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Female Reproductive Disorders, Diseases, and Costs of Exposure to Endocrine Disrupting Chemicals in the European Union
Hunt, Patricia A; Sathyanarayana, Sheela; Fowler, Paul A; Trasande, Leonardo
We estimated the economic costs of female reproductive disorders attributable to endocrine disrupting chemical exposures. These may contribute substantially to fibroids and endometriosis, costing nearly euro1.5 billion annually.
PMCID:4880176
PMID: 27003299
ISSN: 1945-7197
CID: 2059572
Urinary polycyclic aromatic hydrocarbons and measures of oxidative stress, inflammation and renal function in adolescents: NHANES 2003-2008
Farzan, Shohreh F; Chen, Yu; Trachtman, Howard; Trasande, Leonardo
OBJECTIVE: Recent evidence has suggested that polycyclic aromatic hydrocarbons (PAHs) may contribute to cardiometabolic and kidney dysfunction by increasing oxidative stress, but little is known about impacts in childhood. STUDY DESIGN: We performed cross-sectional analyses of 660 adolescents aged 12-19 years in the 2003-2008 National Health and Nutrition Examination Survey (NHANES), using levels of 10 monohydroxylated urinary PAH metabolites as our exposure. Our primary outcomes of interest were biomarkers of oxidative stress and renal function, including estimated glomerular filtration rate (eGFR), urinary albumin to creatinine ratio (ACR), insulin resistance, and serum uric acid, gamma glutamyl transferase (GGT) and C-reactive protein (CRP). RESULTS: We observed statistically significant associations between PAH metabolites and levels of serum GGT, CRP, uric acid and eGFR. Each 100% increase in 2-hydroxyphenanthrene was related to a 3.36% increase in uric acid (95% CI: 0.338-6.372; p=0.032), a 3.86% increase in GGT (95% CI: 1.361-6.362; p=0.005) and a 16.78% increase in CRP (95% CI: 1.848-31.689; p=0.029). Each 100% increase in 4-hydroxyphenanthrene was associated with a 6.18% increase in GGT (95% CI: 4.064-8.301; p<0.001) and a 13.66% increase in CRP (95% CI: 2.764-24.564; p=0.017). Each 100% increase in 9-hydroxyfluorene was associated with a 2.58% increase in GGT (95% CI: 0.389-4776; p=0.024). Each 100% increase in 3-hydroxyphenanthrene was associated with a 2.66% decrease in eGFR (95% CI: -4.979 to -0.331; p=0.028). CONCLUSIONS: Urinary PAH metabolites were associated with serum uric acid, GGT and CRP, suggesting possible impacts on cardiometabolic and kidney function in adolescents. Prospective work is needed to investigate the potential long-term health consequences of these findings.
PMCID:4679617
PMID: 26610293
ISSN: 1096-0953
CID: 1857042
Improving Knowledge about Children's Environmental Health in Northwest China
Niu, Jingping; Qu, Qingshan; Li, Juansheng; Liu, Xingrong; Zhang, Benzhong; Li, Zhilan; Ding, Guowu; Sun, Yingbiao; Shi, Yanrong; Wan, Yaxiong; Hu, Xiaobin; Chen, Lung-Chi; Mendelsohn, Alan; Chen, Yu; Trasande, Leonardo
The main purpose of this study was to identify policy maker opinions and attitudes towards children's environmental health (CEH), potential barriers to child-specific protective legislation and implementation in northwest China, and evaluate knowledge and attitudes about CEH before and after an educational conference. We conducted seventy-two interviews with regional officials, researchers and non-governmental organization representatives from five provinces, and surveyed participants (forty-seven) before and after an educational conference in northwest China about CEH. Interviews identified general consensus among participants of the adverse effects of air pollution on children, yet few participants knew of policies to protect them. Barriers identified included limited funding and enforcement, weak regional governments and absence of child-specific policy-making. After the conference, substantially greater self-efficacy was identified for lead, mercury, air pollution and polychlorinated biphenyls (+0.57-0.72 on a 1-5 Likert scale, p = 0.002-0.013), and the scientific knowledge for the role of environment in children's health (+0.58, p = 0.015), and health care provider control (+0.52, p = 0.025) were rated more strongly. We conclude that policy makers in Northwest China appreciate that children are uniquely vulnerable, though additional regulations are needed to account for that vulnerability. Further research should examine effectiveness of the intervention on a larger scale and scope, and evaluate the usefulness of such interventions in translating research into improved care/reduced exposure to environmental hazards.
PMCID:4730471
PMID: 26712775
ISSN: 1660-4601
CID: 1894472
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
Forouzanfar, Mohammad H; Alexander, Lily; Anderson, H Ross; Bachman, Victoria F; Biryukov, Stan; Brauer, Michael; Burnett, Richard; Casey, Daniel; Coates, Matthew M; Cohen, Aaron; Delwiche, Kristen; Estep, Kara; Frostad, Joseph J; Astha, K C; Kyu, Hmwe H; Moradi-Lakeh, Maziar; Ng, Marie; Slepak, Erica Leigh; Thomas, Bernadette A; Wagner, Joseph; Aasvang, Gunn Marit; Abbafati, Cristiana; Abbasoglu Ozgoren, Ayse; Abd-Allah, Foad; Abera, Semaw F; Aboyans, Victor; Abraham, Biju; Abraham, Jerry Puthenpurakal; Abubakar, Ibrahim; Abu-Rmeileh, Niveen M E; Aburto, Tania C; Achoki, Tom; Adelekan, Ademola; Adofo, Koranteng; Adou, Arsene K; Adsuar, Jose C; Afshin, Ashkan; Agardh, Emilie E; Al Khabouri, Mazin J; Al Lami, Faris H; Alam, Sayed Saidul; Alasfoor, Deena; Albittar, Mohammed I; Alegretti, Miguel A; Aleman, Alicia V; Alemu, Zewdie A; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Ali, Mohammed K; Alla, Francois; Allebeck, Peter; Allen, Peter J; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzman, Nelson; Amankwaa, Adansi A; Amare, Azmeraw T; Ameh, Emmanuel A; Ameli, Omid; Amini, Heresh; Ammar, Walid; Anderson, Benjamin O; Antonio, Carl Abelardo T; Anwari, Palwasha; Argeseanu Cunningham, Solveig; Arnlov, Johan; Arsenijevic, Valentina S Arsic; Artaman, Al; Asghar, Rana J; Assadi, Reza; Atkins, Lydia S; Atkinson, Charles; Avila, Marco A; Awuah, Baffour; Badawi, Alaa; Bahit, Maria C; Bakfalouni, Talal; Balakrishnan, Kalpana; Balalla, Shivanthi; Balu, Ravi Kumar; Banerjee, Amitava; Barber, Ryan M; Barker-Collo, Suzanne L; Barquera, Simon; Barregard, Lars; Barrero, Lope H; Barrientos-Gutierrez, Tonatiuh; Basto-Abreu, Ana C; Basu, Arindam; Basu, Sanjay; Basulaiman, Mohammed O; Batis Ruvalcaba, Carolina; Beardsley, Justin; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L; Benjet, Corina; Bennett, Derrick A; Benzian, Habib; Bernabe, Eduardo; Beyene, Tariku J; Bhala, Neeraj; Bhalla, Ashish; Bhutta, Zulfiqar A; Bikbov, Boris; Bin Abdulhak, Aref A; Blore, Jed D; Blyth, Fiona M; Bohensky, Megan A; Bora Basara, Berrak; Borges, Guilherme; Bornstein, Natan M; Bose, Dipan; Boufous, Soufiane; Bourne, Rupert R; Brainin, Michael; Brazinova, Alexandra; Breitborde, Nicholas J; Brenner, Hermann; Briggs, Adam D M; Broday, David M; Brooks, Peter M; Bruce, Nigel G; Brugha, Traolach S; Brunekreef, Bert; Buchbinder, Rachelle; Bui, Linh N; Bukhman, Gene; Bulloch, Andrew G; Burch, Michael; Burney, Peter G J; Campos-Nonato, Ismael R; Campuzano, Julio C; Cantoral, Alejandra J; Caravanos, Jack; Cardenas, Rosario; Cardis, Elisabeth; Carpenter, David O; Caso, Valeria; Castaneda-Orjuela, Carlos A; Castro, Ruben E; Catala-Lopez, Ferran; Cavalleri, Fiorella; Cavlin, Alanur; Chadha, Vineet K; Chang, Jung-Chen; Charlson, Fiona J; Chen, Honglei; Chen, Wanqing; Chen, Zhengming; Chiang, Peggy P; Chimed-Ochir, Odgerel; Chowdhury, Rajiv; Christophi, Costas A; Chuang, Ting-Wu; Chugh, Sumeet S; Cirillo, Massimo; Classen, Thomas K D; Colistro, Valentina; Colomar, Mercedes; Colquhoun, Samantha M; Contreras, Alejandra G; Cooper, Cyrus; Cooperrider, Kimberly; Cooper, Leslie T; Coresh, Josef; Courville, Karen J; Criqui, Michael H; Cuevas-Nasu, Lucia; Damsere-Derry, James; Danawi, Hadi; Dandona, Lalit; Dandona, Rakhi; Dargan, Paul I; Davis, Adrian; Davitoiu, Dragos V; Dayama, Anand; de Castro, E Filipa; De la Cruz-Gongora, Vanessa; De Leo, Diego; de Lima, Graca; Degenhardt, Louisa; del Pozo-Cruz, Borja; Dellavalle, Robert P; Deribe, Kebede; Derrett, Sarah; Des Jarlais, Don C; Dessalegn, Muluken; deVeber, Gabrielle A; Devries, Karen M; Dharmaratne, Samath D; Dherani, Mukesh K; Dicker, Daniel; Ding, Eric L; Dokova, Klara; Dorsey, E Ray; Driscoll, Tim R; Duan, Leilei; Durrani, Adnan M; Ebel, Beth E; Ellenbogen, Richard G; Elshrek, Yousef M; Endres, Matthias; Ermakov, Sergey P; Erskine, Holly E; Eshrati, Babak; Esteghamati, Alireza; Fahimi, Saman; Faraon, Emerito Jose A; Farzadfar, Farshad; Fay, Derek F J; Feigin, Valery L; Feigl, Andrea B; Fereshtehnejad, Seyed-Mohammad; Ferrari, Alize J; Ferri, Cleusa P; Flaxman, Abraham D; Fleming, Thomas D; Foigt, Nataliya; Foreman, Kyle J; Paleo, Urbano Fra; Franklin, Richard C; Gabbe, Belinda; Gaffikin, Lynne; Gakidou, Emmanuela; Gamkrelidze, Amiran; Gankpe, Fortune G; Gansevoort, Ron T; Garcia-Guerra, Francisco A; Gasana, Evariste; Geleijnse, Johanna M; Gessner, Bradford D; Gething, Pete; Gibney, Katherine B; Gillum, Richard F; Ginawi, Ibrahim A M; Giroud, Maurice; Giussani, Giorgia; Goenka, Shifalika; Goginashvili, Ketevan; Gomez Dantes, Hector; Gona, Philimon; Gonzalez de Cosio, Teresita; Gonzalez-Castell, Dinorah; Gotay, Carolyn C; Goto, Atsushi; Gouda, Hebe N; Guerrant, Richard L; Gugnani, Harish C; Guillemin, Francis; Gunnell, David; Gupta, Rahul; Gupta, Rajeev; Gutierrez, Reyna A; Hafezi-Nejad, Nima; Hagan, Holly; Hagstromer, Maria; Halasa, Yara A; Hamadeh, Randah R; Hammami, Mouhanad; Hankey, Graeme J; Hao, Yuantao; Harb, Hilda L; Haregu, Tilahun Nigatu; Haro, Josep Maria; Havmoeller, Rasmus; Hay, Simon I; Hedayati, Mohammad T; Heredia-Pi, Ileana B; Hernandez, Lucia; Heuton, Kyle R; Heydarpour, Pouria; Hijar, Martha; Hoek, Hans W; Hoffman, Howard J; Hornberger, John C; Hosgood, H Dean; Hoy, Damian G; Hsairi, Mohamed; Hu, Guoqing; Hu, Howard; Huang, Cheng; Huang, John J; Hubbell, Bryan J; Huiart, Laetitia; Husseini, Abdullatif; Iannarone, Marissa L; Iburg, Kim M; Idrisov, Bulat T; Ikeda, Nayu; Innos, Kaire; Inoue, Manami; Islami, Farhad; Ismayilova, Samaya; Jacobsen, Kathryn H; Jansen, Henrica A; Jarvis, Deborah L; Jassal, Simerjot K; Jauregui, Alejandra; Jayaraman, Sudha; Jeemon, Panniyammakal; Jensen, Paul N; Jha, Vivekanand; Jiang, Fan; Jiang, Guohong; Jiang, Ying; Jonas, Jost B; Juel, Knud; Kan, Haidong; Kany Roseline, Sidibe S; Karam, Nadim E; Karch, Andre; Karema, Corine K; Karthikeyan, Ganesan; Kaul, Anil; Kawakami, Norito; Kazi, Dhruv S; Kemp, Andrew H; Kengne, Andre P; Keren, Andre; Khader, Yousef S; Khalifa, Shams Eldin Ali Hassan; Khan, Ejaz A; Khang, Young-Ho; Khatibzadeh, Shahab; Khonelidze, Irma; Kieling, Christian; Kim, Daniel; Kim, Sungroul; Kim, Yunjin; Kimokoti, Ruth W; Kinfu, Yohannes; Kinge, Jonas M; Kissela, Brett M; Kivipelto, Miia; Knibbs, Luke D; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kose, M Rifat; Kosen, Soewarta; Kraemer, Alexander; Kravchenko, Michael; Krishnaswami, Sanjay; Kromhout, Hans; Ku, Tiffany; Kuate Defo, Barthelemy; Kucuk Bicer, Burcu; Kuipers, Ernst J; Kulkarni, Chanda; Kulkarni, Veena S; Kumar, G Anil; Kwan, Gene F; Lai, Taavi; Lakshmana Balaji, Arjun; Lalloo, Ratilal; Lallukka, Tea; Lam, Hilton; Lan, Qing; Lansingh, Van C; Larson, Heidi J; Larsson, Anders; Laryea, Dennis O; Lavados, Pablo M; Lawrynowicz, Alicia E; Leasher, Janet L; Lee, Jong-Tae; Leigh, James; Leung, Ricky; Levi, Miriam; Li, Yichong; Li, Yongmei; Liang, Juan; Liang, Xiaofeng; Lim, Stephen S; Lindsay, M Patrice; Lipshultz, Steven E; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K; Logroscino, Giancarlo; London, Stephanie J; Lopez, Nancy; Lortet-Tieulent, Joannie; Lotufo, Paulo A; Lozano, Rafael; Lunevicius, Raimundas; Ma, Jixiang; Ma, Stefan; Machado, Vasco M P; MacIntyre, Michael F; Magis-Rodriguez, Carlos; Mahdi, Abbas A; Majdan, Marek; Malekzadeh, Reza; Mangalam, Srikanth; Mapoma, Christopher C; Marape, Marape; Marcenes, Wagner; Margolis, David J; Margono, Christopher; Marks, Guy B; Martin, Randall V; Marzan, Melvin B; Mashal, Mohammad T; Masiye, Felix; Mason-Jones, Amanda J; Matsushita, Kunihiro; Matzopoulos, Richard; Mayosi, Bongani M; Mazorodze, Tasara T; McKay, Abigail C; McKee, Martin; McLain, Abigail; Meaney, Peter A; Medina, Catalina; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Mekonnen, Wubegzier; Melaku, Yohannes A; Meltzer, Michele; Memish, Ziad A; Mendoza, Walter; Mensah, George A; Meretoja, Atte; Mhimbira, Francis Apolinary; Micha, Renata; Miller, Ted R; Mills, Edward J; Misganaw, Awoke; Mishra, Santosh; Mohamed Ibrahim, Norlinah; Mohammad, Karzan A; Mokdad, Ali H; Mola, Glen L; Monasta, Lorenzo; Montanez Hernandez, Julio C; Montico, Marcella; Moore, Ami R; Morawska, Lidia; Mori, Rintaro; Moschandreas, Joanna; Moturi, Wilkister N; Mozaffarian, Dariush; Mueller, Ulrich O; Mukaigawara, Mitsuru; Mullany, Erin C; Murthy, Kinnari S; Naghavi, Mohsen; Nahas, Ziad; Naheed, Aliya; Naidoo, Kovin S; Naldi, Luigi; Nand, Devina; Nangia, Vinay; Narayan, K M Venkat; Nash, Denis; Neal, Bruce; Nejjari, Chakib; Neupane, Sudan P; Newton, Charles R; Ngalesoni, Frida N; Ngirabega, Jean de Dieu; Nguyen, Grant; Nguyen, Nhung T; Nieuwenhuijsen, Mark J; Nisar, Muhammad I; Nogueira, Jose R; Nolla, Joan M; Nolte, Sandra; Norheim, Ole F; Norman, Rosana E; Norrving, Bo; Nyakarahuka, Luke; Oh, In-Hwan; Ohkubo, Takayoshi; Olusanya, Bolajoko O; Omer, Saad B; Opio, John Nelson; Orozco, Ricardo; Pagcatipunan, Rodolfo S Jr; Pain, Amanda W; Pandian, Jeyaraj D; Panelo, Carlo Irwin A; Papachristou, Christina; Park, Eun-Kee; Parry, Charles D; Paternina Caicedo, Angel J; Patten, Scott B; Paul, Vinod K; Pavlin, Boris I; Pearce, Neil; Pedraza, Lilia S; Pedroza, Andrea; Pejin Stokic, Ljiljana; Pekericli, Ayfer; Pereira, David M; Perez-Padilla, Rogelio; Perez-Ruiz, Fernando; Perico, Norberto; Perry, Samuel A L; Pervaiz, Aslam; Pesudovs, Konrad; Peterson, Carrie B; Petzold, Max; Phillips, Michael R; Phua, Hwee Pin; Plass, Dietrich; Poenaru, Dan; Polanczyk, Guilherme V; Polinder, Suzanne; Pond, Constance D; Pope, C Arden; Pope, Daniel; Popova, Svetlana; Pourmalek, Farshad; Powles, John; Prabhakaran, Dorairaj; Prasad, Noela M; Qato, Dima M; Quezada, Amado D; Quistberg, D Alex A; Racape, Lionel; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Sajjad Ur; Raju, Murugesan; Rakovac, Ivo; Rana, Saleem M; Rao, Mayuree; Razavi, Homie; Reddy, K Srinath; Refaat, Amany H; Rehm, Jurgen; Remuzzi, Giuseppe; Ribeiro, Antonio L; Riccio, Patricia M; Richardson, Lee; Riederer, Anne; Robinson, Margaret; Roca, Anna; Rodriguez, Alina; Rojas-Rueda, David; Romieu, Isabelle; Ronfani, Luca; Room, Robin; Roy, Nobhojit; Ruhago, George M; Rushton, Lesley; Sabin, Nsanzimana; Sacco, Ralph L; Saha, Sukanta; Sahathevan, Ramesh; Sahraian, Mohammad Ali; Salomon, Joshua A; Salvo, Deborah; Sampson, Uchechukwu K; Sanabria, Juan R; Sanchez, Luz Maria; Sanchez-Pimienta, Tania G; Sanchez-Riera, Lidia; Sandar, Logan; Santos, Itamar S; Sapkota, Amir; Satpathy, Maheswar; Saunders, James E; Sawhney, Monika; Saylan, Mete I; Scarborough, Peter; Schmidt, Jurgen C; Schneider, Ione J C; Schottker, Ben; Schwebel, David C; Scott, James G; Seedat, Soraya; Sepanlou, Sadaf G; Serdar, Berrin; Servan-Mori, Edson E; Shaddick, Gavin; Shahraz, Saeid; Levy, Teresa Shamah; Shangguan, Siyi; She, Jun; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin H; Shinohara, Yukito; Shiri, Rahman; Shishani, Kawkab; Shiue, Ivy; Sigfusdottir, Inga D; Silberberg, Donald H; Simard, Edgar P; Sindi, Shireen; Singh, Abhishek; Singh, Gitanjali M; Singh, Jasvinder A; Skirbekk, Vegard; Sliwa, Karen; Soljak, Michael; Soneji, Samir; Soreide, Kjetil; Soshnikov, Sergey; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stapelberg, Nicolas J C; Stathopoulou, Vasiliki; Steckling, Nadine; Stein, Dan J; Stein, Murray B; Stephens, Natalie; Stockl, Heidi; Straif, Kurt; Stroumpoulis, Konstantinos; Sturua, Lela; Sunguya, Bruno F; Swaminathan, Soumya; Swaroop, Mamta; Sykes, Bryan L; Tabb, Karen M; Takahashi, Ken; Talongwa, Roberto T; Tandon, Nikhil; Tanne, David; Tanner, Marcel; Tavakkoli, Mohammad; Te Ao, Braden J; Teixeira, Carolina M; Tellez Rojo, Martha M; Terkawi, Abdullah S; Texcalac-Sangrador, Jose Luis; Thackway, Sarah V; Thomson, Blake; Thorne-Lyman, Andrew L; Thrift, Amanda G; Thurston, George D; Tillmann, Taavi; Tobollik, Myriam; Tonelli, Marcello; Topouzis, Fotis; Towbin, Jeffrey A; Toyoshima, Hideaki; Traebert, Jefferson; Tran, Bach X; Trasande, Leonardo; Trillini, Matias; Trujillo, Ulises; Dimbuene, Zacharie Tsala; Tsilimbaris, Miltiadis; Tuzcu, Emin Murat; Uchendu, Uche S; Ukwaja, Kingsley N; Uzun, Selen B; van de Vijver, Steven; Van Dingenen, Rita; van Gool, Coen H; van Os, Jim; Varakin, Yuri Y; Vasankari, Tommi J; Vasconcelos, Ana Maria N; Vavilala, Monica S; Veerman, Lennert J; Velasquez-Melendez, Gustavo; Venketasubramanian, N; Vijayakumar, Lakshmi; Villalpando, Salvador; Violante, Francesco S; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Wagner, Gregory R; Waller, Stephen G; Wallin, Mitchell T; Wan, Xia; Wang, Haidong; Wang, JianLi; Wang, Linhong; Wang, Wenzhi; Wang, Yanping; Warouw, Tati S; Watts, Charlotte H; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Werdecker, Andrea; Wessells, K Ryan; Westerman, Ronny; Whiteford, Harvey A; Wilkinson, James D; Williams, Hywel C; Williams, Thomas N; Woldeyohannes, Solomon M; Wolfe, Charles D A; Wong, John Q; Woolf, Anthony D; Wright, Jonathan L; Wurtz, Brittany; Xu, Gelin; Yan, Lijing L; Yang, Gonghuan; Yano, Yuichiro; Ye, Pengpeng; Yenesew, Muluken; Yentur, Gokalp K; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Younoussi, Zourkaleini; Yu, Chuanhua; Zaki, Maysaa E; Zhao, Yong; Zheng, Yingfeng; Zhou, Maigeng; Zhu, Jun; Zhu, Shankuan; Zou, Xiaonong; Zunt, Joseph R; Lopez, Alan D; Vos, Theo; Murray, Christopher J
BACKGROUND: 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. METHODS: 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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: Bill & Melinda Gates Foundation.
PMCID:4685753
PMID: 26364544
ISSN: 1474-547x
CID: 2033272
Melamine Nephrotoxicity is Mediated by Hyperuricemia
Zhang, Long; Li, Hong Tian; Wang, Lin Lin; Trachtman, Howard; Trasande, Leonardo; Wang, Pei Xin; Liu, Jian Meng
OBJECTIVE: We tested whether melamine nephrotoxicity was exacerbated by urate (a typical component of renal stones in humans) in rats with hyperuricemiainduced by the uricase inhibitor, potassium oxonate (Oxo). METHODS: Rats were exposed to melamine or Oxo alone or combinations of melamine (200-400 mg/kg) and Oxo (200-600 mg/kg) for 3 consecutive days. Kidney injury was evaluated by renal biochemical functions, histomorphology, and lipid peroxidation. Kidney crystals were analyzed for their composition. RESULTS: Nephrotoxicity was minimal in animals administered melamine or Oxo alone, but it was demonstrable in animals administered at least 800 mg/kg of the two compounds combined. All rats in the 400+600 (melamine+Oxo) and 400+400 mg/kg groups and 4 out of 6 in the 200+600 mg/kg group died within 3 days; no rat died in the 200+400 or 200+200 mg/kg group. Dose-dependent renal damage resembling clinical findings in affected patients was observed in rats administered the two compounds. Crystal composition determination revealed the existence of melamine and uric acid in the affected kidneys, resembling human stones. CONCLUSION: Our findings suggest that uric acid plays a key role in melamine-related kidney injury in humans. Future studies should consider uric acid together with melamine when examining adverse effects in humans.
PMID: 26777910
ISSN: 0895-3988
CID: 1921332
Association between perfluoroalkyl acids and kidney function in a cross-sectional study of adolescents
Kataria, Anglina; Trachtman, Howard; Malaga-Dieguez, Laura; Trasande, Leonardo
BACKGROUND: Perfluoroalkyl acids are synthetic compounds widely used in industrial and commercial applications. Laboratory studies suggest that these persistent and bioaccumulative chemicals produce oxidant stress and damage glomerular endothelial cells, raising concern regarding the impact of these compounds on renal function. METHODS: We performed cross-sectional analyses of data 1960 participants aged 12-19 years of the 2003-2010 National Health and Nutrition Examination Surveys. PFAA exposure was assessed using levels of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid, and perfluorohexane sulfonic acid. Primary study outcomes were estimated glomerular filtration rate (eGFR) and serum uric acid. RESULTS: While adjusting for demographics, cotinine, prehypertension, insulin resistance, body mass index, and hypercholesterolemia, adolescents in the highest PFOA and PFOS quartile had a lower eGFR, 6.84 mL/min/1.73 m2 (95 % CI: 2.19 to 11.48) and 9.69 mL/min/1.73 m2 (95 % CI: -4.59 to 14.78), respectively, compared to the lowest quartile. Highest PFOA and PFOS quartiles were also associated with 0.21 mg/dL (95 % CI: 0.056 to 0.37) and 0.19 mg/dL (95 % CI: 0.032 to 0.34) increases in uric acid, respectively. CONCLUSIONS: PFAAs are associated with a reduction in kidney function and increased uric acid levels in otherwise healthy adolescents. Reverse causation and residual confounding could explain the results. Our study results confirm and amplify previous findings, though longitudinal studies examining prenatal and childhood biomarkers in relationship with robust measures of childhood renal function are needed.
PMCID:4654837
PMID: 26590127
ISSN: 1476-069x
CID: 1848912
A Comparison of Ambulatory Care Sensitive Hospitalizations Among Children With and Without Autism Spectrum Disorder
Carbone, Paul S; Young, Paul C; Stoddard, Gregory J; Wilkes, Jacob; Trasande, Leonardo
OBJECTIVE:To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD. METHODS:The 2009 Kids' Inpatient Database was used to examine hospitalizations for ACSC in children within 3 cohorts: those with ASD, those with chronic conditions (CC) without ASD, and those with no CC. RESULTS:The proportion of hospitalizations for ACSC in the ASD cohort was 55.9%, compared with 28.2% in the CC cohort and 22.9% in the no-CC cohort (PÂ <Â .001). Hospitalized children with ASD were more likely to be admitted for a mental health condition, epilepsy, constipation, pneumonia, dehydration, vaccine-preventable diseases, underweight, and nutritional deficiencies compared with the no-CC cohort. Compared with the CC cohort, the ASD cohort was more likely to be admitted for mental health conditions, epilepsy, constipation, dehydration, and underweight. Hospitalized children with ASD admitted for mental health conditions had significantly higher total charges and longer LOS compared with the other 2 cohorts. CONCLUSIONS:The proportion of potentially preventable hospitalizations is higher in hospitalized children with ASD compared with children without ASD. These data underscore the need to improve outpatient care of children with ASD, especially in the areas of mental health care and seizure management. Future research should focus on understanding the reasons for increased inpatient health care utilization in children with ASD admitted for mental health conditions.
PMID: 26547543
ISSN: 1876-2867
CID: 3502412
DHA in Pregnant and Lactating Women from Coastland, Lakeland, and Inland Areas of China: Results of a DHA Evaluation in Women (DEW) Study
Li, You; Li, Hong-Tian; Trasande, Leonardo; Ge, Hua; Yu, Li-Xia; Xu, Gao-Sheng; Bai, Man-Xi; Liu, Jian-Meng
Few studies have examined docosahexaenoic acid (DHA) in pregnant and lactating women in developing countries like China, where DHA-enriched supplements are increasingly popular. We aimed to assess the DHA status among Chinese pregnant and lactating women residing areas differing in the availability of aquatic products. In total, 1211 women in mid-pregnancy (17 +/- 2 weeks), late pregnancy (39 +/- 2 weeks), or lactation (42 +/- 7 days) were enrolled from Weihai (coastland), Yueyang (lakeland), and Baotou (inland) city, with approximately 135 women in each participant group by region. DHA concentrations were measured using capillary gas chromatography, and are reported as weight percent of total fatty acids. Mean plasma DHA concentrations were higher in coastland (mid-pregnancy 3.19%, late pregnancy 2.54%, lactation 2.24%) and lakeland women (2.45%, 1.95%, 2.26%) than inland women (2.25%, 1.67%, 1.68%) (p values < 0.001). Similar differences were observed for erythrocyte DHA. We conclude that DHA concentrations of Chinese pregnant and lactating women are higher in coastland and lakeland regions than in inland areas. DHA status in the study population appears to be stronger than populations from other countries studied to date.
PMCID:4632448
PMID: 26506380
ISSN: 2072-6643
CID: 1816822
The effects of environmental chemicals on renal function
Kataria, Anglina; Trasande, Leonardo; Trachtman, Howard
The global incidence of chronic kidney disease (CKD) is increasing among individuals of all ages. Despite advances in proteomics, genomics and metabolomics, there remains a lack of safe and effective drugs to reverse or stabilize renal function in patients with glomerular or tubulointerstitial causes of CKD. Consequently, modifiable risk factors that are associated with a progressive decline in kidney function need to be identified. Numerous reports have documented the adverse effects that occur in response to graded exposure to a wide range of environmental chemicals. This Review summarizes the effects of such chemicals on four aspects of cardiorenal function: albuminuria, glomerular filtration rate, blood pressure and serum uric acid concentration. We focus on compounds that individuals are likely to be exposed to as a consequence of normal consumer activities or medical treatment, namely phthalates, bisphenol A, polyfluorinated alkyl acids, dioxins and furans, polycyclic aromatic hydrocarbons and polychlorinated biphenyls. Environmental exposure to these chemicals during everyday life could have adverse consequences on renal function and might contribute to progressive cumulative renal injury over a lifetime. Regulatory efforts should be made to limit individual exposure to environmental chemicals in an attempt to reduce the incidence of cardiorenal disease.
PMCID:4689732
PMID: 26100504
ISSN: 1759-507x
CID: 1640872
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
Vos, Theo; Barber, Ryan M; Bell, Brad; Bertozzi-Villa, Amelia; Biryukov, Stan; Bolliger, Ian; Charlson, Fiona; Davis, Adrian; Degenhardt, Louisa; Dicker, Daniel; Duan, Leilei; Erskine, Holly; Feigin, Valery L; Ferrari, Alize J; Fitzmaurice, Christina; Fleming, Thomas; Graetz, Nicholas; Guinovart, Caterina; Haagsma, Juanita; Hansen, Gillian M; Hanson, Sarah Wulf; Heuton, Kyle R; Higashi, Hideki; Kassebaum, Nicholas; Kyu, Hmwe; Laurie, Evan; Liang, Xiofeng; Lofgren, Katherine; Lozano, Rafael; MacIntyre, Michael F; Moradi-Lakeh, Maziar; Naghavi, Mohsen; Nguyen, Grant; Odell, Shaun; Ortblad, Katrina; Roberts, David Allen; Roth, Gregory A; Sandar, Logan; Serina, Peter T; Stanaway, Jeffrey D; Steiner, Caitlyn; Thomas, Bernadette; Vollset, Stein Emil; Whiteford, Harvey; Wolock, Timothy M; Ye, Pengpeng; Zhou, Maigeng; Avila, Marco A; Aasvang, Gunn Marit; Abbafati, Cristiana; Ozgoren, Ayse Abbasoglu; Abd-Allah, Foad; Aziz, Muna IAbdel; Abera, Semaw F; Aboyans, Victor; Abraham, Jerry P; Abraham, Biju; Abubakar, Ibrahim; Abu-Raddad, Laith J; Abu-Rmeileh, Niveen ME; Aburto, Tania C; Achoki, Tom; Ackerman, Ilana N; Adelekan, Ademola; Ademi, Zanfina; Adou, Arsene K; Adsuar, Josef C; Arnlov, Johan; Agardh, Emilie E; Al Khabouri, Mazin J; Alam, Sayed Saidul; Alasfoor, Deena; Albittar, Mohammed I; Alegretti, Miguel A; Aleman, Alicia V; Alemu, Zewdie A; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Alla, Francois; Allebeck, Peter; Allen, Peter J; AlMazroa, Mohammad AbdulAziz; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzman, Nelson; Ameli, Omid; Amini, Heresh; Ammar, Walid; Anderson, Benjamin O; Anderson, HRoss; Antonio, Carl Abelardo T; Anwari, Palwasha; Apfel, Henry; Arsenijevic, Valentain SArsic; Artaman, Al; Asghar, Rana J; Assadi, Reza; Atkins, Lydia S; Atkinson, Charles; Badawi, Alaa; Bahit, Maria C; Bakfalouni, Talal; Balakrishnan, Kalpana; Balalla, Shivanthi; Banerjee, Amitava; Barker-Collo, Suzanne L; Barquera, Simon; Barregard, Lars; Barrero, Lope H; Basu, Sanjay; Basu, Arindam; Baxter, Amanda; Beardsley, Justin; Bedi, Neeraj; Beghi, Ettore; Bekele, Tolesa; Bell, Michelle L; Benjet, Corina; Bennett, Derrick A; Bensenor, Isabela M; Benzian, Habib; Bernabe, Eduardo; Beyene, Tariku J; Bhala, Neeraj; Bhalla, Ashish; Bhutta, Zulfi Qar; Bienhoff, Kelly; Bikbov, Boris; Bin Abdulhak, Aref; Blore, Jed D; Blyth, Fiona M; Bohensky, Megan A; Basara, Berrak Bora; Borges, Guilherme; Bornstein, Natan M; Bose, Dipan; Boufous, Soufiane; Bourne, Rupert R; Boyers, Lindsay N; Brainin, Michael; Brauer, Michael; Brayne, Carol EG; Brazinova, Alexandra; Breitborde, Nicholas JK; Brenner, Hermann; Briggs, Adam DM; Brooks, Peter M; Brown, Jonathan; Brugha, Traolach S; Buchbinder, Rachelle; Buckle, Geoffrey C; Bukhman, Gene; Bulloch, Andrew G; Burch, Michael; Burnett, Richard; Cardenas, Rosario; Cabral, Norberto L; Nonato, Ismael RCampos; Campuzano, Julio C; Carapetis, Jonathan R; Carpenter, David O; Caso, Valeria; Castaneda-Orjuela, Carlos A; Catala-Lopez, Ferran; Chadha, Vineet K; Chang, Jung-Chen; Chen, Honglei; Chen, Wanqing; Chiang, Peggy P; Chimed-Ochir, Odgerel; Chowdhury, Rajiv; Christensen, Hanne; Christophi, Costas A; Chugh, Sumeet S; Cirillo, Massimo; Coggeshall, Megan; Cohen, Aaron; Colistro, Valentina; Colquhoun, Samantha M; Contreras, Alejandra G; Cooper, Leslie T; Cooper, Cyrus; Cooperrider, Kimberly; Coresh, Josef; Cortinovis, Monica; Criqui, Michael H; Crump, John A; Cuevas-Nasu, Lucia; Dandona, Rakhi; Dandona, Lalit; Dansereau, Emily; Dantes, Hector G; Dargan, Paul I; Davey, Gail; Davitoiu, Dragos V; Dayama, Anand; De la Cruz-Gongora, Vanessa; de la Vega, Shelley F; De Leo, Diego; del Pozo-Cruz, Borja; Dellavalle, Robert P; Deribe, Kebede; Derrett, Sarah; Des Jarlais, Don C; Dessalegn, Muluken; de Veber, Gabrielle A; Dharmaratne, Samath D; Diaz-Torne, Cesar; Ding, Eric L; Dokova, Klara; Dorsey, ER; Driscoll, Tim R; Duber, Herbert; Durrani, Adnan M; Edmond, Karen M; Ellenbogen, Richard G; Endres, Matthias; Ermakov, Sergey P; Eshrati, Babak; Esteghamati, Alireza; Estep, Kara; Fahimi, Saman; Farzadfar, Farshad; Fay, Derek FJ; Felson, David T; Fereshtehnejad, Seyed-Mohammad; Fernandes, Jefferson G; Ferri, Cluesa P; Flaxman, Abraham; Foigt, Nataliya; Foreman, Kyle J; Fowkes, FGerry R; Franklin, Richard C; Furst, Thomas; Futran, Neal D; Gabbe, Belinda J; Gankpe, Fortune G; Garcia-Guerra, Francisco A; Geleijnse, Johanna M; Gessner, Bradford D; Gibney, Katherine B; Gillum, Richard F; Ginawi, Ibrahim A; Giroud, Maurice; Giussani, Giorgia; Goenka, Shifalika; Goginashvili, Ketevan; Gona, Philimon; de Cosio, Teresita Gonzalez; Gosselin, Richard A; Gotay, Carolyn C; Goto, Atsushi; Gouda, Hebe N; Guerrant, Richard L; Gugnani, Harish C; Gunnell, David; Gupta, Rajeev; Gupta, Rahul; Gutierrez, Reyna A; Hafezi-Nejad, Nima; Hagan, Holly; Halasa, Yara; Hamadeh, Randah R; Hamavid, Hannah; Hammami, Mouhanad; Hankey, Graeme J; Hao, Yuantao; Harb, Hilda L; Haro, Josep Maria; Havmoeller, Rasmus; Hay, Roderick J; Hay, Simon; Hedayati, Mohammad T; Pi, Ileana BHeredia; Heydarpour, Pouria; Hijar, Martha; Hoek, Hans W; Hoffman, Howard J; Hornberger, John C; Hosgood, HDean; Hossain, Mazeda; Hotez, Peter J; Hoy, Damian G; Hsairi, Mohamed; Hu, Howard; Hu, Guoqing; Huang, John J; Huang, Cheng; Huiart, Laetitia; Husseini, Abdullatif; Iannarone, Marissa; Iburg, Kim M; Innos, Kaire; Inoue, Manami; Jacobsen, Kathryn H; Jassal, Simerjot K; Jeemon, Panniyammakal; Jensen, Paul N; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jonas, Jost B; Joseph, Jonathan; Juel, Knud; Kan, Haidong; Karch, Andre; Karimkhani, Chante; Karthikeyan, Ganesan; Katz, Ronit; Kaul, Anil; Kawakami, Norito; Kazi, Dhruv S; Kemp, Andrew H; Kengne, Andre P; Khader, Yousef S; Khalifa, Shams Eldin AH; Khan, Ejaz A; Khan, Gulfaraz; Khang, Young-Ho; Khonelidze, Irma; Kieling, Christian; Kim, Daniel; Kim, Sungroul; Kimokoti, Ruth W; Kinfu, Yohannes; Kinge, Jonas M; Kissela, Brett M; Kivipelto, Miia; Knibbs, Luke; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kosen, Soewarta; Kramer, Alexander; Kravchenko, Michael; Krishnamurthi, Rita V; Krishnaswami, Sanjay; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kuipers, Ernst J; Kulkarni, Veena S; Kumar, Kaushalendra; Kumar, GAnil; Kwan, Gene F; Lai, Taavi; Lalloo, Ratilal; Lam, Hilton; Lan, Qing; Lansingh, Van C; Larson, Heidi; Larsson, Anders; Lawrynowicz, Alicia EB; Leasher, Janet L; Lee, Jong-Tae; Leigh, James; Leung, Ricky; Levi, Miriam; Li, Bin; Li, Yichong; Li, Yongmei; Liang, Juan; Lim, Stephen; Lin, Hsien-Ho; Lind, Margaret; Lindsay, MPatrice; Lipshultz, Steven E; Liu, Shiwei; Lloyd, Belinda K; Ohno, Summer Lockett; Logroscino, Giancarlo; Looker, Katharine J; Lopez, Alan D; Lopez-Olmedo, Nancy; Lortet-Tieulent, Joannie; Lotufo, Paulo A; Low, Nicola; Lucas, Robyn M; Lunevicius, Raimundas; Lyons, Ronan A; Ma, Jixiang; Ma, Stefan; Mackay, Mark T; Majdan, Marek; Malekzadeh, Reza; Mapoma, Christopher C; Marcenes, Wagner; March, Lyn M; Margono, Chris; Marks, Guy B; Marzan, Melvin B; Masci, Joseph R; Mason-Jones, Amanda J; Matzopoulos, Richard G; Mayosi, Bongani M; Mazorodze, Tasara T; McGill, Neil W; McGrath, John J; McKee, Martin; McLain, Abby; McMahon, Brian J; Meaney, Peter A; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Mekonnen, Wubegzier; Melaku, Yohannes A; Meltzer, Michele; Memish, Ziad A; Mensah, George; Meretoja, Atte; Mhimbira, Francis A; Micha, Renata; Miller, Ted R; Mills, Edward J; Mitchell, Philip B; Mock, Charles N; Moffitt, Terrie E; Ibrahim, Norlinah Mohamed; Mohammad, Karzan A; Mokdad, Ali H; Mola, Glen L; Monasta, Lorenzo; Montico, Marcella; Montine, Thomas J; Moore, Ami R; Moran, Andrew E; Morawska, Lidia; Mori, Rintaro; Moschandreas, Joanna; Moturi, Wilkister N; Moyer, Madeline; Mozaffarian, Dariush; Mueller, Ulrich O; Mukaigawara, Mitsuru; Murdoch, Michele E; Murray, Joseph; Murthy, Kinnari S; Naghavi, Paria; Nahas, Ziad; Naheed, Aliya; Naidoo, Kovin S; Naldi, Luigi; Nand, Devina; Nangia, Vinay; Narayan, KMVenkat; Nash, Denis; Nejjari, Chakib; Neupane, Sudan P; Newman, Lori M; Newton, Charles R; Ng, Marie; Ngalesoni, Frida N; Nhung, Nguyen T; Nisar, Muhammad I; Nolte, Sandra; Norheim, Ole F; Norman, Rosana E; Norrving, Bo; Nyakarahuka, Luke; Oh, In Hwan; Ohkubo, Takayoshi; Omer, Saad B; Opio, John Nelson; Ortiz, Alberto; Pandian, Jeyaraj D; Panelo, Carlo Irwin A; Papachristou, Christina; Park, Eun-Kee; Parry, Charles D; Caicedo, Angel JPaternina; Patten, Scott B; Paul, Vinod K; Pavlin, Boris I; Pearce, Neil; Pedraza, Lilia S; Pellegrini, Carlos A; Pereira, David M; Perez-Ruiz, Fernando P; Perico, Norberto; Pervaiz, Aslam; Pesudovs, Konrad; Peterson, Carrie B; Petzold, Max; Phillips, Michael R; Phillips, David; Phillips, Bryan; Piel, Frederic B; Plass, Dietrich; Poenaru, Dan; Polanczyk, Guilherme V; Polinder, Suzanne; Pope, CA., III; Popova, Svetlana; Poulton, Richie G; Pourmalek, Farshad; Prabhakaran, Dorairaj; Prasad, Noela M; Qato, Dima; Quistberg, DA; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Sajjad Ur; Raju, Murugesan; Rakovac, Ivo; Rana, Saleem M; Razavi, Homie; Refaat, Amany; Rehm, Jurgen; Remuzzi, Giuseppe; Resnikoff, Serge; Ribeiro, Antonio L; Riccio, Patricia M; Richardson, Lee; Richardus, Jan Hendrik; Riederer, Anne M; Robinson, Margot; Roca, Anna; Rodriguez, Alina; Rojas-Rueda, David; Ronfani, Luca; Rothenbacher, Dietrich; Roy, Nobhojit; Ruhago, George M; Sabin, Nsanzimana; Sacco, Ralph L; Ksoreide, Kjetil; Saha, Sukanta; Sahathevan, Ramesh; Sahraian, Mohammad Ali; Sampson, Uchechukwu; Sanabria, Juan R; Sanchez-Riera, Lidia; Santos, Itamar S; Satpathy, Maheswar; Saunders, James E; Sawhney, Monika; Saylan, Mete I; Scarborough, Peter; Schoettker, Ben; Schneider, Ione JC; Schwebel, David C; Scott, James G; Seedat, Soraya; Sepanlou, Sadaf G; Serdar, Berrin; Servan-Mori, Edson E; Shackelford, Katya; Shaheen, Amira; Shahraz, Saeid; Levy, Teresa Shamah; Shangguan, Siyi; She, Jun; Sheikhbahaei, Sara; Shepard, Donald S; Shi, Peilin; Shibuya, Kenji; Shinohara, Yukito; Shiri, Rahman; Shishani, Kawkab; Shiue, Ivy; Shrime, Mark G; Sigfusdottir, Inga D; Silberberg, Donald H; Simard, Edgar P; Sindi, Shireen; Singh, Jasvinder A; Singh, Lavanya; Skirbekk, Vegard; Sliwa, Karen; Soljak, Michael; Soneji, Samir; Soshnikov, Sergey S; Speyer, Peter; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stoeckl, Heidi; Stathopoulou, Vasiliki Kalliopi; Steckling, Nadine; Stein, Murray B; Stein, Dan J; Steiner, Timothy J; Stewart, Andrea; Stork, Eden; Stovner, Lars J; Stroumpoulis, Konstantinos; Sturua, Lela; Sunguya, Bruno F; Swaroop, Mamta; Sykes, Bryan L; Tabb, Karen M; Takahashi, Ken; Tan, Feng; Tandon, Nikhil; Tanne, David; Tanner, Marcel; Tavakkoli, Mohammad; Taylor, Hugh R; Ao, Braden JTe; Temesgen, Awoke Misganaw; Ten Have, Margreet; Tenkorang, Eric Yeboah; Terkawi, Abdullah Sulieman; Theadom, Alice M; Thomas, Elissa; Thorne-Lyman, Andrew L; Thrift, Amanda G; Tleyjeh, Imad M; Tonelli, Marcello; Topouzis, Fotis; Towbin, Jeffrey A; Toyoshima, Hideaki; Traebert, Jefferson; Tran, Bach X; Trasande, Leonardo; Trillini, Matias; Truelsen, Thomas; Trujillo, Ulises; Tsilimbaris, Miltiadis; Tuzcu, Emin M; Ukwaja, Kingsley N; Undurraga, Eduardo A; Uzun, Selen B; van Brakel, Wim H; de Vijver, Steven van; Van Dingenen, Rita; van Gool, Coen H; Varakin, Yuri Y; Vasankari, Tommi J; Vavilala, Monica S; Veerman, Lennert J; Velasquez-Melendez, Gustavo; Venketasubramanian, Narayanaswamy; Vijayakumar, Lakshmi; Villalpando, Salvador; Violante, Francesco S; Vlassov, Vasiliy V; Waller, Stephen; Wallin, Mitchell T; Wan, Xia; Wang, Linhong; Wang, JianLi; Wang, Yanping; Warouw, Tati S; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Werdecker, Andrea; Wessells, KRyan R; Westerman, Ronny; Wilkinson, James D; Williams, Hywel C; Williams, Thomas N; Woldeyohannes, Solomon M; Wolfe, Charles DA; Wong, John Q; Wong, Haidong; Woolf, Anthony D; Wright, Jonathan L; Wurtz, Brittany; Xu, Gelin; Yang, Gonghuan; Yano, Yuichiro; Yenesew, Muluken A; Yentur, Gokalp K; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa; Yu, Chuanhua; Kim, Kim Yun; Zaki, Maysaa El Sayed; Zhang, Yong; Zhao, Zheng; Zhao, Yong; Zhu, Jun; Zonies, David; Zunt, Joseph R; Salomon, Joshua A; Murray, Christopher JL; Global Burden Dis Study
BACKGROUND: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. METHODS: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. FINDINGS/RESULTS: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. INTERPRETATION/CONCLUSIONS: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. FUNDING/BACKGROUND:Bill & Melinda Gates Foundation.
PMCID:4561509
PMID: 26063472
ISSN: 1474-547x
CID: 3048832
