, V. V., Vollset, S. E., Waller, S., Wan, X., Weichenthal, S., Weiderpass, E., Weintraub, R. G., Westerman, R., Wilkinson, J. D., Williams, H. C., Yang, Y. C., Yentur, G. K., Yip, P., Yonemoto, N., Younis, M., Yu, C., Jin, K. Y., Zaki, M. E., Zhu, S., Vos, T., Lopez, A. D., Murray, C. J. 2014; 384 (9947): 957-979
  • 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 prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., Mullany, E. C., Biryukov, S., Abbafati, C., Abera, S. F., Abraham, J. P., Abu-Rmeileh, N. M., Achoki, T., Albuhairan, F. S., Alemu, Z. A., Alfonso, R., Ali, M. K., Ali, R., Guzman, N. A., Ammar, W., Anwari, P., Banerjee, A., Barquera, S., Basu, S., Bennett, D. A., Bhutta, Z., Blore, J., Cabral, N., Nonato, I. C., Chang, J., Chowdhury, R., Courville, K. J., Criqui, M. H., Cundiff, D. K., Dabhadkar, K. C., Dandona, L., Davis, A., Dayama, A., Dharmaratne, S. D., Ding, E. L., Durrani, A. M., Esteghamati, A., Farzadfar, F., Fay, D. F., Feigin, V. L., Flaxman, A., Forouzanfar, M. H., Goto, A., Green, M. A., Gupta, R., Hafezi-Nejad, N., Hankey, G. J., Harewood, H. C., Havmoeller, R., Hay, S., Hernandez, L., Husseini, A., Idrisov, B. T., Ikeda, N., Islami, F., Jahangir, E., Jassal, S. K., Jee, S. H., Jeffreys, M., Jonas, J. B., Kabagambe, E. K., Khalifa, S. E., Kengne, A. P., Khader, Y. S., Khang, Y., Kim, D., Kimokoti, R. W., Kinge, J. M., Kokubo, Y., Kosen, S., Kwan, G., Lai, T., Leinsalu, M., Li, Y., Liang, X., Liu, S., Logroscino, G., Lotufo, P. A., Lu, Y., Ma, J., Mainoo, N. K., Mensah, G. A., Merriman, T. R., Mokdad, A. H., Moschandreas, J., Naghavi, M., Naheed, A., Nand, D., Narayan, K. M., Nelson, E. L., Neuhouser, M. L., Nisar, M. I., Ohkubo, T., Oti, S. O., Pedroza, A., Prabhakaran, D., Roy, N., Sampson, U., Seo, H., Sepanlou, S. G., Shibuya, K., Shiri, R., Shiue, I., Singh, G. M., Singh, J. A., Skirbekk, V., Stapelberg, N. J., Sturua, L., Sykes, B. L., Tobias, M., Tran, B. X., Trasande, L., Toyoshima, H., van de Vijver, S., Vasankari, T. J., Veerman, J. L., Velasquez-Melendez, G., Vlassov, V. V., Vollset, S. E., Vos, T., Wang, C., Wang, X., Weiderpass, E., Werdecker, A., Wright, J. L., Yang, Y. C., Yatsuya, H., Yoon, J., Yoon, S., Zhao, Y., Zhou, M., Zhu, S., Lopez, A. D., Murray, C. J., Gakidou, E. 2014; 384 (9945): 766-781

    Abstract

    In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013.We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs).Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down.Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene.Bill & Melinda Gates Foundation.

    View details for DOI 10.1016/S0140-6736(14)60460-8

    View details for PubMedID 24880830

    View details for PubMedCentralID PMC4624264

  • Association between smoke-free workplace and second-hand smoke exposure at home in India. Tobacco control Lee, J. T., Agrawal, S., Basu, S., Glantz, S. A., Millett, C. 2014; 23 (4): 308-312

    Abstract

    The implementation of comprehensive smoke-free laws has been associated with reductions in second-hand smoke exposure at home in several high income countries. There is little information on whether these benefits extend to low income and middle income countries with a growing tobacco-related disease burden such as India.State and individual-level analysis of cross-sectional data from the Global Adult Tobacco Survey India, 2009/2010. Associations between working in a smoke-free indoor environment and living in a smoke-free home were examined using correlation at the state level, and multivariate logistic regression at the individual level.The percentage of respondents employed indoors (outside the home) working in smoke-free environments who lived in a smoke-free home was 64.0% compared with 41.7% of those who worked where smoking occurred. Indian states with higher proportions of smoke-free workplaces had higher proportions of smoke-free homes (rs=0.54, p<0.005). In the individual-level analysis, working in a smoke-free workplace was associated with a significantly higher likelihood of living in a smoke-free home (adjusted OR=2.07; 95% CI 1.64 to 2.52) after adjustment for potential confounders.Implementation of smoke-free legislation in India was associated with a higher proportion of adults reporting a smoke-free home. These findings further strengthen the case for accelerated implementation of Article 8 of the Framework Convention on Tobacco Control (FCTC) in low and middle income countries.

    View details for DOI 10.1136/tobaccocontrol-2012-050817

    View details for PubMedID 23525121

  • A Metabolic-Epidemiological Microsimulation Model to Estimate the Changes in Energy Intake and Physical Activity Necessary to Meet the Healthy People 2020 Obesity Objective AMERICAN JOURNAL OF PUBLIC HEALTH Basu, S., Seligman, H., Winkleby, M. 2014; 104 (7): 1209-1216

    Abstract

    We combined a metabolic and an epidemiological model of obesity to estimate changes in calorie intake and physical activity necessary to achieve the Healthy People 2020 objective of reducing adult obesity prevalence from 33.9% to 30.5%.We used the National Health and Nutrition Examination Survey (1999-2010) to construct and validate a microsimulation model of the US population aged 10 years and older, for 2010 to 2020.Obesity prevalence is expected to shift toward older adults, and disparities are expected to widen between White, higher-income groups and minority, lower-income groups if recent calorie consumption and expenditure trends continue into the future. Although a less than 10% reduction in daily calorie intake or increase in physical activity would in theory achieve the Healthy People 2020 objective, no single population-level intervention is likely to achieve the target alone, and individual weight-loss attempts are even more unlikely to achieve the target.Changes in calorie intake and physical activity portend rising inequalities in obesity prevalence. These changes require multiple simultaneous population interventions.

    View details for DOI 10.2105/AJPH.2013.301674

    View details for Web of Science ID 000341809500034

    View details for PubMedID 24832140

  • Differential impact of the economic recession on alcohol use among white British adults, 2004-2010. European journal of public health Harhay, M. O., Bor, J., Basu, S., McKee, M., Mindell, J. S., Shelton, N. J., Stuckler, D. 2014; 24 (3): 410-415

    Abstract

    Unlike other west European countries, there is a long-term trend of rising alcohol consumption and mortality in England. Whether drinking will rise or fall during the current recession is widely debated. We examined how the recession affected alcohol use in adults in England using individual-level data.We analysed a nationally representative sample of non-institutionalized white persons aged 20-60 years from seven waves of the Health Survey for England, 2004-2010 (n = 36 525), to assess trends in alcohol use and frequency before, during and after the recession and in association with unemployment, correcting for possible changes in sample composition and socio-demographic confounders. The primary analysis compared 2006/7 with 2008/9, following the official onset of the UK recession in early 2008.During England's recession, there was a significant decrease in frequent drinking defined as drinking four or more days in the past week (27.1% in 2006 to 23.9% in 2009, P < 0.001), the number of units of alcohol imbibed on the heaviest drinking day (P < 0.01) and the number of days that individuals reported drinking over the past seven days (P < 0.01). However, among current drinkers who were unemployed there was a significantly elevated risk of binge drinking in 2009 and 2010 (odds ratio = 1.64, 95% confidence interval: 1.22-2.19, P = 0.001) that was not previously observed in 2004-2008 (1.03, 0.76-1.41; test for effect heterogeneity: P = 0.036).England's recession was associated with less hazardous drinking among the population overall, but with rises in binge drinking among a smaller high-risk group of unemployed drinkers.

    View details for DOI 10.1093/eurpub/ckt134

    View details for PubMedID 24058184

  • Ending SNAP Subsidies For Sugar-Sweetened Beverages Could Reduce Obesity And Type 2 Diabetes HEALTH AFFAIRS Basu, S., Seligman, H. K., Gardner, C., Bhattacharya, J. 2014; 33 (6): 1032-1039

    Abstract

    To reduce obesity and type 2 diabetes rates, lawmakers have proposed modifying Supplemental Nutrition Assistance Program (SNAP) benefits to encourage healthier food choices. We examined the impact of two proposed policies: a ban on using SNAP dollars to buy sugar-sweetened beverages; and a subsidy in which for every SNAP dollar spent on fruit and vegetables, thirty cents is credited back to participants' SNAP benefit cards. We used nationally representative data and models describing obesity, type 2 diabetes, and determinants of food consumption among a sample of over 19,000 SNAP participants. We found that a ban on SNAP purchases of sugar-sweetened beverages would be expected to significantly reduce obesity prevalence and type 2 diabetes incidence, particularly among adults ages 18-65 and some racial and ethnic minorities. The subsidy policy would not be expected to have a significant effect on obesity and type 2 diabetes, given available data. Such a subsidy could, however, more than double the proportion of SNAP participants who meet federal vegetable and fruit consumption guidelines.

    View details for DOI 10.1377/hlthaff.2013.1246

    View details for Web of Science ID 000338187200015

  • Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings JOURNAL OF HYPERTENSION Modesti, P. A., Agostoni, P., Agyemang, C., Basu, S., Benetos, A., Cappuccio, F. P., Ceriello, A., Del Prato, S., Kalyesubula, R., O'Brien, E., Kilama, M. O., Perlini, S., Picano, E., Reboldi, G., Remuzzi, G., Stuckler, D., Twagirumukiza, M., Van Bortel, L. M., Watfa, G., Zhao, D., Parati, G. 2014; 32 (5): 951-960

    Abstract

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.

    View details for DOI 10.1097/HJH.0000000000000125

    View details for Web of Science ID 000334312600002

    View details for PubMedID 24577410

  • The political economy of austerity and healthcare: Cross-national analysis of expenditure changes in 27 European nations 1995-2011. Health policy Reeves, A., McKee, M., Basu, S., Stuckler, D. 2014; 115 (1): 1-8

    Abstract

    Why have patterns of healthcare spending varied during the Great Recession? Using cross-national, harmonised data for 27 EU countries from 1995 to 2011, we evaluated political, economic, and health system determinants of recent changes to healthcare expenditure. Data from EuroStat, the IMF, and World Bank (2013 editions) were evaluated using multivariate random- and fixed-effects models, correcting for pre-existing time-trends. Reductions in government health expenditure were not significantly associated with magnitude of economic recessions (annual change in GDP, p=0.31, or cumulative decline, p=0.40 or debt crises (measured by public debt as a percentage of GDP, p=0.38 or per capita, p=0.83)). Nor did ideology of governing parties have an effect. In contrast, each $100 reduction in tax revenue was associated with a $2.72 drop in health spending (95% CI: $1.03-4.41). IMF borrowers were significantly more likely to reduce healthcare budgets than non-IMF borrowers (OR=3.88, 95% CI: 1.95 -7.74), even after correcting for potential confounding by indication. Exposure to lending from international financial institutions, tax revenue falls, and decisions to implement cuts correlate more closely than underlying economic conditions or orientation of political parties with healthcare expenditure change in EU member states.

    View details for DOI 10.1016/j.healthpol.2013.11.008

    View details for PubMedID 24315493

  • Governance and health in the Arab world LANCET Batniji, R., Khatib, L., Cammett, M., Sweet, J., Basu, S., Jamal, A., Wise, P., Giacaman, R. 2014; 383 (9914): 343-355

    Abstract

    Since late 2010, the Arab world has entered a tumultuous period of change, with populations demanding more inclusive and accountable government. The region is characterised by weak political institutions, which exclude large proportions of their populations from political representation and government services. Building on work in political science and economics, we assess the extent to which the quality of governance, or the extent of electoral democracy, relates to adult, infant, and maternal mortality, and to the perceived accessibility and improvement of health services. We compiled a dataset from the World Bank, WHO, Institute for Health Metrics and Evaluation, Arab Barometer Survey, and other sources to measure changes in demographics, health status, and governance in the Arab World from 1980 to 2010. We suggest an association between more effective government and average reductions in mortality in this period; however, there does not seem to be any relation between the extent of democracy and mortality reductions. The movements for changing governance in the region threaten access to services in the short term, forcing migration and increasing the vulnerability of some populations. In view of the patterns observed in the available data, and the published literature, we suggest that efforts to improve government effectiveness and to reduce corruption are more plausibly linked to population health improvements than are efforts to democratise. However, these patterns are based on restricted mortality data, leaving out subjective health metrics, quality of life, and disease-specific data. To better guide efforts to transform political and economic institutions, more data are needed for health-care access, health-care quality, health status, and access to services of marginalised groups.

    View details for DOI 10.1016/S0140-6736(13)62185-6

    View details for Web of Science ID 000330212600034

    View details for PubMedID 24452043

  • An alternative mechanism for international health aid: evaluating a Global Social Protection Fund HEALTH POLICY AND PLANNING Basu, S., Stuckler, D., McKee, M. 2014; 29 (1): 127-136

    Abstract

    Several public health groups have called for the creation of a global fund for 'social protection'-a fund that produces the international equivalent of domestic tax collection and safety net systems to finance care for the ill and disabled and related health costs. All participating countries would pay into a global fund based on a metric of their ability to pay and withdraw from the common pool based on a metric of their need for funds. We assessed how alternative strategies and metrics by which to operate such a fund would affect its size and impact on health system financing. Using a mathematical model, we found that common targets for health funding in low-income countries require higher levels of aid expenditures than presently distributed. Some mechanisms exist that may incentivize reduction of domestic health inequalities, and direct most funds towards the poorest populations. Payments from high-income countries are also likely to decrease over time as middle-income countries' economies grow.

    View details for DOI 10.1093/heapol/czs141

    View details for Web of Science ID 000329136400012

    View details for PubMedID 23335466

  • Averting Obesity and Type 2 Diabetes in India through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study. PLoS medicine Basu, S., Vellakkal, S., Agrawal, S., Stuckler, D., Popkin, B., Ebrahim, S. 2014; 11 (1)

    Abstract

    Taxing sugar-sweetened beverages (SSBs) has been proposed in high-income countries to reduce obesity and type 2 diabetes. We sought to estimate the potential health effects of such a fiscal strategy in the middle-income country of India, where there is heterogeneity in SSB consumption, patterns of substitution between SSBs and other beverages after tax increases, and vast differences in chronic disease risk within the population.Using consumption and price variations data from a nationally representative survey of 100,855 Indian households, we first calculated how changes in SSB price alter per capita consumption of SSBs and substitution with other beverages. We then incorporated SSB sales trends, body mass index (BMI), and diabetes incidence data stratified by age, sex, income, and urban/rural residence into a validated microsimulation of caloric consumption, glycemic load, overweight/obesity prevalence, and type 2 diabetes incidence among Indian subpopulations facing a 20% SSB excise tax. The 20% SSB tax was anticipated to reduce overweight and obesity prevalence by 3.0% (95% CI 1.6%-5.9%) and type 2 diabetes incidence by 1.6% (95% CI 1.2%-1.9%) among various Indian subpopulations over the period 2014-2023, if SSB consumption continued to increase linearly in accordance with secular trends. However, acceleration in SSB consumption trends consistent with industry marketing models would be expected to increase the impact efficacy of taxation, averting 4.2% of prevalent overweight/obesity (95% CI 2.5-10.0%) and 2.5% (95% CI 1.0-2.8%) of incident type 2 diabetes from 2014-2023. Given current consumption and BMI distributions, our results suggest the largest relative effect would be expected among young rural men, refuting our a priori hypothesis that urban populations would be isolated beneficiaries of SSB taxation. Key limitations of this estimation approach include the assumption that consumer expenditure behavior from prior years, captured in price elasticities, will reflect future behavior among consumers, and potential underreporting of consumption in dietary recall data used to inform our calculations.Sustained SSB taxation at a high tax rate could mitigate rising obesity and type 2 diabetes in India among both urban and rural subpopulations. Please see later in the article for the Editors' Summary.

    View details for DOI 10.1371/journal.pmed.1001582

    View details for PubMedID 24409102

    View details for PubMedCentralID PMC3883641

  • Six concerns about the data in aid debates: applying an epidemiological perspective to the analysis of aid effectiveness in health and development HEALTH POLICY AND PLANNING Stuckler, D., McKee, M., Basu, S. 2013; 28 (8): 871-883

    Abstract

    Is aid helping, hindering, or having no effect on development and health? The answer to this question is highly contested, with proponents on all sides adhering strongly to their competing interpretations. We ask how it is possible for those who are often using the same data to hold such divergent views. Here, we employ an epidemiological perspective and find that, in many cases, the arguments are characterised by methodological weaknesses. There may be selective citation of results and failure to account for bias and confounding, such as where an extraneous factor influencing the outcome is correlated with increased aid or, in confounding by indication, where increased aid is a consequence of a country being in an especially adverse situation. Studies may also lack external validity, whereby lack of data (a widespread problem) or similar considerations mean that analyses are undertaken on an unrepresentative subset of countries. Multiple outcome measures can also be problematic, where the main outcome of interest is not specified in advance. Many studies fail to account for differential time lags between changes in aid and the outcomes being studied. Some studies may also be underpowered to detect an association where one exists. Although, ideally, this debate should be informed by large scale randomised controlled trials, this will often be unfeasible. Given this limitation, it is essential that those engaged in it are cognisant of the many methodological issues that face any observational study.

    View details for DOI 10.1093/heapol/czs126

    View details for Web of Science ID 000328362100008

    View details for PubMedID 23242695

  • Disability and Chronic Disease Among Older Adults in India: Detecting Vulnerable Populations Through the WHO SAGE Study AMERICAN JOURNAL OF EPIDEMIOLOGY Basu, S., King, A. C. 2013; 178 (11): 1620-1628

    Abstract

    Chronic noncommunicable diseases (NCDs) are now prevalent in many low- and middle-income countries and confer a heightened risk of disability. It is unclear how public health programs can identify the older adults at highest risk of disability related to NCDs within diverse developing country populations. We studied nationally representative survey data from 7,150 Indian adults older than 50 years of age who participated in the World Health Organization Study on Global Aging and Adult Health (2007-2010) to identify population subgroups who are highly disabled. Using machine-learning algorithms, we identified sociodemographic correlates of disability. Although having 2 or more symptomatic NCDs was a key correlate of disability, the prevalence of symptomatic, undiagnosed NCDs was highest among the lowest 2 wealth quintiles of Indian adults, contrary to prior hypotheses of increased NCDs with wealth. Women and persons from rural populations were also disproportionately affected by nondiagnosed NCDs, with high out-of-pocket health care expenditures increasing the probability of remaining symptomatic from NCDs. These findings also indicate that NCD prevalence surveillance studies in low- and middle-income countries should expand beyond self-reported diagnoses to include more extensive symptom- and examination-based surveys, given the likely high rate of surveillance bias due to barriers to diagnosis among vulnerable populations.

    View details for DOI 10.1093/aje/kwt191

    View details for Web of Science ID 000327717600004

    View details for PubMedID 24049156

  • Relationship of soft drink consumption to global overweight, obesity, and diabetes: a cross-national analysis of 75 countries. American journal of public health Basu, S., McKee, M., Galea, G., Stuckler, D. 2013; 103 (11): 2071-2077

    Abstract

    Objectives. We estimated the relationship between soft drink consumption and obesity and diabetes worldwide. Methods. We used multivariate linear regression to estimate the association between soft drink consumption and overweight, obesity, and diabetes prevalence in 75 countries, controlling for other foods (cereals, meats, fruits and vegetables, oils, and total calories), income, urbanization, and aging. Data were obtained from the Euromonitor Global Market Information Database, the World Health Organization, and the International Diabetes Federation. Bottled water consumption, which increased with per-capita income in parallel to soft drink consumption, served as a natural control group. Results. Soft drink consumption increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons in 2010. A 1% rise in soft drink consumption was associated with an additional 4.8 overweight adults per 100 (adjusted B; 95% confidence interval [CI] = 3.1, 6.5), 2.3 obese adults per 100 (95% CI = 1.1, 3.5), and 0.3 adults with diabetes per 100 (95% CI = 0.1, 0.8). These findings remained robust in low- and middle-income countries. Conclusions. Soft drink consumption is significantly linked to overweight, obesity, and diabetes worldwide, including in low- and middle-income countries. (Am J Public Health. Published online ahead of print March 14, 2013: e1-e7. doi:10.2105/AJPH.2012.300974).

    View details for DOI 10.2105/AJPH.2012.300974

    View details for PubMedID 23488503

  • Austere or not? UK coalition government budgets and health inequalities. Journal of the Royal Society of Medicine Reeves, A., Basu, S., McKee, M., Marmot, M., Stuckler, D. 2013; 106 (11): 432-436

    View details for DOI 10.1177/0141076813501101

    View details for PubMedID 24025229

  • Nutritional policy changes in the supplemental nutrition assistance program: a microsimulation and cost-effectiveness analysis. Medical decision making Basu, S., Seligman, H., Bhattacharya, J. 2013; 33 (7): 937-948

    Abstract

    Some experts have proposed limiting the use of Supplemental Nutrition Assistance Program (SNAP) benefits, for calorie-dense foods or subsidizing SNAP purchases of healthier foods.To estimate health effects and cost-effectiveness of banning or taxing sugar-sweetened beverages (SSBs) or subsidizing fruits and vegetables purchased with SNAP.. Microsimulation. Data Sources. National Health and Nutrition Examination Survey, US Department of Agriculture Quarterly Food-at-Home Price Database, and SNAP program data. Target Population: US adults aged 25 to 64 y. Time Horizon. 10 y. Perspective. Governmental. Outcome MEASURES: Incremental costs, quality-adjusted life-years (QALYs), body mass index, Alternative Healthy Eating Index, Food Security Score, diabetes person-years, and deaths from myocardial infarctions (MIs) and strokes.of Base-Case Analysis. Banning SSB purchases using SNAP benefits would be expected to avert 510,000 diabetes person-years and 52,000 deaths from MIs and strokes over the next decade, with a savings of $2900 per QALY saved. A penny-per-ounce tax on SSBs purchased with SNAP dollars would produce higher cost savings due to tax revenues but avert fewer chronic disease deaths. However, some SNAP participants are likely to preferentially purchase SSBs through their disposable income, indirectly reducing their food security. A 30% produce subsidy would be expected to avert 39,000 diabetes person-years and 4600 cardiovascular deaths over 10 y without effects on food security. Results of Sensitivity Analysis. Results are sensitive to the intake elasticities of SSBs and produce. Limitations. Input data did not provide information on heterogeneity in response to price changes within the SNAP-using POPULATION: CONCLUSIONS: SNAP restrictions on SSBs could lower chronic disease mortality, but further testing should examine indirect effects on disposable income and food security. Subsidizing produce could confer fewer benefits or risks but at higher cost.

    View details for DOI 10.1177/0272989X13493971

    View details for PubMedID 23811757

  • Complexity in mathematical models of public health policies: a guide for consumers of models. PLoS medicine Basu, S., Andrews, J. 2013; 10 (10)

    View details for DOI 10.1371/journal.pmed.1001540

    View details for PubMedID 24204214

  • Does investment in the health sector promote or inhibit economic growth? GLOBALIZATION AND HEALTH Reeves, A., Basu, S., McKee, M., Meissner, C., Stuckler, D. 2013; 9
  • Socioeconomic Inequalities in Non-Communicable Diseases Prevalence in India: Disparities between Self-Reported Diagnoses and Standardized Measures PLOS ONE Vellakkal, S., Subramanian, S. V., Millett, C., Basu, S., Stuckler, D., Ebrahim, S. 2013; 8 (7)

    Abstract

    Whether non-communicable diseases (NCDs) are diseases of poverty or affluence in low-and-middle income countries has been vigorously debated. Most analyses of NCDs have used self-reported data, which is biased by differential access to healthcare services between groups of different socioeconomic status (SES). We sought to compare self-reported diagnoses versus standardised measures of NCD prevalence across SES groups in India.We calculated age-adjusted prevalence rates of common NCDs from the Study on Global Ageing and Adult Health, a nationally representative cross-sectional survey. We compared self-reported diagnoses to standardized measures of disease for five NCDs. We calculated wealth-related and education-related disparities in NCD prevalence by calculating concentration index (C), which ranges from -1 to +1 (concentration of disease among lower and higher SES groups, respectively).NCD prevalence was higher (range 5.2 to 19.1%) for standardised measures than self-reported diagnoses (range 3.1 to 9.4%). Several NCDs were particularly concentrated among higher SES groups according to self-reported diagnoses (Csrd) but were concentrated either among lower SES groups or showed no strong socioeconomic gradient using standardized measures (Csm): age-standardised wealth-related C: angina Csrd 0.02 vs. Csm -0.17; asthma and lung diseases Csrd -0.05 vs. Csm -0.04 (age-standardised education-related Csrd 0.04 vs. Csm -0.05); vision problems Csrd 0.07 vs. Csm -0.05; depression Csrd 0.07 vs. Csm -0.13. Indicating similar trends of standardized measures detecting more cases among low SES, concentration of hypertension declined among higher SES (Csrd 0.19 vs. Csm 0.03).The socio-economic patterning of NCD prevalence differs markedly when assessed by standardized criteria versus self-reported diagnoses. NCDs in India are not necessarily diseases of affluence but also of poverty, indicating likely under-diagnosis and under-reporting of diseases among the poor. Standardized measures should be used, wherever feasible, to estimate the true prevalence of NCDs.

    View details for DOI 10.1371/journal.pone.0068219

    View details for Web of Science ID 000323110600012

    View details for PubMedID 23869213

  • Social Epidemiology of Hypertension in Middle-Income Countries: Determinants of Prevalence, Diagnosis, Treatment, and Control in the WHO SAGE Study. Hypertension Basu, S., Millett, C. 2013; 62 (1): 18-26

    Abstract

    Large-scale hypertension screening campaigns have been recommended for middle-income countries. We sought to identify sociodemographic predictors of hypertension prevalence, diagnosis, treatment, and control among middle-income countries. We analyzed data from 47 443 adults in all 6 middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa) sampled in nationally representative household assessments from 2007 to 2010 as part of the World Health Organization Study on Global Aging and Adult Health. We estimated regression models accounting for age, sex, urban/rural location, nutrition, and obesity, as well as hypothesized covariates of healthcare access, such as income and insurance. Hypertension prevalence varied from 23% (India) to 52% (Russia), with between 30% (Russia) and 83% (Ghana) of hypertensives undiagnosed before the survey and between 35% (Russia) and 87% (Ghana) untreated. Although the risk of hypertension significantly increased with age (odds ratio, 4.6; 95% confidence interval, 3.0-7.1; among aged, 60-79 versus <40 years), the risk of being undiagnosed or untreated fell significantly with age. Obesity was a significant correlate to hypertension (odds ratio, 3.7; 95% confidence interval, 2.1-6.8 for obese versus normal weight), and was prevalent even among the lowest income quintile (13% obesity). Insurance status and income also emerged as significant correlates to diagnosis and treatment probability, respectively. More than 90% of hypertension cases were uncontrolled, with men having 3 times the odds as women of being uncontrolled. Overall, the social epidemiology of hypertension in middle-income countries seems to be correlated to increasing obesity prevalence, and hypertension control rates are particularly low for adult men across distinct cultures.

    View details for DOI 10.1161/HYPERTENSIONAHA.113.01374

    View details for PubMedID 23670299

  • The Effect of Tobacco Control Measures during a Period of Rising Cardiovascular Disease Risk in India: A Mathematical Model of Myocardial Infarction and Stroke PLOS MEDICINE Basu, S., Glantz, S., Bitton, A., Millett, C. 2013; 10 (7)

    Abstract

    We simulated tobacco control and pharmacological strategies for preventing cardiovascular deaths in India, the country that is expected to experience more cardiovascular deaths than any other over the next decade.A microsimulation model was developed to quantify the differential effects of various tobacco control measures and pharmacological therapies on myocardial infarction and stroke deaths stratified by age, gender, and urban/rural status for 2013 to 2022. The model incorporated population-representative data from India on multiple risk factors that affect myocardial infarction and stroke mortality, including hypertension, hyperlipidemia, diabetes, coronary heart disease, and cerebrovascular disease. We also included data from India on cigarette smoking, bidi smoking, chewing tobacco, and secondhand smoke. According to the model's results, smoke-free legislation and tobacco taxation would likely be the most effective strategy among a menu of tobacco control strategies (including, as well, brief cessation advice by health care providers, mass media campaigns, and an advertising ban) for reducing myocardial infarction and stroke deaths over the next decade, while cessation advice would be expected to be the least effective strategy at the population level. In combination, these tobacco control interventions could avert 25% of myocardial infarctions and strokes (95% CI: 17%-34%) if the effects of the interventions are additive. These effects are substantially larger than would be achieved through aspirin, antihypertensive, and statin therapy under most scenarios, because of limited treatment access and adherence; nevertheless, the impacts of tobacco control policies and pharmacological interventions appear to be markedly synergistic, averting up to one-third of deaths from myocardial infarction and stroke among 20- to 79-y-olds over the next 10 y. Pharmacological therapies could also be considerably more potent with further health system improvements.Smoke-free laws and substantially increased tobacco taxation appear to be markedly potent population measures to avert future cardiovascular deaths in India. Despite the rise in co-morbid cardiovascular disease risk factors like hyperlipidemia and hypertension in low- and middle-income countries, tobacco control is likely to remain a highly effective strategy to reduce cardiovascular deaths. Please see later in the article for the Editors' Summary.

    View details for DOI 10.1371/journal.pmed.1001480

    View details for Web of Science ID 000322590800006

    View details for PubMedID 23874160

  • Malignant Neglect: The Failure to Address the Need to Prevent Premature Non-communicable Disease Morbidity and Mortality. PLoS medicine Stuckler, D., Basu, S. 2013; 10 (6)

    Abstract

    David Stuckler and Sanjay Basu comment on a study by Carl Lachat and colleagues documenting the lack of policies addressing noncommunicable disease prevention in low- and middle-income countries and outline steps for making such policies accessible, effective, and transparent.

    View details for DOI 10.1371/journal.pmed.1001466

    View details for PubMedID 23776416

  • Alcohol use during the great recession of 2008-2009. Alcohol and alcoholism Bor, J., Basu, S., Coutts, A., McKee, M., Stuckler, D. 2013; 48 (3): 343-348

    Abstract

    The aim of this study was to assess changes in alcohol use in the USA during the Great Recession.Drinking participation, drinking frequency, drinking intensity, total alcohol consumption and frequency of binge drinking were assessed in a nationally representative sample of 2,050,431 US women and men aged 18 and older, interviewed between 2006 and 2010.The prevalence of any alcohol use significantly declined during the economic recession, from 52.0% in 2006-2007 to 51.6% in 2008-2009 (P < 0.05), corresponding to 880,000 fewer drinkers (95% confidence interval [CI] 140,000 to 1.6 million). There was an increase, however, in the prevalence of frequent binging, from 4.8% in 2006-2007 to 5.1% in 2008-2009 (P < 0.01), corresponding to 770,000 more frequent bingers (95% CI 390,000 to 1.1 million). Non-Black, unmarried men under 30 years, who recently became unemployed, were at highest risk for frequent binging.During the Great Recession there was an increase in abstention from alcohol and a rise in frequent binging.

    View details for DOI 10.1093/alcalc/agt002

    View details for PubMedID 23360873

  • Was the Great Depression a cause or correlate of significant mortality declines? An epidemiological response to Granados JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Stuckler, D., Meissner, C., Fishback, P., Basu, S., McKee, M. 2013; 67 (5): 467-467

    View details for DOI 10.1136/jech-2012-201903

    View details for Web of Science ID 000316560300016

    View details for PubMedID 23201621

  • Financial crisis, austerity, and health in Europe LANCET Karanikolos, M., Mladovsky, P., Cylus, J., Thomson, S., Basu, S., Stuckler, D., Mackenbach, J. P., McKee, M. 2013; 381 (9874): 1323-1331

    Abstract

    The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis.

    View details for DOI 10.1016/S0140-6736(13)60102-6

    View details for Web of Science ID 000317351000035

    View details for PubMedID 23541059

  • Access to cancer medicines in India LANCET ONCOLOGY Kishore, S. P., Basu, S., Selvaraj, S. 2013; 14 (4): E136-E136

    View details for Web of Science ID 000317390300001

    View details for PubMedID 23561744

  • Is Passive Diagnosis Enough? The Impact of Subclinical Disease on Diagnostic Strategies for Tuberculosis AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE Dowdy, D. W., Basu, S., Andrews, J. R. 2013; 187 (5): 543-551

    Abstract

    Tuberculosis (TB) is characterized by a subclinical phase (symptoms absent or not considered abnormal); prediagnostic phase (symptoms noticed but diagnosis not pursued); and clinical phase (care actively sought). Diagnostic capacity during these phases is limited.To estimate the population-level impact of TB case-finding strategies in the presence of subclinical and prediagnostic disease.We created a mathematical epidemic model of TB, calibrated to global incidence. We then introduced three prototypical diagnostic interventions: increased sensitivity of diagnosis in the clinical phase by 20% ("passive"); early diagnosis during the prediagnostic phase at a rate of 10% per year ("enhanced"); and population-based diagnosis of 5% of undiagnosed prevalent cases per year ("active").If the subclinical phase was ignored, as in most models, the passive strategy was projected to reduce TB incidence by 18% (90% uncertainty range [UR], 11-32%) by year 10, compared with 23% (90% UR, 14-35%) for the enhanced strategy and 18% (90% UR, 11-28%) for the active strategy. After incorporating a subclinical phase into the model, consistent with population-based prevalence surveys, the active strategy still reduced 10-year TB incidence by 16% (90% UR, 11-28%), but the passive and enhanced strategies' impact was attenuated to 11% (90% UR, 8-25%) and 6% (90% UR, 4-13%), respectively. The degree of attenuation depended strongly on the transmission rate during the subclinical phase.Subclinical disease may limit the impact of current diagnostic strategies for TB. Active detection of undiagnosed prevalent cases may achieve greater population-level TB control than increasing passive case detection.

    View details for DOI 10.1164/rccm.201207-1217OC

    View details for Web of Science ID 000315977200014

    View details for PubMedID 23262515

  • The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data PLOS ONE Basu, S., Yoffe, P., Hills, N., Lustig, R. H. 2013; 8 (2)

    Abstract

    While experimental and observational studies suggest that sugar intake is associated with the development of type 2 diabetes, independent of its role in obesity, it is unclear whether alterations in sugar intake can account for differences in diabetes prevalence among overall populations. Using econometric models of repeated cross-sectional data on diabetes and nutritional components of food from 175 countries, we found that every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1% (p <0.001) after testing for potential selection biases and controlling for other food types (including fibers, meats, fruits, oils, cereals), total calories, overweight and obesity, period-effects, and several socioeconomic variables such as aging, urbanization and income. No other food types yielded significant individual associations with diabetes prevalence after controlling for obesity and other confounders. The impact of sugar on diabetes was independent of sedentary behavior and alcohol use, and the effect was modified but not confounded by obesity or overweight. Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.

    View details for DOI 10.1371/journal.pone.0057873

    View details for Web of Science ID 000315519000167

    View details for PubMedID 23460912

  • The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010 EUROPEAN JOURNAL OF PUBLIC HEALTH Gili, M., Roca, M., Basu, S., McKee, M., Stuckler, D. 2013; 23 (1): 103-108

    Abstract

    Nearly all European countries have been affected by the economic crisis that began in 2007, but the consequences have been among the worst in Spain. We investigated the associations of the recession on the frequency of mood, anxiety, somatoform, alcohol-related and eating disorders among those visiting Spanish primary care settings.Primary care physicians selected randomized samples of patients attending primary care centres representing Spain's consulting populations. A total of 7940 patients in 2006-07 and 5876 in 2010-11 were administered the Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument to diagnose mental disorders. Multivariate logistic regression models were used to quantify overall changes in the frequency of mental disorders, adjusting for potential socio-demographic differences in consulting populations unrelated to economic factors.Compared with the pre-crisis period of 2006, the 2010 survey revealed substantial and significant increases in the proportion of patients with mood (19.4% in major depression), anxiety (8.4% in generalized anxiety disorder), somatoform (7.3%) and alcohol-related disorders (4.6% in alcohol dependence), all significant at P < 0.001, but not in eating disorders (0.15%, P = 0.172). Independent of observed risks of unemployment [odds ratio (OR) = 1.72, P < 0.001], we observed a significantly elevated risk of major depression associated with mortgage repayment difficulties (OR = 2.12, P < 0.001) and evictions (OR = 2.95, P < 0.001). About one-third of the overall risk in the consulting population's attendance with mental health disorders could be attributed to the combined risks of household unemployment and mortgage payment difficulties.Recession has significantly increased the frequency of mental health disorders and alcohol abuse among primary care attendees in Spain, particularly among families experiencing unemployment and mortgage payment difficulties.

    View details for DOI 10.1093/eurpub/cks035

    View details for Web of Science ID 000314126700022

    View details for PubMedID 23132877

  • The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003 JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Quercioli, C., Messina, G., Basu, S., McKee, M., Nante, N., Stuckler, D. 2013; 67 (2): 132-138

    Abstract

    During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care).The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders.Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services.Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

    View details for DOI 10.1136/jech-2011-200640

    View details for Web of Science ID 000313335900004

    View details for PubMedID 23024258

  • Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries PUBLIC HEALTH NUTRITION Basu, S., Stuckler, D., McKee, M., Galea, G. 2013; 16 (1): 179-186

    Abstract

    Ageing and urbanization leading to sedentary lifestyles have been the major explanations proposed for a dramatic rise in diabetes worldwide and have been the variables used to predict future diabetes rates. However, a transition to Western diets has been suggested as an alternative driver. We sought to determine what socio-economic and dietary factors are the most significant population-level contributors to diabetes prevalence rates internationally.Multivariate regression models were used to study how market sizes of major food products (sugars, cereals, vegetable oils, meats, total joules) corresponded to diabetes prevalence, incorporating lagged and cumulative effects. The underlying social determinants of food market sizes and diabetes prevalence rates were also studied, including ageing, income, urbanization, overweight prevalence and imports of foodstuffs.Data were obtained from 173 countries.Population-based survey recipients were the basis for diabetes prevalence and food market data.We found that increased income tends to increase overall food market size among low- and middle-income countries, but the level of food importation significantly shifts the content of markets such that a greater proportion of available joules is composed of sugar and related sweeteners. Sugar exposure statistically explained why urbanization and income have been correlated with diabetes rates.Current diabetes projection methods may estimate future diabetes rates poorly if they fail to incorporate the impact of nutritional factors. Imported sugars deserve further investigation as a potential population-level driver of global diabetes.

    View details for DOI 10.1017/S1368980012002881

    View details for Web of Science ID 000313399300023

    View details for PubMedID 22691632

  • Palm oil taxes and cardiovascular disease mortality in India: economic-epidemiologic model. BMJ (Clinical research ed.) Basu, S., Babiarz, K. S., Ebrahim, S., Vellakkal, S., Stuckler, D., Goldhaber-Fiebert, J. D. 2013; 347: f6048-?

    View details for DOI 10.1136/bmj.f6048

    View details for PubMedID 24149818

  • INTRODUCTION: 'DYING FOR GOLD': THE EFFECTS OF MINERAL MININGON HIV, TUBERCULOSIS, SILICOSIS, AND OCCUPATIONAL DISEASES IN SOUTHERN AFRICA INTERNATIONAL JOURNAL OF HEALTH SERVICES Stuckler, D., Steele, S., Lurie, M., Basu, S. 2013; 43 (4): 639-649

    View details for DOI 10.2190/HS.43.4.c

    View details for Web of Science ID 000326096600003

  • Palm oil taxes and cardiovascular disease mortality in India: economic-epidemiologic model. BMJ (Clinical research ed.) Basu, S., Babiarz, K. S., Ebrahim, S., Vellakkal, S., Stuckler, D., Goldhaber-Fiebert, J. D. 2013; 347: f6048-?

    Abstract

    To examine the potential effect of a tax on palm oil on hyperlipidemia and on mortality due to cardiovascular disease in India.Economic-epidemiologic model.A microsimulation model of mortality due to myocardial infarction and stroke among Indian populations was constructed, incorporating nationally representative data on systolic blood pressure, total cholesterol, tobacco smoking, diabetes, and cardiovascular event history, and stratified by age, sex, and urban/rural residence. Household expenditure data were used to estimate the change in consumption of palm oil following changes in oil price and the potential substitution of alternative oils that might occur after imposition of a tax. A 20% excise tax on palm oil purchases was simulated over the period 2014-23.The model was used to project future mortality due to myocardial infarction and stroke, as well as the potential effect of a tax on food insecurity, accounting for the effect of increased food prices.A 20% tax on palm oil purchases would be expected to avert approximately 363 000 (95% confidence interval 247 000 to 479 000) deaths from myocardial infarctions and strokes over the period 2014-23 in India (1.3% reduction in cardiovascular deaths) if people do not substitute other oils for reduced palm oil consumption. Given estimates of substitution of palm oil with other oils following a 20% price increase for palm oil, the beneficial effects of increased polyunsaturated fat consumption would be expected to enhance the projected reduction in deaths to as much as 421 000 (256 000 to 586 000). The tax would be expected to benefit men more than women and urban populations more than rural populations, given differential consumption and cardiovascular risk. In a scenario incorporating the effect of taxation on overall food expenditures, the tax may increase food insecurity by <1%, resulting in 16 000 (95% confidence interval 12 000 to 22 000) deaths.Curtailing palm oil intake through taxation may modestly reduce hyperlipidemia and cardiovascular mortality, but with potential distributional consequences differentially benefiting male and urban populations, as well as affecting food security.

    View details for DOI 10.1136/bmj.f6048

    View details for PubMedID 24149818

  • Effects of Greek economic crisis on health are real BRITISH MEDICAL JOURNAL Kentikelenis, A., Karanikolos, M., Papanicolas, I., Basu, S., McKee, M., Stuckler, D. 2012; 345

    View details for DOI 10.1136/bmj.e8602

    View details for Web of Science ID 000312701700004

    View details for PubMedID 23262574

  • Increase in state suicide rates in the USA during economic recession LANCET Reeves, A., Stuckler, D., McKee, M., Gunnell, D., Chang, S., Basu, S. 2012; 380 (9856): 1813-1814
  • Dietary Salt Reduction and Cardiovascular Disease Rates in India: A Mathematical Model PLOS ONE Basu, S., Stuckler, D., Vellakkal, S., Ebrahim, S. 2012; 7 (9)

    Abstract

    Reducing salt intake has been proposed to prevent cardiovascular disease in India. We sought to determine whether salt reductions would be beneficial or feasible, given the worry that unrealistically large reductions would be required, worsening iodine deficiency and benefiting only urban subpopulations.Future myocardial infarctions (MI) and strokes in India were predicted with a Markov model simulating men and women aged 40 to 69 in both urban and rural locations, incorporating the risk reduction from lower salt intake. If salt intake does not change, we expect ~8.3 million MIs (95% CI: 6.9-9.6 million), 830,000 strokes (690,000-960,000) and 2.0 million associated deaths (1.5-2.4 million) per year among Indian adults aged 40 to 69 over the next three decades. Reducing intake by 3 g/day over 30 years (-0.1 g/year, 25% reduction) would reduce annual MIs by 350,000 (a 4.6% reduction; 95% CI: 320,000-380,000), strokes by 48,000 (-6.5%; 13,000-83,000) and deaths by 81,000 (-4.9%; 59,000-100,000) among this group. The largest decline in MIs would be among younger urban men, but the greatest number of averted strokes would be among rural men, and nearly one-third of averted strokes and one-fifth of averted MIs would be among rural women. Only under a highly pessimistic scenario would iodine deficiency increase (by <0.0001%, ~1600 persons), since inadequate iodized salt access--not low intake of iodized salt--is the major cause of deficiency and would be unaffected by dietary salt reduction.Modest reductions in salt intake could substantially reduce cardiovascular disease throughout India.

    View details for DOI 10.1371/journal.pone.0044037

    View details for Web of Science ID 000308458400030

    View details for PubMedID 22970159

  • Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review PLOS MEDICINE Basu, S., Andrews, J., Kishore, S., Panjabi, R., Stuckler, D. 2012; 9 (6)

    Abstract

    Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries.Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive dynamics" for funding appeared between the two sectors, such that public funds and personnel were redirected to private sector development, followed by reductions in public sector service budgets and staff.Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector; however, the public sector appears frequently to lack timeliness and hospitality towards patients.

    View details for DOI 10.1371/journal.pmed.1001244

    View details for Web of Science ID 000305946200015

    View details for PubMedID 22723748

  • Banking crises and mortality during the Great Depression: evidence from US urban populations, 1929-1937 JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Stuckler, D., Meissner, C., Fishback, P., Basu, S., McKee, M. 2012; 66 (5): 410-419

    Abstract

    Previous research suggests that the Great Depression led to improvements in public health. However, these studies rely on highly aggregated national data (using fewer than 25 data points) and potentially biased measures of the Great Depression. The authors assess the effects of the Great Depression using city-level estimates of US mortality and an underlying measure of economic crisis, bank suspensions, at the state level.Cause-specific mortalities covering 114 US cities in 36 states between 1929 and 1937 were regressed against bank suspensions and income data from the Federal Deposit Insurance Corporation Database, using dynamic fixed-effects models and adjustments for potential confounding variables.Reductions in all-cause mortalities were mainly attributable to declines in death rates owing to pneumonia (26.4% of total), flu (13.1% of total) and respiratory tuberculosis (11.2% of total), while death rates increased from heart disease (19.4% of total), cancer (8.1% of total) and diabetes (2.9%). Only heart disease can plausibly relate to the contemporaneous economic shocks. The authors found that a higher rate of bank suspensions was significantly associated with higher suicide rates (β=0.32, 95% CI 0.24 to 0.41) but lower death rates from motor-vehicle accidents (β=-0.18, 95% CI -0.29 to -0.07); no significant effects were observed for 30 other causes of death or with a time lag.In contrast with existing research, the authors find that many of the changes in deaths from different causes during the Great Depression were unrelated to economic shocks. Further research is needed to understand the causes of the marked variations in mortality change across cities and states, including the effects of the New Deal and Prohibition.

    View details for DOI 10.1136/jech.2010.121376

    View details for Web of Science ID 000302472400007

    View details for PubMedID 21441177

  • Health and the financial crisis in Greece Reply LANCET Kentikelenis, A., Karanikolos, M., Papanicolas, I., Basu, S., McKee, M., Stuckler, D. 2012; 379 (9820): 1002-1002
  • Health effects of financial crisis: omens of a Greek tragedy LANCET Kentikelenis, A., Karanikolos, M., Papanicolas, I., Basu, S., McKee, M., Stuckler, D. 2011; 378 (9801): 1457-1458
  • Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis BRITISH MEDICAL JOURNAL Basu, S., Stuckler, D., Bitton, A., Glantz, S. A. 2011; 343

    Abstract

    Almost 20% of people smoke tobacco worldwide--a percentage projected to rise in many poor countries. Smoking has been linked to increased individual risk of tuberculosis infection and mortality, but it remains unclear how these risks affect population-wide tuberculosis rates.We constructed a state transition, compartmental, mathematical model of tuberculosis epidemics to estimate the impact of alternative future smoking trends on tuberculosis control. We projected tuberculosis incidence, prevalence, and mortality in each World Health Organization region from 2010 to 2050, and incorporated changing trends in smoking, case detection, treatment success, and HIV prevalence.The model predicted that smoking would produce an excess of 18 million tuberculosis cases (standard error 16-20) and 40 million deaths from tuberculosis (39-41) between 2010 and 2050, if smoking trends continued along current trajectories. The effect of smoking was anticipated to increase the number of tuberculosis cases by 7% (274 million v 256 million) and deaths by 66% (101 million v 61 million), compared with model predictions that did not account for smoking. Smoking was also expected to delay the millennium development goal target to reduce tuberculosis mortality by half from 1990 to 2015. The model estimated that aggressive tobacco control (achieving a 1% decrease in smoking prevalence per year down to eradication) would avert 27 million smoking attributable deaths from tuberculosis by 2050. However, if the prevalence of smoking increased to 50% of adults (as observed in countries with high tobacco use), the model estimated that 34 million additional deaths from tuberculosis would occur by 2050.Tobacco smoking could substantially increase tuberculosis cases and deaths worldwide in coming years, undermining progress towards tuberculosis mortality targets. Aggressive tobacco control could avert millions of deaths from tuberculosis.

    View details for DOI 10.1136/bmj.d5506

    View details for Web of Science ID 000295779300001

    View details for PubMedID 21972295

  • Effects of the 2008 recession on health: a first look at European data LANCET Stuckler, D., Basu, S., Suhrcke, M., Coutts, A., McKee, M. 2011; 378 (9786): 124-125

    View details for Web of Science ID 000292948800021

    View details for PubMedID 21742166

  • Democracy and growth in divided societies: A health-inequality trap? SOCIAL SCIENCE & MEDICINE Powell-Jackson, T., Basu, S., Balabanova, D., McKee, M., Stuckler, D. 2011; 73 (1): 33-41

    Abstract

    Despite a tremendous increase in financial resources, many countries are not on track to achieve the child and maternal mortality targets set out in the Millennium Development Goals 4 and 5. It is commonly argued that two main social factors - improved democratic governance and aggregate income - will ultimately lead to progress in reducing child and maternal mortality. However, these two factors alone may be insufficient to achieve progress in settings where there is a high level of social division. To test the effects of growth and democratisation, and their interaction with social inequalities, we regressed data on child and maternal mortality rates for 192 countries against internationally used indexes of income, democracy, and population inequality (including income, ethnic, linguistic, and religious divisions) covering the period 1970-2007. We found that a higher degree of social division, especially ethnic and linguistic fractionalisation, was significantly associated with greater child and maternal mortality rates. We further found that, even in democratic states, greater social division was associated with lower overall population access to healthcare and lesser expansion of health system infrastructure. Perversely, while greater democratisation and aggregate income were associated with reduced maternal and child mortality overall, in regions with high levels of ethnic fragmentation the health benefits of democratisation and rising income were undermined and, at high levels of inequality reversed, so that democracy and growth were adversely related to child and maternal mortality. These findings are consistent with literature suggesting that high degrees of social division in the context of democratisation can strengthen the power of dominant elite and ethnic groups in political decision-making, resulting in health and welfare policies that deprive minority groups (a health-inequality trap). Thus, we show that improving economic growth and democratic governance are insufficient to achieve child and maternal health targets in communities with high levels of persistent social inequality. To reduce child and maternal mortality in highly divided societies, it will be necessary not only to increase growth and promote democratic elections, but also empower disenfranchised communities.

    View details for DOI 10.1016/j.socscimed.2011.04.013

    View details for Web of Science ID 000293263500005

    View details for PubMedID 21680070

  • The Impact of Economic Crises on Communicable Disease Transmission and Control: A Systematic Review of the Evidence PLOS ONE Suhrcke, M., Stuckler, D., Suk, J. E., Desai, M., Senek, M., McKee, M., Tsolova, S., Basu, S., Abubakar, I., Hunter, P., Rechel, B., Semenza, J. C. 2011; 6 (6)

    Abstract

    There is concern among public health professionals that the current economic downturn, initiated by the financial crisis that started in 2007, could precipitate the transmission of infectious diseases while also limiting capacity for control. Although studies have reviewed the potential effects of economic downturns on overall health, to our knowledge such an analysis has yet to be done focusing on infectious diseases. We performed a systematic literature review of studies examining changes in infectious disease burden subsequent to periods of crisis. The review identified 230 studies of which 37 met our inclusion criteria. Of these, 30 found evidence of worse infectious disease outcomes during recession, often resulting from higher rates of infectious contact under poorer living circumstances, worsened access to therapy, or poorer retention in treatment. The remaining studies found either reductions in infectious disease or no significant effect. Using the paradigm of the "SIR" (susceptible-infected-recovered) model of infectious disease transmission, we examined the implications of these findings for infectious disease transmission and control. Key susceptible groups include infants and the elderly. We identified certain high-risk groups, including migrants, homeless persons, and prison populations, as particularly vulnerable conduits of epidemics during situations of economic duress. We also observed that the long-term impacts of crises on infectious disease are not inevitable: considerable evidence suggests that the magnitude of effect depends critically on budgetary responses by governments. Like other emergencies and natural disasters, preparedness for financial crises should include consideration of consequences for communicable disease control.

    View details for DOI 10.1371/journal.pone.0020724

    View details for Web of Science ID 000291612600019

    View details for PubMedID 21695209

  • Transmission dynamics and control of cholera in Haiti: an epidemic model LANCET Andrews, J. R., Basu, S. 2011; 377 (9773): 1248-1255

    Abstract

    Official projections of the cholera epidemic in Haiti have not incorporated existing disease trends or patterns of transmission, and proposed interventions have been debated without comparative estimates of their effect. We used a mathematical model of the epidemic to provide projections of future morbidity and mortality, and to produce comparative estimates of the effects of proposed interventions.We designed mathematical models of cholera transmission based on existing models and fitted them to incidence data reported in Haiti for each province from Oct 31, 2010, to Jan 24, 2011. We then simulated future epidemic trajectories from March 1 to Nov 30, 2011, to estimate the effect of clean water, vaccination, and enhanced antibiotic distribution programmes.We project 779,000 cases of cholera in Haiti (95% CI 599,000-914,000) and 11,100 deaths (7300-17,400) between March 1 and Nov 30, 2011. We expect that a 1% per week reduction in consumption of contaminated water would avert 105,000 cases (88,000-116,000) and 1500 deaths (1100-2300). We predict that the vaccination of 10% of the population, from March 1, will avert 63,000 cases (48,000-78,000) and 900 deaths (600-1500). The proposed extension of the use of antibiotics to all patients with severe dehydration and half of patients with moderate dehydration is expected to avert 9000 cases (8000-10,000) and 1300 deaths (900-2000).A decline in cholera prevalence in early 2011 is part of the natural course of the epidemic, and should not be interpreted as indicative of successful intervention. Substantially more cases of cholera are expected than official estimates used for resource allocation. Combined, clean water provision, vaccination, and expanded access to antibiotics might avert thousands of deaths.National Institutes of Health.

    View details for DOI 10.1016/S0140-6736(11)60273-0

    View details for Web of Science ID 000289597300031

    View details for PubMedID 21414658

  • Does recession reduce global health aid? Evidence from 15 high-income countries, 1975-2007 BULLETIN OF THE WORLD HEALTH ORGANIZATION Stuckler, D., Basu, S., Wang, S. W., McKee, M. 2011; 89 (4): 252-257

    Abstract

    To test the hypothesis that economic recessions lead to reduced global development assistance for health (DAH).Data obtained from the Creditor Reporting System of the Organisation for Economic Co-operation and Development (OECD) for 15 OECD countries were used to model the percentage change (relative difference) in commitments and disbursements for DAH as a function of three measures of economic recession: recessionary year (as a dummy variable with 0 for no recession and 1 for recession), percentage change in per capita gross domestic product and percentage point change in unemployment rate for recessionary cycles from 1975 through 2007. We looked for an association both during the concurrent recessionary year and one and two years later.No statistically significant association was found in the short or long run between measures of economic recession and the amount of official DAH committed or disbursed.Any important decrease in overall DAH following the current economic recession would have little historical precedent and claims of inevitability would be unjustifiable.

    View details for DOI 10.2471/BLT.10.080663

    View details for Web of Science ID 000289704000016

    View details for PubMedID 21479089

  • Mining and Risk of Tuberculosis in Sub-Saharan Africa AMERICAN JOURNAL OF PUBLIC HEALTH Stuckler, D., Basu, S., McKee, M., Lurie, M. 2011; 101 (3): 524-530

    Abstract

    We estimated the relationship between mining and tuberculosis (TB) among countries in sub-Saharan Africa.We used multivariate regression to estimate the contribution of mining activity to TB incidence, prevalence, and mortality, as well as rates of TB among people living with HIV, with control for economic, health system, and population confounders.Mining production was associated with higher population TB incidence rates (adjusted b = 0.093; 95% confidence interval [CI] = 0.067, 0.120; with an increase of mining production of 1 SD corresponding to about 33% higher TB incidence or 760,000 more incident cases), after adjustment for economic and population controls. Similar results were observed for TB prevalence and mortality, as well as with alternative measures of mining activity. Independent of HIV, there were significant associations between mining production and TB incidence in countries with high HIV prevalence (≥ 4% antenatal HIV prevalence; HIV-adjusted B = 0.066; 95% CI = 0.050, 0.082) and between log gold mining production and TB incidence in all studied countries (HIV-adjusted B = 0.053; 95% CI = 0.032, 0.073).Mining is a significant determinant of countrywide variation in TB among sub-Saharan African nations. Comprehensive TB control strategies should explicitly address the role of mining activity and environments in the epidemic.

    View details for DOI 10.2105/AJPH.2009.175646

    View details for Web of Science ID 000287571800029

    View details for PubMedID 20516372

  • INTERNATIONAL MONETARY FUND AND AID DISPLACEMENT INTERNATIONAL JOURNAL OF HEALTH SERVICES Stuckler, D., Basu, S., McKee, M. 2011; 41 (1): 67-76

    Abstract

    Several recent papers find evidence that global health aid is being diverted to reserves, education, military, or other sectors, and is displacing government spending. This is suggested to occur because ministers of finance have competing, possibly corrupt, priorities and deprive the health sector of resources. Studies have found that development assistance for health routed to governments has a negative impact on health spending and that similar assistance routed to private nongovernmental organizations has a positive impact. An alternative hypothesis is that World Bank and IMF macro-economic policies, which specifically advise governments to divert aid to reserves to cope with aid volatility and keep government spending low, could be causing the displacement of health aid. This article evaluates whether aid displacement was greater when countries undertook a new borrowing program from the IMF between 1996 and 2006. As found in existing studies, for each $1 of development assistance for health, about $0.37 is added to the health system. However, evaluating IMF-borrowing versus non-IMF-borrowing countries reveals that non-borrowers add about $0.45 whereas borrowers add less than $0.01 to the health system. On average, health system spending grew at about half the speed when countries were exposed to the IMF than when they were not. It is important to take account of the political economy of global health finance when interpreting data on financial flows.

    View details for DOI 10.2190/HS.41.1.e

    View details for Web of Science ID 000285631100005

    View details for PubMedID 21319721

  • Who's Afraid of Noncommunicable Diseases? Raising Awareness of the Effects of Noncommunicable Diseases on Global Health JOURNAL OF HEALTH COMMUNICATION Alleyne, G., Basu, S., Stuckler, D. 2011; 16: 82-93

    Abstract

    Public-health priorities are in part driven by fear, yet fear has long been recognized as posing a threat to effective public health interventions. In this article, the authors review the role of fear in global health by focusing on the leading global cause of death and disability: noncommunicable diseases. Taking an historical perspective, first the authors review Samuel Adams' 1911 analysis of the role of fear in generating public health priority and his recommendations about mass educating the public. Next, they show that Adams' analysis still applies today, drawing on contemporary responses to H1N1 and HIV, while illustrating the ongoing neglect of long-term threats such as noncommunicable diseases. Then, they pose the question, "Is it possible, necessary, or useful to create a fear factor for noncommunicable diseases?" After reviewing mixed evidence about the effects of fear on social change (on individual behaviors and on building a mass movement to achieve collective action), the authors conclude by setting out an evidence-based, marketing strategy to generate a sustained, rational response to the noncommunicable disease epidemic.

    View details for DOI 10.1080/10810730.2011.602178

    View details for Web of Science ID 000299950800010

    View details for PubMedID 21916716

  • Health Care Capacity and Allocations Among South Africa's Provinces: Infrastructure-Inequality Traps After the End of Apartheid AMERICAN JOURNAL OF PUBLIC HEALTH Stuckler, D., Basu, S., McKee, M. 2011; 101 (1): 165-172

    Abstract

    We assessed the determinants of health care funding allocations among South Africa's provinces and their effects on health care from 1996 through 2007.We performed multivariate regression of funding allocation data against measures of disease burden and health system infrastructure by province.Disease burden was increasingly negatively correlated with funding allocations and explained less than one quarter of the variation in allocations among provinces. Nearly three quarters of the variation in allocations was explained by preexisting hospital infrastructure and health care workers. The density of private hospitals in the preceding year was associated with greater government allocations (b(private) = 0.12; 95% confidence interval [CI] = 0.08, 0.15), but public hospital density in the preceding year was not (b(public) = 0.05; 95% CI = -0.02, 0.11). Greater allocations were associated with a higher number of doctors (b = 0.54; 95% CI = 0.34, 0.75) but fewer nurses (b = -0.37; 95% CI = -0.72,-0.25) in the same year.Regions with a greater capacity to spend funds received more funding and created more infrastructure than those with greater health needs. Historical infrastructure inequalities may have created an infrastructure-inequality trap, in which the distribution of funds to those with greater "absorptive capacity" exacerbates inequalities.

    View details for DOI 10.2105/AJPH.2009.184895

    View details for Web of Science ID 000285665000030

    View details for PubMedID 21148716

  • Addressing Institutional Amplifiers in the Dynamics and Control of Tuberculosis Epidemics AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Basu, S., Stuckler, D., McKee, M. 2011; 84 (1): 30-37

    Abstract

    Tuberculosis outbreaks originating in prisons, mines, or hospital wards can spread to the larger community. Recent proposals have targeted these high-transmission institutional amplifiers by improving case detection, treatment, or reducing the size of the exposed population. However, what effects these alternative proposals may have is unclear. We mathematically modeled these control strategies and found case detection and treatment methods insufficient in addressing epidemics involving common types of institutional amplifiers. Movement of persons in and out of amplifiers fundamentally altered the transmission dynamics of tuberculosis in a manner not effectively mitigated by detection or treatment alone. Policies increasing the population size exposed to amplifiers or the per-person duration of exposure within amplifiers potentially worsened incidence, even in settings with high rates of detection and treatment success. However, reducing the total population size entering institutional amplifiers significantly lowered tuberculosis incidence and the risk of propagating new drug-resistant tuberculosis strains.

    View details for Web of Science ID 000285903800006

    View details for PubMedID 21212197

  • Chronic Diseases: Chronic Diseases and Development 1 Raising the priority of preventing chronic diseases: a political process LANCET Geneau, R., Stuckler, D., Stachenko, S., McKee, M., Ebrahim, S., Basu, S., Chockalingham, A., Mwatsama, M., Jamal, R., Alwan, A., Beaglehole, R. 2010; 376 (9753): 1689-1698
  • Raising the priority of preventing chronic diseases: a political process. Lancet Geneau, R., Stuckler, D., Stachenko, S., McKee, M., Ebrahim, S., Basu, S., Chockalingham, A., Mwatsama, M., Jamal, R., Alwan, A., Beaglehole, R. 2010; 376 (9753): 1689-1698

    Abstract

    Chronic diseases, especially cardiovascular diseases, diabetes, cancer, and chronic obstructive respiratory diseases,are neglected globally despite growing awareness of the serious burden that they cause. Global and national policies have failed to stop, and in many cases have contributed to, the chronic disease pandemic. Low-cost and highly effective solutions for the prevention of chronic diseases are readily available; the failure to respond is now a political, rather than a technical issue. We seek to understand this failure and to position chronic disease centrally on the global health and development agendas. To identify strategies for generation of increased political priority for chronic diseases and to further the involvement of development agencies, we use an adapted political process model. This model has previously been used to assess the success and failure of social movements. On the basis of this analysis,we recommend three strategies: reframe the debate to emphasise the societal determinants of disease and the interrelation between chronic disease, poverty, and development; mobilise resources through a cooperative and inclusive approach to development and by equitably distributing resources on the basis of avoidable mortality; and build one merging strategic and political opportunities, such as the World Health Assembly 2008–13 Action Plan and the high level meeting of the UN General Assembly in 2011 on chronic disease. Until the full set of threats—which include chronic disease—that trap poor households in cycles of debt and illness are addressed, progress towards equitable human development will remain inadequate.

    View details for DOI 10.1016/S0140-6736(10)61414-6

    View details for PubMedID 21074260

  • Responding to the economic crisis: a primer for public health professionals JOURNAL OF PUBLIC HEALTH Stuckler, D., Basu, S., McKee, M., Suhrcke, M. 2010; 32 (3): 298-306

    Abstract

    Does the current economic crisis require the deep cuts in public spending announced in the June 2010 emergency budget, with potential implications for public health? The arguments for and against such cuts in response to economic recession are complex, but if public health professionals are to engage in debates about future public spending, they should be informed by relevant evidence. In this perspective, we note that opinions among politicians and economists about how to respond to economic downturns are divided, while other EU countries, many with greater levels of debt than the UK, are protecting public expenditure unless required to do so by the International Monetary Fund. Current UK debt may in fact be viewed as sustainable given current information about interest rates, inflation and economic growth. Before accepting large cuts in public spending, it is important to contrast the lack of evidence for such short-term fixes with potentially dire repercussions for population health and welfare.

    View details for DOI 10.1093/pubmed/fdq060

    View details for Web of Science ID 000281186000003

    View details for PubMedID 20729376

  • Is wealthier always healthier? The impact of national income level, inequality, and poverty on public health in Latin America SOCIAL SCIENCE & MEDICINE Biggs, B., King, L., Basu, S., Stuckler, D. 2010; 71 (2): 266-273

    Abstract

    Despite findings indicating that both national income level and income inequality are each determinants of public health, few have studied how national income level, poverty and inequality interact with each other to influence public health outcomes. We analyzed the relationship between gross domestic product (GDP) per capita in purchasing power parity, extreme poverty rates, the gini coefficient for personal income and three common measures of public health: life expectancy, infant mortality rates, and tuberculosis (TB) mortality rates. Introducing poverty and inequality as modifying factors, we then assessed whether the relationship between GDP and health differed during times of increasing, decreasing, and decreasing or constant poverty and inequality. Data were taken from twenty-two Latin American countries from 1960 to 2007 from the December 2008 World Bank World Development Indicators, World Health Organization Global Tuberculosis Database 2008, and the Socio-Economic Database for Latin America and the Caribbean. Consistent with previous studies, we found increases in GDP have a sizable positive impact on population health. However, the strength of the relationship is powerfully influenced by changing levels of poverty and inequality. When poverty was increasing, greater GDP had no significant effect on life expectancy or TB mortality, and only led to a small reduction in infant mortality rates. When inequality was rising, greater GDP had only a modest effect on life expectancy and infant mortality rates, and no effect on TB mortality rates. In sharp contrast, during times of decreasing or constant poverty and inequality, there was a very strong relationship between increasing GDP and higher life expectancy and lower TB and infant mortality rates. Finally, inequality and poverty were found to exert independent, substantial effects on the relationship between national income level and health. Wealthier is indeed healthier, but how much healthier depends on how increases in wealth are distributed.

    View details for DOI 10.1016/j.socscimed.2010.04.002

    View details for Web of Science ID 000279985600009

    View details for PubMedID 20471147

  • Drivers of Inequality in Millennium Development Goal Progress: A Statistical Analysis PLOS MEDICINE Stuckler, D., Basu, S., McKee, M. 2010; 7 (3)

    Abstract

    Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of available domestic funds), or health system infrastructure. We also examined the impact of joint epidemics of HIV/AIDS and noncommunicable diseases (NCDs), which may limit the ability of households to address child mortality and increase risks of infectious diseases.We calculated each country's distance from its MDG goals for HIV/AIDS, tuberculosis, and infant and child mortality targets for the year 2005 using the United Nations MDG database for 227 countries from 1990 to the present. We studied the association of economic development (gross domestic product [GDP] per capita in purchasing-power-parity), the relative priority placed on health (health spending as a percentage of GDP), real health spending (health system expenditures in purchasing-power-parity), HIV/AIDS burden (prevalence rates among ages 15-49 y), and NCD burden (age-standardised chronic disease mortality rates), with measures of distance from attainment of health MDGs. To avoid spurious correlations that may exist simply because countries with high disease burdens would be expected to have low MDG progress, and to adjust for potential confounding arising from differences in countries' initial disease burdens, we analysed the variations in rates of change in MDG progress versus expected rates for each country. While economic development, health priority, health spending, and health infrastructure did not explain more than one-fifth of the differences in progress to health MDGs among countries, burdens of HIV and NCDs explained more than half of between-country inequalities in child mortality progress (R(2)-infant mortality = 0.57, R(2)-under 5 mortality = 0.54). HIV/AIDS and NCD burdens were also the strongest correlates of unequal progress towards tuberculosis goals (R(2) = 0.57), with NCDs having an effect independent of HIV/AIDS, consistent with micro-level studies of the influence of tobacco and diabetes on tuberculosis risks. Even after correcting for health system variables, initial child mortality, and tuberculosis diseases, we found that lower burdens of HIV/AIDS and NCDs were associated with much greater progress towards attainment of child mortality and tuberculosis MDGs than were gains in GDP. An estimated 1% lower HIV prevalence or 10% lower mortality rate from NCDs would have a similar impact on progress towards the tuberculosis MDG as an 80% or greater rise in GDP, corresponding to at least a decade of economic growth in low-income countries.Unequal progress in health MDGs in low-income countries appears significantly related to burdens of HIV and NCDs in a population, after correcting for potentially confounding socioeconomic, disease burden, political, and health system variables. The common separation between NCDs, child mortality, and infectious syndromes among development programs may obscure interrelationships of illness affecting those living in poor households--whether economic (e.g., as money spent on tobacco is lost from child health expenditures) or biological (e.g., as diabetes or HIV enhance the risk of tuberculosis).

    View details for DOI 10.1371/journal.pmed.1000241

    View details for Web of Science ID 000276311600010

    View details for PubMedID 20209000

  • Financing the Millennium Development Goals for health and beyond: sustaining the 'Big Push'. Globalization and health Ooms, G., Stuckler, D., Basu, S., McKee, M. 2010; 6: 17-?

    Abstract

    Many of the Millennium Development Goals are not being achieved in the world's poorest countries, yet only five years remain until the target date. The financing of these Goals is not merely insufficient; current evidence indicates that the temporary nature of the financing, as well as challenges to coordinating its delivery and directing it to the most needy recipients, hinder achievement of the Goals in countries that may benefit most. Traditional approaches to providing development assistance for health have not been able to address both prevalent and emergent public health challenges captured in the Goals; these challenges demand sustained forms of financial redistribution through a coordinated mechanism. A global social health protection fund is proposed to address recurring failures in the modern aid distribution mechanism. Such a Fund could use established and effective strategies for aid delivery to mitigate many financial problems currently undermining the Millennium Development Goals initiative.

    View details for DOI 10.1186/1744-8603-6-17

    View details for PubMedID 20932274

  • AN EVALUATION OF THE INTERNATIONAL MONETARY FUND'S CLAIMS ABOUT PUBLIC HEALTH INTERNATIONAL JOURNAL OF HEALTH SERVICES Stuckler, D., Basu, S., Gilmore, A., Batniji, R., Ooms, G., Marphatia, A. A., Hammonds, R., McKee, M. 2010; 40 (2): 327-332

    Abstract

    The International Monetary Fund's recent claims concerning its impact on public health are evaluated against available data. First, the IMF claims that health spending either does not change or increases with IMF-supported programs, but there is substantial evidence to the contrary. Second, the IMF claims to have relaxed strict spending requirements in response to the 2008-9 financial crisis, but there is no evidence supporting this claim, and some limited evidence from the Center for Economic Policy Research contradicting it. Third, the IMF states that wage ceilings on public health are no longer part of its explicit conditionalities to poor countries, as governments can choose how to achieve public spending targets; but in practice, ministers are left with few viable alternatives than to reduce health budgets to achieve specific IMF-mandated targets, so the result effectively preserves former policy. Fourth, the IMF's claim that it has increased aid to poor countries also seems to be contradicted by its policies of diverting aid to reserves, as well as evidence that a very small fraction of the Fund's new lending in response to the financial crisis has reached poor countries. Finally, the IMF's claim that it follows public health standards in tobacco control contrasts with its existing policies, which fail to follow the guidelines recommended by the World Bank and World Health Organization. The authors recommend that the IMF (1) become more transparent in its policies, practices, and data to allow improved independent evaluations of its impact on public health (including Health Impact Assessment) and (2) review considerable public health evidence indicating a negative association between its current policies and public health outcomes.

    View details for DOI 10.2190/HS.40.2.m

    View details for Web of Science ID 000277258100013

    View details for PubMedID 20440976

  • Turning a blind eye: the mobilization of radiology services in resource-poor regions. Globalization and health Maru, D. S., Schwarz, R., Jason, A., Basu, S., Sharma, A., Moore, C. 2010; 6: 18-?

    Abstract

    While primary care, obstetrical, and surgical services have started to expand in the world's poorest regions, there is only sparse literature on the essential support systems that are required to make these operations function. Diagnostic imaging is critical to effective rural healthcare delivery, yet it has been severely neglected by the academic, public, and private sectors. Currently, a large portion of the world's population lacks access to any form of diagnostic imaging. In this paper we argue that two primary imaging modalities--diagnostic ultrasound and X-Ray--are ideal for rural healthcare services and should be scaled-up in a rapid and standardized manner. Such machines, if designed for resource-poor settings, should a) be robust in harsh environmental conditions, b) function reliably in environments with unstable electricity, c) minimize radiation dangers to staff and patients, d) be operable by non-specialist providers, and e) produce high-quality images required for accurate diagnosis. Few manufacturers are producing ultrasound and X-Ray machines that meet the specifications needed for rural healthcare delivery in resource-poor regions. A coordinated effort is required to create demand sufficient for manufacturers to produce the desired machines and to ensure that the programs operating them are safe, effective, and financially feasible.

    View details for DOI 10.1186/1744-8603-6-18

    View details for PubMedID 20946643

  • Turning a blind eye: the mobilization of radiology services in resource-poor regions GLOBALIZATION AND HEALTH Maru, D. S., Schwarz, R., Andrews, J., Basu, S., Sharma, A., Moore, C. 2010; 6
  • Financing the Millennium Development Goals for health and beyond: sustaining the 'Big Push' GLOBALIZATION AND HEALTH Ooms, G., Stuckler, D., Basu, S., McKee, M. 2010; 6
  • The health implications of financial crisis: a review of the evidence. Ulster medical journal Stuckler, D., Basu, S., Suhrcke, M., McKee, M. 2009; 78 (3): 142-145

    Abstract

    What will the current economic crisis mean for the health of the people of Northern Ireland? We review the experience of three major economic crises in the 20(th) century: the Great Depression (1929), the Post-communist Depression (early 1990 s) and the East Asian financial crisis (late 1990 s). Available evidence suggests that health is at risk in times of rapid economic change, in both booms and busts. However the impact on mortality is exacerbated where people have easy access to the means to harm themselves and is ameliorated by the presence of strong social cohesion and social protection systems. On this basis, Northern Ireland may escape relatively unscathed in the short term but as every crisis also provides an opportunity, this is an appropriate time for the Northern Ireland Executive to reflect on whether they are making a sufficient investment in the long term health of their population.

    View details for PubMedID 19907678

  • The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis LANCET Stuckler, D., Basu, S., Suhrcke, M., Coutts, A., McKee, M. 2009; 374 (9686): 315-323

    Abstract

    There is widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health. We investigated how economic changes have affected mortality rates over the past three decades and identified how governments might reduce adverse effects.We used multivariate regression, correcting for population ageing, past mortality and employment trends, and country-specific differences in health-care infrastructure, to examine associations between changes in employment and mortality, and how associations were modified by different types of government expenditure for 26 European Union (EU) countries between 1970 and 2007.We noted that every 1% increase in unemployment was associated with a 0.79% rise in suicides at ages younger than 65 years (95% CI 0.16-1.42; 60-550 potential excess deaths [mean 310] EU-wide), although the effect size was non-significant at all ages (0.49%, -0.04 to 1.02), and with a 0.79% rise in homicides (95% CI 0.06-1.52; 3-80 potential excess deaths [mean 40] EU-wide). By contrast, road-traffic deaths decreased by 1.39% (0.64-2.14; 290-980 potential fewer deaths [mean 630] EU-wide). A more than 3% increase in unemployment had a greater effect on suicides at ages younger than 65 years (4.45%, 95% CI 0.65-8.24; 250-3220 potential excess deaths [mean 1740] EU-wide) and deaths from alcohol abuse (28.0%, 12.30-43.70; 1550-5490 potential excess deaths [mean 3500] EU-wide). We noted no consistent evidence across the EU that all-cause mortality rates increased when unemployment rose, although populations varied substantially in how sensitive mortality was to economic crises, depending partly on differences in social protection. Every US$10 per person increased investment in active labour market programmes reduced the effect of unemployment on suicides by 0.038% (95% CI -0.004 to -0.071).Rises in unemployment are associated with significant short-term increases in premature deaths from intentional violence, while reducing traffic fatalities. Active labour market programmes that keep and reintegrate workers in jobs could mitigate some adverse health effects of economic downturns.Centre for Crime and Justice Studies, King's College, London, UK; and Wates Foundation (UK).

    View details for DOI 10.1016/S0140-6736(09)61124-7

    View details for Web of Science ID 000268508200029

    View details for PubMedID 19589588

  • The Evolution of Tuberculosis Virulence BULLETIN OF MATHEMATICAL BIOLOGY Basu, S., Galvani, A. P. 2009; 71 (5): 1073-1088

    Abstract

    The evolution of Mycobacterium tuberculosis presents several challenges for public health. HIV and resistance to antimycobacterial medications have evolutionary implications for how Mycobacterium tuberculosis will evolve, as these factors influence the host environment and transmission dynamics of tuberculosis strains. We present an evolutionary invasion analysis of tuberculosis that characterizes the direction of tuberculosis evolution in the context of different natural and human-driven selective pressures, including changes in tuberculosis treatment and HIV prevalence. We find that the evolution of tuberculosis virulence can be affected by treatment success rates, the relative transmissibility of emerging strains, the rate of reactivation from latency among hosts, and the life expectancy of hosts. We find that the virulence of tuberculosis strains may also increase as a consequence of rising HIV prevalence, requiring faster case detection strategies in areas where the epidemics of HIV and tuberculosis collide.

    View details for DOI 10.1007/s11538-009-9394-x

    View details for Web of Science ID 000267157700003

    View details for PubMedID 19172358

  • Averting epidemics of extensively drug-resistant tuberculosis PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Basu, S., Friedland, G. H., Medlock, J., Andrews, J. R., Shah, N. S., Gandhi, N. R., Moll, A., Moodley, P., Sturm, A. W., Galvani, A. P. 2009; 106 (18): 7672-7677

    Abstract

    Extensively drug-resistant tuberculosis (XDR TB) has been detected in most provinces of South Africa, particularly in the KwaZulu-Natal province where several hundred cases have been reported since 2004. We analyzed the transmission dynamics of XDR TB in the region using mathematical models, and observed that nosocomial transmission clusters of XDR TB may emerge into community-based epidemics under the public health conditions of many South African communities. The effective reproductive number of XDR TB in KwaZulu-Natal may be around 2. Intensified community-based case finding and therapy appears critical to curtailing transmission. In the setting of delayed disease presentation and high system demand, improved diagnostic approaches may need to be employed in community-based programs rather than exclusively at tertiary hospitals. Using branching process mathematics, we observed that early, community-based drug-susceptibility testing and effective XDR therapy could help curtail ongoing transmission and reduce the probability of XDR TB epidemics in neighboring territories.

    View details for DOI 10.1073/pnas.0812472106

    View details for Web of Science ID 000265783600073

    View details for PubMedID 19365076

  • Primary and secondary tuberculosis preventive treatment in HIV clinics: simulating alternative strategies INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE Basu, S., Maru, D., POOLMAN, E., Galvani, A. 2009; 13 (5): 652-658

    Abstract

    Isoniazid preventive treatment (IPT) has been recommended for human immunodeficiency virus (HIV) infected individuals.We used a mathematical model to simulate the benefits and risks of preventive treatment delivered through antiretroviral (ARV) clinics using clinical data from Botswana.Preventive treatment was found to reduce the incidence of tuberculosis (TB) by at least 12 cases per 100000 population per year versus the scenario without such treatment over a 50-year simulation. Isoniazid (INH) resistant TB was observed to increase by <1% per year, even when using pessimistic assumptions about resistance emergence. The use of tuberculin skin testing had little impact as a screening procedure, while secondary treatment was observed to nearly double the impact of a preventive treatment program. Regardless of whether or not preventive treatment was implemented, INH-resistant TB rose in the context of increasing HIV prevalence, but was minimally amplified by preventive treatment itself.IPT programs implemented through ARV clinics may be effective at reducing TB incidence. The resistance contribution of IPT appears unlikely to supersede its overall incidence and mortality benefits.

    View details for Web of Science ID 000265424900021

    View details for PubMedID 19383201

  • Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis LANCET INFECTIOUS DISEASES Orenstein, E. W., Basu, S., Shah, N. S., Andrews, J. R., Friedland, G. H., Moll, A. P., Gandhi, N. R., Galvani, A. P. 2009; 9 (3): 153-161

    Abstract

    Multidrug-resistant (MDR) tuberculosis is a growing clinical and public-health concern. To evaluate existing evidence regarding treatment regimens for MDR tuberculosis, we used a Bayesian random-effects meta-analysis of the available therapeutic studies to assess how the reported proportion of patients treated successfully is influenced by differences in treatment regimen design, study methodology, and patient population. Successful treatment outcome was defined as cure or treatment completion. 34 clinical reports with a mean of 250 patients per report met the inclusion criteria. Our analysis shows that the proportion of patients treated successfully improved when treatment duration was at least 18 months, and if patients received directly observed therapy throughout treatment. Studies that combined both factors had significantly higher pooled success proportions (69%, 95% credible interval [CI] 64-73%) than other studies of treatment outcomes (58%, 95% CI 52-64%). Individualised treatment regimens had higher treatment success (64%, 95% CI 59-68%) than standardised regimens (54%, 95% CI 43-68%), although the difference was not significant. Treatment approaches and study methodologies were heterogeneous across studies. Many important variables, including patients' HIV status, were inconsistently reported between studies. These results underscore the importance of strong patient support and treatment follow-up systems to develop successful MDR tuberculosis treatment programmes.

    View details for Web of Science ID 000263787500014

    View details for PubMedID 19246019

  • The production of consumption: addressing the impact of mineral mining on tuberculosis in southern Africa. Globalization and health Basu, S., Stuckler, D., Gonsalves, G., Lurie, M. 2009; 5: 11-?

    Abstract

    Miners in southern Africa experience incident rates of tuberculosis up to ten times greater than the general population. Migration to and from mines may be amplifying tuberculosis epidemics in the general population.Migration to and from mineral mines contributes to HIV risks and associated tuberculosis incidence. Health and safety conditions within mines also promote the risk of silicosis (a tuberculosis risk factor) and transmission of tuberculosis bacilli in close quarters. In the context of migration, current tuberculosis prevention and treatment strategies often fail to provide sufficient continuity of care to ensure appropriate tuberculosis detection and treatment. Reports from Lesotho and South Africa suggest that miners pose transmission risks to other household or community members as they travel home undetected or inadequately treated, particularly with drug-resistant forms of tuberculosis. Reducing risky exposures on the mines, enhancing the continuity of primary care services, and improving the enforcement of occupational health codes may mitigate the harmful association between mineral mining activities and tuberculosis incidence among affected communities.Tuberculosis incidence appears to be amplified by mineral mining operations in southern Africa. A number of immediately-available measures to improve continuity of care for miners, change recruitment and compensation practices, and reduce the primary risk of infection may critically mitigate the negative association between mineral mining and tuberculosis.

    View details for DOI 10.1186/1744-8603-5-11

    View details for PubMedID 19785769

  • THE INTERNATIONAL MONETARY FUND'S EFFECTS ON GLOBAL HEALTH: BEFORE AND AFTER THE 2008 FINANCIAL CRISIS INTERNATIONAL JOURNAL OF HEALTH SERVICES Stuckler, D., Basu, S. 2009; 39 (4): 771-781

    Abstract

    In April 2009, the G20 countries committed US $750 billion to the International Monetary Fund (IMF), which has assumed a central role in global economic management. The IMF provides loans to financially ailing countries, but with strict conditions, typically involving a mix of privatization, liberalization, and fiscal austerity programs. These loan conditions have been extremely controversial. In principle, they are designed to help countries balance their books. In practice, they often translate into reductions in social spending, including spending on public health and health care delivery. As more countries are being exposed to IMF policies, there is a need to establish what we know and do not know about the IMF's effects on global health. This article introduces a series in which contributors review the evidence on the relationship between the IMF and public health and discuss potential ways to improve the Fund's effects on health. While more evidence is needed for some regions, there is sufficient evidence to indicate that IMF programs have been significantly associated with weakened health care systems, reduced effectiveness of health-focused development aid, and impeded efforts to control tobacco, infectious diseases, and child and maternal mortality. Reforms are urgently needed to prevent the current wave of IMF programs from further undermining public health in financially ailing countries and limiting progress toward the health Millennium Development Goals.

    View details for DOI 10.2190/HS.39.4.j

    View details for Web of Science ID 000271559500010

    View details for PubMedID 19927414

  • The production of consumption: addressing the impact of mineral mining on tuberculosis in southern Africa GLOBALIZATION AND HEALTH Basu, S., Stuckler, D., Gonsalves, G., Lurie, M. 2009; 5
  • Integrating epidemiology, psychology, and economics to achieve HPV vaccination targets PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Basu, S., Chapman, G. B., Galvani, A. P. 2008; 105 (48): 19018-19023

    Abstract

    Human papillomavirus (HPV) vaccines provide an opportunity to reduce the incidence of cervical cancer. Optimization of cervical cancer prevention programs requires anticipation of the degree to which the public will adhere to vaccination recommendations. To compare vaccination levels driven by public perceptions with levels that are optimal for maximizing the community's overall utility, we develop an epidemiological game-theoretic model of HPV vaccination. The model is parameterized with survey data on actual perceptions regarding cervical cancer, genital warts, and HPV vaccination collected from parents of vaccine-eligible children in the United States. The results suggest that perceptions of survey respondents generate vaccination levels far lower than those that maximize overall health-related utility for the population. Vaccination goals may be achieved by addressing concerns about vaccine risk, particularly those related to sexual activity among adolescent vaccine recipients. In addition, cost subsidizations and shifts in federal coverage plans may compensate for perceived and real costs of HPV vaccination to achieve public health vaccination targets.

    View details for DOI 10.1073/pnas.0808114105

    View details for Web of Science ID 000261489100073

    View details for PubMedID 19015536

  • The transmission and control of XDR TB in South Africa: an operations research and mathematical modelling approach EPIDEMIOLOGY AND INFECTION Basu, S., Galvani, A. P. 2008; 136 (12): 1585-1598

    Abstract

    Extensively drug-resistant tuberculosis (XDR TB) has emerged as a threat to TB control efforts in several high-burden areas, generating international concern. XDR TB is now found in every region of the world, but appears most worrisome in the context of HIV and in resource-limited settings with congregate hospital wards. Here, we examine the emergence and transmission dynamics of the disease, incorporating the mathematical modelling literature related to airborne infection and epidemiological studies related to the operations of TB control programmes in resource-limited settings. We find that while XDR TB may present many challenges in the setting of resource constraints, the central problems highlighted by the emergence of XDR TB are those that have plagued TB programmes for years. These include a slow rate of case detection that permits prolonged infectiousness, the threat of airborne infection in enclosed spaces, the problem of inadequate treatment delivery and treatment completion, and the need to develop health systems that can address the combination of TB and poverty. Mathematical models of TB transmission shed light on the idea that community-based therapy and rapid detection systems may be beneficial in resource-limited settings, while congregate hospital wards are sites for major structural reform.

    View details for DOI 10.1017/S0950268808000964

    View details for Web of Science ID 000261553500001

    View details for PubMedID 18606028

  • The Theoretical Influence of Immunity between Strain Groups on the Progression of Drug-Resistant Tuberculosis Epidemics JOURNAL OF INFECTIOUS DISEASES Basu, S., Orenstein, E., Galvani, A. P. 2008; 198 (10): 1502-1513

    Abstract

    Emerging research suggests that genetically distinct strains of Mycobacterium tuberculosis may modulate the immune system differently. This may be of importance in high-burden settings where > or =1 genetic group of M. tuberculosis confers significant morbidity.A dynamic mathematical model was constructed to evaluate how different degrees of cross-immunity among M. tuberculosis groups could affect epidemics of drug-resistant tuberculosis (TB).Simulated populations with immunogenically distinct TB strain groups experienced a heightened risk of drug-resistant TB, compared with populations without such strain diversity, even when the same rates of case detection and treatment success were achieved. The highest risks of infection were observed in populations in which HIV was prevalent. Drug-resistant strains with very low transmission fitness could still propagate in environments with reduced cross-immunity among different strain groups, even after common targets for case detection and treatment success are reached.It is possible that the propagation of drug-resistant strains could depend not only on the rate of development of resistance and the fitness of the drug-resistant strains but, also, on the diversity of the strains in the region. The risk of infection with drug-resistant strains could be amplified in locations where there is reduced cross-immunity between originating strain groups. This amplification may be most profound during the first few decades of TB treatment expansion.

    View details for DOI 10.1086/592508

    View details for Web of Science ID 000260472400012

    View details for PubMedID 18816192

  • Clinical outcomes of hepatitis C treatment in a prison setting: Feasibility and effectiveness for challenging treatment populations CLINICAL INFECTIOUS DISEASES Maru, D. S., Bruce, R. D., Basu, S., Altice, F. L. 2008; 47 (7): 952-961

    Abstract

    More than one-third of people in the United States with hepatic C virus (HCV) infection pass through the correctional system annually. Data are lacking on outcomes of treatment with pegylated interferon plus ribavirin (PEG-RBV) in correctional settings.During 2002-2006, we analyzed patients in the Connecticut Department of Correction who received PEG-RBV. We assessed the rates of sustained virological response, hospitalization, and use of medications to treat psychiatric disorders and anemia.Of 138 treatment-naive patients referred for treatment, 68 (49%) were approved. Overall, sustained virological response occurred in 47.1% of patients (for HCV genotype 1, 43.1%; for HCV genotypes 2 and 3, 58.8%). Only 9 patients (13%) discontinued treatment because of adverse effects. Multiple regression analysis revealed that not achieving a sustained virological response was correlated with HCV genotype 1 infection plus cirrhosis (adjusted odds ratio, 12.9; 95% confidence interval, 1.1-148) and baseline major depression (adjusted odds ratio, 3.4; 95% confidence interval, 1.01-11.6), but not with HIV infection, a baseline HCV RNA level >or=400,000 IU/mL, or black race. Compared with baseline, the rate of prescription of a new mood stabilizer (2.2 vs. 0.8 prescriptions per person-year) or an opioid (1.8 vs. 0.5 prescriptions per person-year) was higher during treatment, whereas there was no change in the rate of prescription of benzodiazepines and antipsychotic medications.These results support the feasibility and clinical effectiveness of PEG-RBV for the treatment of chronic HCV infection in correctional facilities.

    View details for DOI 10.1086/591707

    View details for Web of Science ID 000259038400017

    View details for PubMedID 18715156

  • Mass incarceration can explain population increases in TB and multidrug-resistant TB in European and central Asian countries PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Stuckler, D., Basu, S., McKee, M., King, L. 2008; 105 (36): 13280-13285

    Abstract

    Several microlevel studies have pinpointed prisons as an important site for tuberculosis (TB) and multidrug-resistant TB in European and central Asian countries. To date, no comparative analyses have examined whether rises in incarceration rates can account for puzzling differences in TB trends among overall populations. Using longitudinal TB and cross-sectional multidrug-resistant TB data for 26 eastern European and central Asian countries, we examined whether and to what degree increases in incarceration account for differences in population TB and multidrug-resistant TB burdens. We find that each percentage point increase in incarceration rates relates to an increased TB incidence of 0.34% (population attributable risk, 95% C.I.: 0.10-0.58%, P < 0.01), after controlling for TB infrastructure; HIV prevalence; and several surveillance, economic, demographic, and political indicators. Net increases in incarceration account for a 20.5% increase in TB incidence or nearly three-fifths of the average total increase in TB incidence in the countries studied from 1991 to 2002. Although the number of prisoners is a significant determinant of differences in TB incidence and multidrug-resistant TB prevalence among countries, the rate of prison growth is a larger determinant of these outcomes, and its effect is exacerbated but not confounded by HIV. Differences in incarceration rates are a major determinant of differences in population TB outcomes among eastern European and central Asian countries, and treatment expansion alone does not appear to resolve the effect of mass incarceration on TB incidence.

    View details for DOI 10.1073/pnas.0801200105

    View details for Web of Science ID 000259251700021

    View details for PubMedID 18728189

  • International Monetary Fund programs and tuberculosis outcomes in post-communist countries PLOS MEDICINE Stuckler, D., King, L. P., Basu, S. 2008; 5 (7): 1079-1090

    Abstract

    Previous studies have indicated that International Monetary Fund (IMF) economic programs have influenced health-care infrastructure in recipient countries. The post-communist Eastern European and former Soviet Union countries experienced relatively similar political and economic changes over the past two decades, and participated in IMF programs of varying size and duration. We empirically examine how IMF programs related to changes in tuberculosis incidence, prevalence, and mortality rates among these countries.We performed multivariate regression of two decades of tuberculosis incidence, prevalence, and mortality data against variables potentially influencing tuberculosis program outcomes in 21 post-communist countries for which comparative data are available. After correcting for confounding variables, as well as potential detection, selection, and ecological biases, we observed that participating in an IMF program was associated with increased tuberculosis incidence, prevalence, and mortality rates by 13.9%, 13.2%, and 16.6%, respectively. Each additional year of participation in an IMF program was associated with increased tuberculosis mortality rates by 4.1%, and each 1% increase in IMF lending was associated with increased tuberculosis mortality rates by 0.9%. On the other hand, we estimated a decrease in tuberculosis mortality rates of 30.7% (95% confidence interval, 18.3% to 49.5%) associated with exiting the IMF programs. IMF lending did not appear to be a response to worsened health outcomes; rather, it appeared to be a precipitant of such outcomes (Granger- and Sims-causality tests), even after controlling for potential political, socioeconomic, demographic, and health-related confounders. In contrast, non-IMF lending programs were connected with decreased tuberculosis mortality rates (-7.6%, 95% confidence interval, -1.0% to -14.1%). The associations observed between tuberculosis mortality and IMF programs were similar to those observed when evaluating the impact of IMF programs on tuberculosis incidence and prevalence. While IMF programs were connected with large reductions in generalized government expenditures, tuberculosis program coverage, and the number of physicians per capita, non-IMF lending programs were not significantly associated with these variables.IMF economic reform programs are associated with significantly worsened tuberculosis incidence, prevalence, and mortality rates in post-communist Eastern European and former Soviet countries, independent of other political, socioeconomic, demographic, and health changes in these countries. Future research should attempt to examine how IMF programs may have related to other non-tuberculosis-related health outcomes.

    View details for DOI 10.1371/journal.pmed.0050143

    View details for Web of Science ID 000257970500014

    View details for PubMedID 18651786

  • Prevention of nosocomial transmission of extensively drug-resistant tuberculosis in rural South African district hospitals: an epidemiological modelling study LANCET Basu, S., Andrews, J. R., Poolman, E. M., Gandhi, N. R., Shah, N. S., Moll, A., Moodley, P., Galvani, A. P., Friedland, G. H. 2007; 370 (9597): 1500-1507

    Abstract

    Extensively drug-resistant (XDR) tuberculosis has spread among hospitalised patients in South Africa, but the epidemic-level effect of hospital-based infection control strategies remains unknown. We modelled the plausible effect of rapidly available infection control strategies on the overall course of the XDR tuberculosis epidemic in a rural area of South Africa.We investigated the effect of administrative, environmental, and personal infection control measures on the epidemic trajectory of XDR tuberculosis in the rural community of Tugela Ferry. Assessments were done with a mathematical model incorporating over 2 years of longitudinal inpatient and community-based data. The model simulated inpatient airborne tuberculosis transmission, community tuberculosis transmission, and the effect of HIV and antiretroviral therapy.If no new interventions are introduced, about 1300 cases of XDR tuberculosis are predicted to occur in the area of Tugela Ferry by the end of 2012, more than half of which are likely to be nosocomially transmitted. Mask use alone would avert fewer than 10% of cases in the overall epidemic, but could prevent a large proportion of cases of XDR tuberculosis in hospital staff. The combination of mask use with reduced hospitalisation time and a shift to outpatient therapy could prevent nearly a third of XDR tuberculosis cases. Supplementing this approach with improved ventilation, rapid drug resistance testing, HIV treatment, and tuberculosis isolation facilities could avert 48% of XDR tuberculosis cases (range 34-50%) by the end of 2012. However, involuntary detention could result in an unexpected rise in incidence due to restricted isolation capacity.A synergistic combination of available nosocomial infection control strategies could prevent nearly half of XDR tuberculosis cases, even in a resource-limited setting. XDR tuberculosis transmission will probably continue in the community, indicating the need to develop and implement parallel community-based programmes.

    View details for Web of Science ID 000250487000027

    View details for PubMedID 17964351

  • Pharmacological pain control for human immunodeficiency virus-infected adults with a history of drug dependence JOURNAL OF SUBSTANCE ABUSE TREATMENT Basu, S., Bruce, R. D., Barry, D. T., Altice, F. L. 2007; 32 (4): 399-409

    Abstract

    Clinicians treating human immunodeficiency virus (HIV)-infected patients with substance use disorders often face the challenge of managing patients' acute or chronic pain conditions while keeping in mind the potential dangers of prescription opiate dependence. In this clinical review, we critically appraise the existing data concerning barriers to appropriate treatment of pain among HIV-infected patients with substance use disorders. We then analyze published studies concerning the choice of pharmacological pain control regimens for acute and chronic pain conditions in HIV-infected patients, keeping in mind HIV-specific issues related to drug interactions and substance use disorders. We summarize this information in the form of flowcharts for physicians approaching HIV-infected patients who present with complaints of pain, providing evidence-based guidance for the structuring of pain management services and for addressing aberrant drug-taking behaviors.

    View details for DOI 10.1016/j.jsat.2006.10.005

    View details for Web of Science ID 000246575800009

    View details for PubMedID 17481463

  • XDR-TB in South Africa: Theory and practice PLOS MEDICINE Andrews, J., Basu, S., Scales, D., Maru, D. S., Subbaraman, R. 2007; 4 (4): 770-771

    View details for DOI 10.1371/journal.pmed.0040163

    View details for Web of Science ID 000245947000028

    View details for PubMedID 17455998

  • The potential role of buprenorphine in the treatment of opioid dependence in HIV-infected individuals and in HIV infection prevention Forum for Collaborative HIV Research Altice, F. L., Sullivan, L. E., Smith-Rohrberg, D., Basu, S., Stancliff, S., Eldred, L. OXFORD UNIV PRESS INC. 2006: S178–S183

    Abstract

    Untreated opioid dependence is a major obstacle to the successful treatment and prevention of human immunodeficiency virus (HIV) infection. In this review, we examine the interwoven epidemics of HIV infection and opioid dependence and the emerging role of buprenorphine in improving HIV treatment outcomes among infected individuals, as well as its role in primary and secondary prevention. This article addresses some of the emerging issues about integrating buprenorphine treatment into HIV clinical care settings and the various strategies that must be considered. Specifically, it addresses the role of buprenorphine in improving HIV treatment outcomes through engagement in care, access to antiretroviral therapy and preventive therapies for opportunistic infections, and the potential benefits of and pitfalls in integrating buprenorphine into HIV clinical care settings. We discuss the key research questions regarding buprenorphine in the area of improving HIV treatment outcomes and prevention, including a review of published studies of buprenorphine and antiretroviral treatment and currently ongoing studies, and provide insight into and models for integrating buprenorphine into HIV clinical care settings. Dialogue among practitioners and policy makers in the HIV care and substance abuse communities will facilitate an effective expansion of buprenorphine and ensure that these beneficial outcomes are achieved.

    View details for Web of Science ID 000242126100003

    View details for PubMedID 17109304

  • Populations who test drugs should benefit from them NATURE Basu, S., Andrews, J., Smith-Rohrberg, D. 2006; 440 (7084): 605-605

    View details for DOI 10.1038/440605d

    View details for Web of Science ID 000236350400021

    View details for PubMedID 16572144

  • Models for integrating buprenorphine therapy into the primary HIV care setting CLINICAL INFECTIOUS DISEASES Basu, S., Smith-Rohrberg, D., Bruce, R. D., Altice, F. L. 2006; 42 (5): 716-721

    Abstract

    Opiate dependence among human immunodeficiency virus (HIV)-infected patients has been associated with negative clinical outcomes, yet few affected patients receive appropriate and coordinated treatment for both conditions. The introduction of buprenorphine maintenance therapy into HIV care settings provides an opportunity for providers to integrate treatment for opiate dependence into their practices. Buprenorphine maintenance therapy has been associated with reductions in opiate use, increased social stability, improved adherence to antiretroviral therapy, and lowered rates of injection drug use. We describe the following 4 models for the integration of buprenorphine maintenance therapy into HIV care: (1) a primary care model, in which the highly active antiretroviral therapy-administering clinician also prescribes buprenorphine; (2) a model that relies on an on-site specialist in addiction medicine or psychiatry to prescribe the buprenorphine; (3) a hybrid model, in which an on-site specialist provides the induction (with or without stabilization phases) and the HIV care provider provides the maintenance phase; and (4) a drug treatment model that provides buprenorphine maintenance therapy services with HIV services in the substance abuse clinic setting. The key barriers against effective integration of buprenorphine maintenance therapy and primary HIV services are discussed, and we suggest several mechanisms to overcome such obstacles.

    View details for Web of Science ID 000235060200022

    View details for PubMedID 16447120

  • Clinical management of depression and anxiety in HIV-infected adults AIDS Basu, S., Chwastiak, L. A., Bruce, R. D. 2005; 19 (18): 2057-2067

    View details for Web of Science ID 000233493200001

    View details for PubMedID 16284454

  • HIV testing in correctional institutions: evaluating existing strategies, setting new standards. AIDS & public policy journal Basu, S., Smith-Rohrberg, D., Hanck, S., Altice, F. L. 2005; 20 (1-2): 3-24

    Abstract

    Before introducing an HIV testing protocol into correctional facilities, the unique nature of these environments must be taken into account. We analyze three testing strategies that have been used in correctional settings--mandatory, voluntary, and routine "opt out" testing--and conclude that routine testing is most likely beneficial to inmates, the correctional system, and the outside community. The ethics of pre-release testing, and the issues surrounding segregation, confidentiality, and linking prisoners with community-based care, also play a role in determining how best to establish HIV testing strategies in correctional facilities. Testing must be performed in a manner that is not simply beneficial to public health, but also enhances the safety and health status of individual inmates. Longer-stay prison settings provide ample opportunities not just for testing but also for in-depth counseling, mental health and substance abuse treatment, and antiretroviral therapy. Jails present added complexities because of their shorter stay with respect to prisons, and testing, treatment, and counseling policies must be adapted to these settings.

    View details for PubMedID 17260566