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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
Wang, Haidong; Naghavi, Mohsen; Allen, Christine; Barber, Ryan M; Bhutta, Zulfiqar A; Carter, Austin; Casey, Daniel C; Charlson, Fiona J; Chen, Alan Zian; Coates, Matthew M; Coggeshall, Megan; Dandona, Lalit; Dicker, Daniel J; Erskine, Holly E; Ferrari, Alize J; Fitzmaurice, Christina; Foreman, Kyle; Forouzanfar, Mohammad H; Fraser, Maya S; Pullman, Nancy; Gething, Peter W; Goldberg, Ellen M; Graetz, Nicholas; Haagsma, Juanita A; Hay, Simon I; Huynh, Chantal; Johnson, Catherine; Kassebaum, Nicholas J; Kinfu, Yohannes; Kulikoff, Xie Rachel; Kutz, Michael; Kyu, Hmwe H; Larson, Heidi J; Leung, Janni; Liang, Xiaofeng; Lim, Stephen S; Lind, Margaret; Lozano, Rafael; Marquez, Neal; Mensah, George A; Mikesell, Joe; Mokdad, Ali H; Mooney, Meghan D; Nguyen, Grant; Nsoesie, Elaine; Pigott, David M; Pinho, Christine; Roth, Gregory A; Salomon, Joshua A; Sandar, Logan; Silpakit, Naris; Sligar, Amber; Sorensen, Reed JD; Stanaway, Jeffrey; Steiner, Caitlyn; Teeple, Stephanie; Thomas, Bernadette A; Troeger, Christopher; VanderZanden, Amelia; Vollset, Stein Emil; Wanga, Valentine; Whiteford, Harvey A; Wolock, Timothy; Zoeckler, Leo; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M; Abd-Allah, Foad; Abera, Semaw Ferede; Abreu, Daisy MX; Abu-Raddad, Laith J; Abyu, Gebre Yitayih; Achoki, Tom; Adelekan, Ademola Lukman; Ademi, Zanfina; Adou, Arsene Kouablan; Adsuar, Jose C; Afanvi, Kossivi Agbelenko; Afshin, Ashkan; Agardh, Emilie Elisabet; Agarwal, Arnav; Agrawal, Anurag; Kiadaliri, Aliasghar Ahmad; Ajala, Oluremi N; Akanda, All Shafqat; Akinyemi, Rufus Olusola; Akinyemiju, Tomi F; Akseer, Nadia; Al Lami, Faris Hasan; Alabed, Samer; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore KM; Alasfoor, Deena; Aldhahri, Saleh Fahed; Aldridge, Robert William; Alegretti, Miguel Angel; Aleman, Alicia V; Alemu, Zewdie Aderaw; Alexander, Lily T; Alhabib, Samia; Ali, Raghib; Alkerwi, Ala'a; Alla, Francois; Allebeck, Peter; Al-Raddadi, Rajaa; Alsharif, Ubai; Altirkawi, Khalid A; Martin, Elena Alvarez; Alvis-Guzman, Nelson; Amare, Azmeraw T; Amegah, Adeladza Kofi; Ameh, Emmanuel A; Amini, Heresh; Ammar, Walid; Amrock, Stephen Marc; Andersen, Hjalte H; Anderson, Benjamin; Anderson, Gregory M; Antonio, Carl Abelardo T; Aregay, Atsede Fantahun; Arnlov, Johan; Arsenijevic, Valentina SArsic; Al Artaman; Asayesh, Hamid; Asghar, Rana Jawad; Atique, Suleman; Arthur Avokpaho, Euripide Frinel G; Awasthi, Ashish; Azzopardi, Peter; Bacha, Umar; Badawi, Alaa; Bahit, Maria C; Balakrishnan, Kalpana; Banerjee, Amitava; Barac, Aleksandra; Barker-Collo, Suzanne L; Barnighausen, Till; Barregard, Lars; Barrero, Lope H; Basu, Arindam; Basu, Sanjay; Bayou, Yibeltal Tebekaw; Bazargan-Hejazi, Shahrzad; Beardsley, Justin; Bedi, Neeraj; Beghi, Ettore; Belay, Haileeyesus Adamu; Bell, Brent; Bell, Michelle L; Bello, Aminu K; Bennett, Derrick A; Bensenor, Isabela M; Berhane, Adugnaw; Bernabe, Eduardo; Betsu, Balem Demtsu; Beyene, Addisu Shunu; Bhala, Neeraj; Bhalla, Ashish; Biadgilign, Sibhatu; Bikbov, Boris; Bin Abdulhak, Aref A; Biroscak, Brian J; Biryukov, Stan; Bjertness, Espen; Blore, Jed D; Blosser, Christopher D; Bohensky, Megan A; Borschmann, Rohan; Bose, Dipan; Bourne, Rupert RA; Brainin, Michael; Brayne, Carol EG; Brazinova, Alexandra; Breitborde, Nicholas JK; Brenner, Hermann; Brewer, Jerry D; Brown, Alexandria; Brown, Jonathan; Brugha, Traolach S; Buckle, Geoffrey Colin; Butt, Zahid A; Calabria, Bianca; Campos-Novato, Ismael Ricardo; Campuzano, Julio Cesar; Carapetis, Jonathan R; Cardenas, Rosario; Carpenter, David; Carrero, Juan Jesus; Castaneda-Oquela, Carlos A; Rivas, Jacqueline Castillo; Catala-Lopez, Ferran; Cavalleri, Fiorella; Cercy, Kelly; Cerda, Jorge; Chen, Wanqing; Chew, Adrienne; Chiang, Peggy Pei -Chia; Chibalabala, Mirriam; Chibueze, Chioma Ezinne; Chimed-Ochir, Odgerel; Chisumpa, Vesper Hichilombwe; Choi, Jee-Young Jasmine; Chowdhury, Rajiv; Christensen, Hanne; Christopher, Devasahayam Jesudas; Ciobanu, Liliana G; Cirillo, Massimo; Cohen, Aaron J; Colistro, Valentina; Colomar, Mercedes; Colquhoun, Samantha M; Cooper, Cyrus; Cooper, Leslie Trumbull; Cortinovis, Monica; Cowie, Benjamin C; Crump, John A; Damsere-Derry, James; Danawi, Hadi; Dandona, Rakhi; Daoud, Farah; Darby, Sarah C; Dargan, Paul I; das Neves, Jose; Davey, Gail; Davis, Adrian C; Davitoiu, Dragos V; de Castro, EFilipa; de Jager, Pieter; De Leo, Diego; Degenhardt, Louisa; Dellavalle, Robert P; Deribe, Kebede; Deribew, Amare; Dharmaratne, Samath D; Dhillon, Preet K; Diaz-Torne, Cesar; Ding, Eric L; dos Santos, Kadine Priscila Bender; Dossou, Edem; Driscoll, Tim R; Duan, Leilei; Dubey, Manisha; Bartholow, Bruce; Ellenbogen, Richard G; Lycke, Christian; Elyazar, Iqbal; Endries, Aman Yesuf; Ermakov, Sergey Petrovich; Eshrati, Babak; Esteghamati, Alireza; Estep, Kara; Faghmous, Imad DA; Fahimi, Saman; Jose, Emerito; Farid, Talha A; Sa Farinha, Carla Sofia e; Faro, Andre; Farvid, Maryam S; Farzadfar, Farshad; Feigin, Valery L; Fereshtehnejad, Seyed-Mohammad; Fernandes, Jefferson G; Fernandes, Joao C; Fischer, Florian; Fitchett, Joseph RA; Flaxman, Abraham; Foigt, Nataliya; Fowkes, FGerry R; Franca, Elisabeth Barboza; Franklin, Richard C; Friedman, Joseph; Frostad, Joseph; Hirst, Thomas; Futran, Neal D; Gall, Seana L; Gambashidze, Ketevan; Gamkrelidze, Amiran; Ganguly, Parthasarathi; Gankpe, Fortune Gbetoho; Gebre, Teshome; Gebrehiwot, Tsegaye Tsewelde; Gebremedhin, Amanuel Tesfay; Gebru, Alemseged Aregay; Geleijnse, Johanna M; Gessner, Bradford D; Ghoshal, Aloke Gopal; Gibney, Katherine B; Gillum, Richard F; Gilmour, Stuart; Giref, Ababi Zergaw; Giroud, Maurice; Gishu, Melkamu Dedefo; Giussani, Giorgia; Glaser, Elizabeth; Godwin, William W; Gomez-Dantes, Hector; Gona, Philimon; Goodridge, Amador; Gopalani, Sameer Vali; Gosselin, Richard A; Gotay, Carolyn C; Goto, Atsushi; Gouda, Hebe N; Greaves, Felix; Gugnani, Harish Chander; Gupta, Rahul; Gupta, Rajeev; Gupta, Vipin; Gutierrez, Reyna A; Hafezi-Nejad, Nima; Haile, Demewoz; Hailu, Alemayehu Desalegne; Hailu, Gessessew Bugssa; Halasa, Yara A; Hamadeh, Randah Ribhi; Hamidi, Samer; Hancock, Jamie; Handal, Alexis J; Hankey, Graeme J; Hao, Yuantao; Harb, Hilda L; Harikrishnan, Sivadasanpillai; Haro, Josep Maria; Havmoeller, Rasmus; Heckbert, Susan R; Heredia-Pi, Ileana Beatriz; Heydarpour, Pouria; Hilderink, Henk BM; Hoek, Hans W; Hogg, Robert S; Horino, Masako; Horita, Nobuyuki; Hosgood, HDean; Hotez, Peter J; Hoy, Damian G; Hsairi, Mohamed; Htet, Aung Soe; Than Htike, Maung Maung; Hu, Guoqing; Huang, Cheng; Huang, Hsiang; Huiart, Laetitia; Husseini, Abdullatif; Huybrechts, Inge; Huynh, Grace; Iburg, Kim Moesgaard; Innos, Kaire; Inoue, Manami; Iyer, Veena J; Jacobs, Troy A; Jacobsen, Kathryn H; Jahanmehr, Nader; Jakovljevic, Mihajlo B; James, Peter; Javanbakht, Mehdi; Jayaraman, Sudha P; Jayatilleke, Achala Upendra; Jeemon, Panniyammakal; Jensen, Paul N; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jibat, Tariku; Jimenez-Corona, Aida; Jonas, Jost B; Joshi, Tushar Kant; Kabir, Zubair; Karnak, Ritul; Kan, Haidong; Kant, Surya; Karch, Andre; Karema, Corine Kakizi; Karimkhani, Chante; Karletsos, Dimitris; Karthikeyan, Ganesan; Kasaeian, Amir; Katibeh, Marzieh; Kaul, Anil; Kawakami, Norito; Kayibanda, Jeanne Francoise; Keiyoro, Peter Njenga; Kemmer, Laura; Kemp, Andrew Haddon; Kengne, Andre Pascal; Keren, Andre; Kereselidze, Maia; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khalil, Ibrahim A; Khan, Abdur Rahman; Khan, Ejaz Ahmad; Khang, Young-Ho; Khera, Sahil; Muthafer Khoja, Tawfik Ahmed; Kieling, Christian; Kim, Daniel; Kim, Yun Jin; Kissela, Brett M; Kissoon, Niranjan; Knibbs, Luke D; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kolte, Dhaval; Kopec, Jacek A; Kosen, Soewarta; Koul, Parvaiz A; Koyanagi, Ai; Krog, Norun Hjertager; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kudom, Andreas A; Kuipers, Ernst J; Kulkarni, Veena S; Kumar, GAnil; Kwan, Gene F; Lal, Aparna; Lal, Dharmesh Kumar; Lalloo, Ratilal; Lam, Hilton; Lam, Jennifer O; Langan, Sinead M; Lansingh, Van C; Larsson, Anders; Laryea, Dennis Odai; Latif, Asma Abdul; Lawrynowicz, Alicia Elena Beatriz; Leigh, James; Levi, Miriam; Li, Yongmei; Lindsay, MPatrice; Lipshultz, Steven E; Liu, Patrick Y; Liu, Shiwei; Liu, Yang; Lo, Loon-Tzian; Logroscino, Giancarlo; Lotufo, Paulo A; Lucas, Robyn M; Lunevicius, Raimundas; Lyons, Ronan A; Ma, Stefan; Pedro Machado, Vasco Manuel; Mackay, Mark T; MacLachlan, Jennifer H; Abd El Razek, Hassan Magdy; Abd El Razek, Mohammed Magdy; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Ayele Manamo, Wondimu Ayele; Mandisarisa, John; Mangalam, Srikanth; Mapoma, Chabila C; Marcenes, Wagner; Margolis, David Joel; Martin, Gerard Robert; Martinez-Raga, Jose; Marzan, Melvin Barrientos; Masiye, Felix; Mason-Jones, Amanda J; Massano, Joao; Matzopoulos, Richard; Mayosi, Bongani M; McGarvey, Stephen Theodore; McGrath, John J; Mckee, Martin; McMahon, Brian J; Meaney, Peter A; Mehari, Alem; Mehndiratta, Man Mohan; Mena-Rodriguez, Fabiola; Mekonnen, Alemayehu B; Melaku, Yohannes Adama; Memiah, Peter; Memish, Ziad A; Mendoza, Walter; Meretoja, Atte; Meretoja, Tuomo J; Mhimbira, Francis Apolinary; Micha, Renata; Miller, Ted R; Mirarefin, Mojde; Misganaw, Awoke; Mock, Charles N; Abdulmuhsin Mohammad, Karzan; Mohammadi, Alireza; Mohammed, Shafiu; Mohan, Viswanathan; Mola, Glen Liddell D; Monasta, Lorenzo; Montanez Hernandez, Julio Cesar; Montero, Pablo; Montico, Marcella; Montine, Thomas J; Moradi-Lakeh, Maziar; Morawska, Lidia; Morgan, Katherine; Mori, Rintaro; Mozaffarian, Dariush; Mueller, Ulrich; Satyanarayana Murthy, Gudlavalleti Venkata; Murthy, Srinivas; Musa, Kamarul Imran; Nachega, Jean B; Nagel, Gabriele; Naidoo, Kovin S; Naik, Nitish; Naldi, Luigi; Nangia, Vinay; Nash, Denis; Nejjari, Chakib; Neupane, Subas; Newton, Charles R; Newton, John N; Ng, Marie; Ngalesoni, Frida Namnyak; Ngirabega, Jean de Dieu; Quyen Le Nguyen; Nisar, Muhammad Imran; Nkamedjie Pete, Patrick Martial; Nomura, Marika; Norheim, Ole F; Norman, Paul E; Norrving, Bo; Nyakarahuka, Luke; Ogbo, Felix Akpojene; Ohkubo, Takayoshi; Ojelabi, Foluke Adetola; Olivares, Pedro R; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Opio, John Nelson; Oren, Eyal; Ortiz, Alberto; Osman, Majdi; Ota, Erika; Ozdemir, Raziye; Pa, Mahesh; Pandian, Jeyaraj D; Pant, Puspa Raj; Papachristou, Christina; Park, Eun-Kee; Park, Jae-Hyun; Parry, Charles D; Parsaeian, Mahboubeh; Caicedo, Angel JPaternina; Patten, Scott B; Patton, George C; Paul, Vinod K; Pearce, Neil; Pedro, Joao Mario; Stokic, Ljiljana Pejin; Pereira, David M; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Phillips, Michael Robert; Piel, Frederic B; Pillay, Julian David; Plass, Dietrich; Platts-Mills, James A; Polinder, Suzanne; Pope, CArden; Popova, Svetlana; Poulton, Richie G; Pourmalek, Farshad; Prabhakaran, Dorairaj; Qorbani, Mostafa; Quame-Amaglo, Justice; Quistberg, DAlex; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Sajjad Ur; Rai, Rajesh Kumar; Rajavi, Zhale; Rajsic, Sasa; Raju, Murugesan; Rakovac, Ivo; Rana, Saleem M; Ranabhat, Chhabi L; Rangaswamy, Thara; Rao, Puja; Rao, Sowmya R; Refaat, Amany H; Rehm, Jurgen; Reitsma, Marissa B; Remuzzi, Giuseppe; Resnikofff, Serge; Ribeiro, Antonio L; Ricci, Stefano; Blancas, Maria Jesus Rios; Roberts, Bayard; Roca, Anna; Rojas-Rueda, David; Ronfani, Luca; Roshandel, Gholamreza; Rothenbacher, Dietrich; Roy, Ambuj; Roy, Nawal K; Ruhago, George Mugambage; Sagar, Rajesh; Saha, Sukanta; Sahathevan, Ramesh; Saleh, Muhammad Muhammad; Sanabria, Juan R; Sanchez-Nino, Maria Dolores; Sanchez-Riera, Lidia; Santos, Itamar S; Sarmiento-Suarez, Rodrigo; Sartorius, Benn; Satpathy, Maheswar; Savic, Miloje; Sawhney, Monika; Schaub, Michael P; Schmidt, Maria Ines; Schneider, Ione JC; Schottker, Ben; Schutte, Aletta E; Schwebel, David C; Seedat, Soraya; Sepanlou, Sadaf G; Servan-Mori, Edson E; Shackelford, Katya A; Shaddick, Gavin; Shaheen, Amira; Shahraz, Saeid; Shaikh, Masood Ali; Shakh-Nazarova, Marina; Sharma, Rajesh; She, Jun; Sheikhbahaei, Sara; Shen, Jiabin; Shen, Ziyan; Shepard, Donald S; Sheth, Kevin N; Shetty, Balakrishna P; Shi, Peilin; Shibuya, Kenji; Shin, Min-Jeong; Shiri, Rahman; Shiue, Ivy; Shrime, Mark G; Sigfusdottir, Inga Dora; Silberberg, Donald H; Silva, Diego Augusto Santos; Silveira, Dayane Gabriele Alves; Silverberg, Jonathan I; Simard, Edgar P; Singh, Abhishek; Singh, Gitanjali M; Singh, Jasvinder A; Singh, Om Prakash; Singh, Prashant Kumar; Singh, Virendra; Soneji, Samir; Soreide, Kjetil; Soriano, Joan B; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stathopoulou, Vasiliki; Stein, Dan J; Stein, Murray B; Stranges, Saverio; Stroumpoulis, Konstantinos; Sunguya, Bruno F; Sur, Patrick; Swaminathan, Soumya; Sykes, Bryan L; Szoeke, Cassandra EI; Tabares-Seisdedos, Rafael; Tabb, Karen M; Takahashi, Ken; Takala, Jukka S; Talongwa, Roberto Tchio; Tandon, Nikhil; Tavakkoli, Mohammad; Taye, Bineyam; Taylor, Hugh R; Ao, Braden JTe; Tedla, Bemnet Amare; Tefera, Worku Mekonnen; Ten Have, Margreet; Terkawi, Abdullah Sulieman; Tesfay, Fisaha Haile; Tessema, Gizachew Assefa; Thomson, Alan J; Thorne-Lyman, Andrew L; Thrift, Amanda G; Thurston, George D; Tillmann, Taavi; Tirschwell, David L; Tonelli, Marcello; Topor-Madry, Roman; Topouzis, Fotis; Nx, Jeffrey Allen Towb; Traebert, Jefferson; Tran, Bach Xuan; Truelsen, Thomas; Trujillo, Ulises; Tura, Abera Kenay; Tuzcu, Emin Murat; Uchendu, Uche S; Ukwaja, Kingsley N; Undurraga, Eduardo A; Uthman, Olalekan A; Van Dingenen, Rita; Van Donkelaar, Aaron; Vasankari, Tommi; Vasconcelos, Ana Maria Nogales; Venketasubramanian, Narayanaswamy; Vidavalur, Ramesh; Vijayakumar, Lakshmi; Villalpando, Salvador; Violante, Francesco S; Vlassov, Vasiliy Victorovich; Wagner, Joseph A; Wagner, Gregory R; Wallin, Mitchell T; Wang, Linhong; Watkins, David A; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Werdecker, Andrea; Westerman, Ronny; White, Richard A; Wijeratne, Tissa; Wilkinson, James D; Williams, Hywel C; Wiysonge, Charles Shey; Woldeyohannes, Solomon Meseret; Wolfe, Charles DA; Won, Sungho; Wong, John Q; Woolf, Anthony D; Xavier, Denis; Xiao, Qingyang; Xu, Gelin; Yakob, Bereket; Yalew, Ayalnesh Zemene; Yan, Lijing L; Yano, Yuichiro; Yaseri, Mehdi; Ye, Pengpeng; Yebyo, Henock Gebremedhin; Yip, Paul; Yirsaw, Biruck Desalegn; Yonemoto, Naohiro; Yonga, Gerald; Younis, Mustafa Z; Yu, Shicheng; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zannad, Faiez; Zavala, Diego E; Zeeb, Hajo; Zeleke, Berihun M; Zhang, Hao; Zodpey, Sanjay; Zonies, David; Zuhlke, Liesl Joanna; Vos, Theo; Lopez, Alan D; Murray, Christopher JL; GBD 015 Mortality and Causes Death
Background 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. Methods 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). Findings 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. Interpretation 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
PMCID:5388903
PMID: 27733281
ISSN: 1474-547x
CID: 2374702
Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
Vos, Theo; Allen, Christine; Arora, Megha; Barber, Ryan M; Bhutta, Zulfiqar A; Brown, Alexandria; Carter, Austin; Casey, Daniel C; Charlson, Fiona J; Chen, Alan Z; Coggeshall, Megan; Cornaby, Leslie; Dandona, Lalit; Dicker, Daniel J; Dilegge, Tina; Erskine, Holly E; Ferrari, Alize J; Fitzmaurice, Christina; Fleming, Tom; Forouzanfar, Mohammad H; Fullman, Nancy; Gething, Peter W; Goldberg, Ellen M; Graetz, Nicholas; Haagsma, Juanita A; Johnson, Catherine O; Kassebaum, Nicholas J; Kawashima, Toana; Kemmer, Laura; Khalil, Ibrahim A; Kinfu, Yohannes; Kyu, Hmwe H; Leung, Janni; Liang, Xiaofeng; Lim, Stephen S; Lopez, Alan D; Lozano, Rafael; Marczak, Laurie; Mensah, George A; Mokdad, Ali H; Naghavi, Mohsen; Nguyen, Grant; Nsoesie, Elaine; Olsen, Helen; Pigott, David M; Pinho, Christine; Rankin, Zane; Reinig, Nikolas; Salomon, Joshua A; Sandar, Logan; Smith, Alison; Stanaway, Jeffrey; Steiner, Caitlyn; Teeple, Stephanie; Thomas, Bernadette A; Troeger, Christopher; Wagner, Joseph A; Wang, Haidong; Wanga, Valentine; Whiteford, Harvey A; Zoeckler, Leo; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M; Abd-Allah, Foad; Abraham, Biju; Abubakar, Ibrahim; Abu-Raddad, Laith J; Abu-Rmeileh, Niveen ME; Ackerman, Ilana N; Adebiyi, Akindele Olupelumi; Ademi, Zanfina; Adou, Arsene Kouablan; Afanvi, Kossivi Agbelenko; Agardh, Emilie Elisabet; Agarwal, Arnav; Kiadaliri, Aliasghar Ahmad; Ahmadieh, Hamid; Ajala, Oluremi N; Akinyemi, Rufus Olusola; Akseer, Nadia; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore KM; Aldhahri, Saleh Fahed; Alegretti, Miguel Angel; Alemu, Zewdie Aderaw; Alexander, Lily T; Alhabib, Samia; Ali, Raghib; Alkerwi, Ala'a; Alla, Francois; Allebeck, Peter; Al-Raddadi, Rajaa; Alsharif, Ubai; Altirkawi, Khalid A; Alvis-Guzman, Nelson; Amare, Azmeraw T; Amberbir, Alemayehu; Amini, Heresh; Ammar, Walid; Amrock, Stephen Marc; Andersen, Hjalte H; Anderson, Gregory M; Anderson, Benjamin; Antonio, Carl Abelardo T; Aregay, Atsede Fantahun; Arnlov, Johan; Al Artaman; Asayesh, Hamid; Assadi, Reza; Atique, Suleman; Avokpaho, Euripide Frinel GArthur; Awasthi, Ashish; Quintanilla, Beatriz Paulina Ayala; Azzopardi, Peter; Bacha, Umar; Badawi, Alaa; Balakrishnan, Kalpana; Banerjee, Amitava; Barac, Aleksandra; Barker-Collo, Suzanne L; Barnighausen, Till; Barregard, Lars; Barrero, Lope H; Basu, Arindam; Bazargan-Hejazi, Shahrzad; Bell, Brent; Bell, Michelle L; Bennett, Derrick A; Bensenor, Isabela M; Benzian, Habib; Berhane, Adugnaw; Bernabe, Eduardo; Betsu, Balem Demtsu; Beyene, Addisu Shunu; Bhala, Neeraj; Bhatt, Samir; Biadgilign, Sibhatu; Bienhofff, Kelly; Bikbov, Boris; Biryukov, Stan; Bisanzio, Donal; Bjertness, Espen; Blore, Jed; Borschmann, Rohan; Boufous, Soufiane; Brainin, Michael; Brazinova, Alexandra; Breitborde, Nicholas JK; Brown, Jonathan; Buchbinder, Rachelle; Buckle, Geoffrey Colin; Butt, Zahid A; Calabria, Bianca; Ricardo Campos-Nonato, Ismael; Cesar Campuzano, Julio; Carabin, Helene; Cardenas, Rosario; Carpenter, David O; Carrero, Juan Jesus; Castaneda-Orjuela, Carlos A; Castillo Rivas, Jacqueline; Catala-Lopez, Ferran; Chang, Jung-Chen; Chiang, Peggy Pei-Chia; Chibueze, Chioma Ezinne; Chisumpa, Vesper Hichilombwe; Choi, Jee-Young Jasmine; Chowdhury, Rajiv; Christensen, Hanne; Christopher, Devasahayam Jesudas; Ciobanu, Liliana G; Cirillo, Massimo; Coates, Matthew M; Colquhoun, Samantha M; Cooper, Cyrus; Cortinovis, Monica; Crump, John A; Damtew, Solomon Abrha; Dandona, Rakhi; Daoud, Farah; Dargan, Paul I; das Neves, Jose; Davey, Gail; Davis, Adrian C; De Leo, Diego; Degenhardt, Louisa; Del Gobbo, Liana C; Dellavalle, Robert P; Deribe, Kebede; Deribew, Amare; Derrett, Sarah; Des Jarlais, Don C; Dharmaratne, Samath D; Dhillon, Preet K; Diaz-Torne, Cesar; Ding, Eric L; Driscoll, Tim R; Duan, Leilei; Dubey, Manisha; Duncan, Bruce Bartholow; Ebrahimi, Hedyeh; Ellenbogen, Richard G; Elyazar, Iqbal; Endres, Matthias; Endries, Aman Yesuf; Ermakov, Sergey Petrovich; Eshrati, Babak; Estep, Kara; Farid, Talha A; Sofia e Sa Farinha, Carla; Faro, Andre; Farvid, Maryam S; Farzadfar, Farshad; Feigin, Valery L; Felson, David T; Fereshtehnejad, Seyed-Mohammad; Fernandes, Jefferson G; Fernandes, Joao C; Fischer, Florian; Fitchett, Joseph RA; Foreman, Kyle; Fowkes, Gerry R; Fox, Jordan; Franklin, Richard C; Friedman, Joseph; Frostad, Joseph; Furst, Thomas; Futran, Neal D; Gabbe, Belinda; Ganguly, Parthasarathi; Gankpe, Fortune Gbetoho; Gebre, Teshome; Gebrehiwot, Tsegaye Tewelde; Gebremedhin, Amanuel Tesfay; Geleijnse, Johanna M; Gessner, Bradford D; Gibney, Katherine B; Ginawi, Ibrahim Abdelmageem Mohamed; Giref, Ababi Zergaw; Giroud, Maurice; Gishu, Melkamu Dedefo; Glaser, Elizabeth; Godwin, William W; Gomez-Dantes, Hector; Gona, Philimon; Goodridge, Amador; Gopalani, Sameer Vali; Gotay, Carolyn C; Goto, Atsushi; Gouda, Hebe N; Grainger, Rebecca; Greaves, Felix; Guillemin, Francis; Guo, Yuming; Gupta, Rahul; Gupta, Rajeev; Gupta, Vipin; Gutierrez, Reyna A; Haile, Demewoz; Hailu, Alemayehu Desalegne; Hailu, Gessessew Bugssa; Halasa, Yara A; Hamadeh, Randah Ribhi; Hamidi, Samer; Hammami, Mouhanad; Hancock, Jamie; Handal, Alexis J; Hankey, Graeme J; Hao, Yuantao; Harb, Hilda L; Harikrishnan, Sivadasanpillai; Maria Haro, Josep; Havmoeller, Rasmus; Hay, Roderick J; Beatriz Heredia-Pi, Ileana; Heydarpour, Pouria; Hoek, Hans W; Horino, Masako; Horita, Nobuyuki; Hosgood, HDean; Hoy, Damian G; Htet, Aung Soe; Huang, Hsiang; Huang, John J; Huynh, Chantal; Iannarone, Marissa; Iburg, Kim Moesgaard; Innos, Kaire; Inoue, Manami; Iyer, Veena J; Jacobsen, Kathryn H; Jahanmehr, Nader; Jakovljevic, Mihajlo B; Javanbakht, Mehdi; Jayatilleke, Achala Upendra; Jee, Sun Ha; Jeemon, Panniyammakal; Jensen, Paul N; Jiang, Ying; Jibat, Tariku; Jimenez-Corona, Aida; Jin, Ye; Jonas, Jost B; Kabir, Zubair; Kalkonde, Yogeshwar; Kamal, Ritul; Kan, Haidong; Karch, Andre; Karema, Corine Kakizi; Karimkhani, Chante; Kasaeian, Amir; Kaul, Anil; Kawakami, Norito; Karimkhani, Chante; Kasaeian, Amir; Kaul, Anil; Kawakami, Norito; Keiyoro, Peter Njenga; Kemp, Andrew Haddon; Keren, Andre; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khaiff, Abdur Rahman; Khaiff, Ejaz Ahmad; Khang, Young-Ho; Khera, Sahil; Khoja, Tawfik Ahmed Muthafer; Khubchandani, Jagdish; Kieling, Christian; Kim, Pauline; Kim, Cho-il; Kim, Daniel; Kim, Yun Jin; Kissoon, Niranjan; Knibbs, Luke D; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kolte, Dhaval; Kopec, Jacek A; Kosen, Soewarta; Kotsakis, Georgios A; Koul, Parvaiz A; Koyanagi, Ai; Kravchenko, Michael; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kudom, Andreas A; Kuipers, Ernst J; Kumar, GAnil; Kutz, Michael; Kwan, Gene F; Lal, Aparna; Lalloo, Ratilal; Lallukka, Tea; Lam, Hilton; Lam, Jennifer O; Langan, Sinead M; Larsson, Anders; Lavados, Pablo M; Leasher, Janet L; Leigh, James; Leung, Ricky; Levi, Miriam; Li, Yichong; Li, Yongmei; Liang, Juan; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K; Lo, Warren D; Logroscino, Giancarlo; Looker, Katharine J; Lotufo, Paulo A; Lunevicius, Raimundas; Lyons, Ronan A; Mackay, Mark T; Abd El Razek, Mohammed Magdy; Mahdavi, Mandi; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Marcenes, Wagner; Margolis, David Joel; Martinez-Raga, Jose; Masiye, Felix; Massano, Joao; McGarvey, Stephen Theodore; McGrath, John J; McKee, Martin; McMahon, Brian J; Meaney, Peter A; Mehari, Alem; Meija-Rodriguez, Fabiola; Mekonnen, Alemayehu B; Melaku, Yohannes Adama; Memiah, Peter; Memish, Ziad A; Mendoza, Walter; Meretoja, Atte; Meretoja, Tuomo J; Mhimbira, Francis Apolinary; Miller, Ted R; Mills, Edward J; Mirarefin, Mojde; Mitchell, Philip B; Mock, Charles N; Mohammadi, Alireza; Mohammed, Shafiu; Monasta, Lorenzo; Montanez Hernandez, Julio Cesar; Montico, Marcella; Mooney, Meghan D; Moradi-Lakeh, Maziar; Morawska, Lidia; Mueller, Ulrich O; Mullany, Erin; Mumford, John Everett; Murdoch, Michele E; Nachega, Jean B; Nagel, Gabriele; Naheed, Aliya; Naldi, Luigi; Nangia, Vinay; Newton, John N; Ng, Marie; Ngalesoni, Frida Namnyak; Quyen Le Nguyen; Nisar, Muhammad Imran; Nkamedjie Pete, Patrick Martial; Nona, Joan M; Norheim, Ole F; Norman, Rosana E; Norrving, Bo; Nunes, Bruno P; Ogbo, Felix Akpojene; Oh, In-Hwan; Ohkubo, Takayoshi; Olivares, Pedro R; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Ortiz, Alberto; Osman, Majdi; Ota, Erika; Mahesh, PA; Park, Eun-Kee; Parsaeian, Mahboubeh; de Azeredo Passos, Valeria Maria; Paternina Caicedo, Angel J; Patten, Scott B; Patton, George C; Pereira, David M; Perez-Padilla, Rogelio; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Phillips, Michael Robert; Piel, Frederic B; Pillay, Julian David; Pishgar, Farhad; Plass, Dietrich; Platts-Mills, James A; Polinder, Suzanne; Pond, Constance D; Popova, Svetlana; Poulton, Richie G; Pourmalek, Farshad; Prabhakaran, Dorairaj; Prasad, Noela M; Qorbani, Mostafa; Rabiee, Rynaz HS; Radfar, Amir; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Sajjad Ur; Rai, Rajesh Kumar; Rajsic, Sasa; Ram, Usha; Rao, Puja; Refaat, Amany H; Reitsma, Marissa B; Remuzzi, Giuseppe; Resnikofff, Serge; Reynolds, Alex; Ribeiro, Antonio L; Rios Blancas, Maria Jesus; Rolm, Hirbo Shore; Rojas-Rueda, David; Ronfani, Luca; Roshandel, Gholamreza; Roth, Gregory A; Rothenbacher, Dietrich; Roy, Ambuj; Sagar, Rajesh; Sahathevan, Ramesh; Sanabria, Juan R; Dolores Sanchez-Nino, Maria; Santos, Itamar S; Santos, Joao Vasco; Sarmiento-Suarez, Rodrigo; Sartorius, Benn; Satpathy, Maheswar; Savic, Miloje; Sawhney, Monika; Schaub, Michael P; Schmidt, Maria Ines; Schneider, Ione JC; Schottker, Ben; Schwebel, David C; Scott, James G; Seedat, Soraya; Sepanlou, Sadaf G; Servan-Mori, Edson E; Shackelford, Katya A; Shaheen, Amira; Shaikh, Masood Ali; Sharma, Rajesh; Sharma, Upasana; Shen, Jiabin; Shepard, Donald S; Sheth, Kevin N; Shibuya, Kenji; Shin, Min-Jeong; Shiri, Rahman; Shiue, Ivy; Shrime, Mark G; Sigfusdottir, Inga Dora; Silva, Diego Augusto Santos; Alves Silveira, Dayane Gabriele; Singh, Abhishek; Singh, Jasvinder A; Singh, Om Prakash; Singh, Prashant Kumar; Sivonda, Anna; Skirbekk, Vegard; Skogen, Jens Christoffer; Sligar, Amber; Silwa, Karen; Soljak, Michael; Soreide, Kjetil; Soriano, Joan B; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stathopoulou, Vasiliki; Steel, Nicholas; Stein, Dan J; Steiner, Timothy J; Steinke, Sabine; Stovner, Lars; Stroumpoulis, Konstantinos; Sunguya, Bruno F; Sur, Patrick; Swaminathan, Soumya; Sykes, Bryan L; Szoeke, Cassandra EI; Tabares-Seisdedos, Rafael; Takala, Jukka S; Landon, Nikhil; Tanne, David; Tavakkoli, Mohammad; Taye, Bineyam; Taylor, Hugh R; Te Ao, Braden J; Tedla, Bemnet Amare; Terkawi, Abdullah Sulieman; Thomson, Alan J; Thorne-Lyman, Andrew L; Thrift, Amanda G; Thurston, George D; Tobe-Gai, Ruoyan; Tonelli, Marcello; Topor-Madry, Roman; Topouzis, Fotis; Tran, Bach Xuan; Dimbuene, Zacharie Tsala; Tsilimbaris, Miltiadis; Tura, Abera Kenay; Tuzcu, Emin Murat; Tyrovolas, Stefanos; Ukwaja, Kingsley N; Undurraga, Eduardo A; Uneke, Chigozie Jesse; Uthman, Olalekan A; van Gool, Coen H; Varakin, Yuri Y; Vasankari, Tommi; Venketasubramanian, Narayanaswamy; Verma, Raj Kumar; Violante, Francesco S; Vladimirov, Sergey K; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Wagner, Gregory R; Waller, Stephen G; Wang, Linhong; Watkins, David A; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Werdecker, Andrea; Westerman, Ronny; White, Richard A; Williams, Hywel C; Wiysonge, Charles Shey; Wolfe, Charles DA; Won, Sungho; Woodbrook, Rachel; Wubshet, Mamo; Xavier, Denis; Xu, Gelin; Yadav, Ajit Kumar; Yan, Lijing L; Yano, Yuichiro; Yaseri, Mehdi; Ye, Pengpeng; Yebyo, Henock Gebremedhin; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Yu, Chuanhua; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zeeb, Hajo; Zhou, Maigeng; Zodpey, Sanjay; Zuhlke, Liesl Joanna; Murray, Christopher JL; GBD 2015 Dis Injury Incidence
Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9.3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17.2 billion, 95% uncertainty interval [UI] 15.4-19.2 billion) and diarrhoeal diseases (2.39 billion, 2.30-2.50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2.36 billion (2.35-2.37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available
PMCID:5055577
PMID: 27733282
ISSN: 1474-547x
CID: 2374712
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
Kassebaum, Nicholas J; Arora, Megha; Barber, Ryan M; Bhutta, Zulfigar A; Carter, Austin; Casey, Daniel C; Charlson, Fiona J; Coates, Matthew M; Coggeshall, Megan; Cornaby, Leslie; Dandona, Lalit; Dicker, Daniel J; Erskine, Holly E; Ferrari, Alize J; Fitzmaurice, Christina; Foreman, Kyle; Forouzanfar, Mohammad H; Fullman, Nancy; Gething, Peter W; Goldberg, Ellen M; Graetz, Nicholas; Haagsma, Juanita A; Johnson, Catherine; Kemmer, Laura; Khalil, Ibrahim A; Kinfu, Yohannes; Kutz, Michael J; Kyu, Hmwe H; Leung, Janni; Liang, Xiaofeng; Lim, Stephen S; Lim, Stephen S; Lozano, Rafael; Mensah, George A; Mikesell, Joe; Mokdad, Ali H; Mooney, Meghan D; Naghavi, Mohsen; Nguyen, Grant; Nsoesie, Elaine; Pigott, David M; Pinho, Christine; Rankin, Zane; Reinig, Nikolas; Salomon, Joshua A; Sandar, Logan; Smith, Alison; Sorensen, Reed JD; Stanaway, Jeffrey; Steiner, Caitlyn; Teeple, Stephanie; Thomas, Bernadette A; Troeger, Chris; VanderZanden, Amelia; Wagner, Joseph A; Wanga, Valentine; Whiteford, Harvey A; Zhou, Maigeng; Zoeckler, Leo; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M; Abd-Allah, Foad; Abraham, Biju; Abubakar, Ibrahim; Abu-Raddad, Laith J; Abu-Rmeileh, Niveen ME; Achoki, Tom; Ackerman, Ilana N; Adebiyi, Akindele Olupelumi; Adedeji, Isaac Akinkunmi; Adsuar, Jose C; Afanvi, Kossivi Agbelenko; Afshin, Ashkan; Agardh, Emilie Elisabet; Agarwal, Arnav; Kumar, Sanjay; Ahmed, Muktar Beshir; Kiadaliri, Aliasghar Ahmad; Ahmadieh, Hamid; Akseer, Nadia; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore KM; Aldhahri, Saleh Fahed; Alegretti, Miguel Angel; Aleman, Alicia V; Alemu, Zewdie Aderaw; Alexander, Lily T; Raghib, Ali; Alkerwi, Ala'a; Alla, Francois; Allebeck, Peter; Alsharif, Ubai; Altirkawi, Khalid A; Martin, Elena Alvarez; Alvis-Guzman, Nelson; Amare, Azmeraw T; Amberbir, Alemayehu; Amegah, Adeladza Kofi; Amini, Heresh; Ammar, Walid; Amrock, Stephen Marc; Anderson, Gregory M; Anderson, Benjamin O; Antonio, Carl Abelardo T; Anwari, Palwasha; Arnlov, Johan; Arsenijevic, Valentina SArsic; Artaman, Al; Asayesh, Hamid; Asghar, Rana Jawad; Avokpaho, Euripide Frinel GArthur; Awasthi, Ashish; Quintanilla, Beatriz Paulina Ayala; Azzopardi, Peter; Bacha, Umar; Badawi, Alaa; Balakrishnan, Kalpana; Banerjee, Amitava; Barac, Aleksandra; Barker-Collo, Suzanne L; Barnighausen, Till; Barregard, Lars; Barrero, Lope H; Basu, Sanjay; Bayou, Tigist Assefa; Beardsley, Justin; Bedi, Neeraj; Beghi, Ettore; Bell, Brent; Bell, Michelle L; Benjet, Corina; Bennett, Derrick A; Bensenor, Isabela M; Berhane, Adugnaw; Bernabe, Eduardo; Betsu, Balem Demtsu; Beyene, Addisu Shunu; Bhala, Neeraj; Bhansali, Anil; Bhatt, Samir; Biadgilign, Sibhatu; Bienhofff, Kelly; Bikbov, Boris; Bin Abdulhak, Aref A; Bisanzio, Donal; Bjertness, Espen; Blore, Jed D; Borschmann, Rohan; Boufous, Soufiane; Bourne, Rupert RA; Brainin, Michael; Brazinova, Alexandra; Breitborde, Nicholas JK; Brugha, Traolach S; Buchbinder, Rachelle; Buckle, Geoffrey Colin; Butt, Zahid A; Calabria, Bianca; Campos-Nonato, Ismael Ricardo; Campuzano, Julio Cesar; Carabin, Helene; Carapetis, Jonathan R; Cardenas, Rosario; Carrero, Juan Jesus; Castaneda-Orjuela, Carlos A; Rivas, Jacqueline Castillo; Catala-Lopez, Ferran; Cavalleri, Fiorella; Chang, Jung-Chen; Chiang, Peggy Pei-Chia; Chibalabala, Mirriam; Chibueze, Chioma Ezinne; Chisumpa, Vesper Hichilombwe; Choi, Jee-Young Jasmine; Choudhury, Lincoln; Christensen, Hanne; Ciobanu, Liliana G; Colistro, Valentina; Colomar, Mercedes; Colquhoun, Samantha M; Cortinovis, Monica; Crump, John A; Damasceno, Albertino; Dandona, Rakhi; Dargan, Paul I; Das Neves, Jose; Davey, Gail; Davis, Adrian C; De Leo, Diego; Degenhardt, Louisa; Del Gobbo, Liana C; Derrett, Sarah; Des Jarlais, Don C; Deveber, Gabrielle A; Dharmaratne, Samath D; Dhillon, Preet K; Ding, Eric L; Doyle, Kerrie E; Driscoll, Tim R; Duan, Leilei; Dubey, Manisha; Duncan, Bruce Bartholow; Ebrahimi, Hedyeh; Ellenbogen, Richard G; Elyazar, Iqbal; Endries, Aman Yesuf; Ermakov, Sergey Petrovich; Eshrati, Babak; Esteghamati, Alireza; Estep, Kara; Fahimi, Saman; Farid, Talha A; Sa Farinha, Carla Sofia e; Faro, Andre; Farvid, Maryam S; Farzadfar, Farshad; Feigin, Valery L; Fereshtehnejad, Seyed-Mohammad; Fernandes, Jefferson G; Fernandes, Joao C; Fischer, Florian; Fitchett, Joseph RA; Foigt, Nataliya; Fowkes, FGerry R; Franklin, Richard C; Friedman, Joseph; Frostad, Joseph; Furst, Thomas; Futran, Neal D; Gabbe, Belinda; Gankpe, Fortune Gbetoho; Garcia-Basteiro, Alberto L; Gebrehiwot, Tsegaye Tewelde; Gebremedhin, Amanuel Tesfay; Geleijnse, Johanna M; Gibney, Katherine B; Gillum, Richard F; Ginawi, Ibrahim Abdelmageem Mohamed; Giref, Ababi Zergaw; Giroud, Maurice; Gishu, Melkamu Dedefo; Godwin, William W; Gomez-Dantes, Hector; Gona, Philimon; Goodridge, Amador; Gopalani, Sameer Vali; Gotay, Carolyn C; Goto, Atsushi; Gouda, Hebe N; Guo, Yuming; Gupta, Rahul; Gupta, Rajeev; Gupta, Vipin; Gutierrez, Reyna A; Hafezi-Nejad, Nima; Haile, Demewoz; Hailu, Alemayehu Desalegne; Hailu, Gessessew Bugssa; Halasa, Yara A; Ribhi, Randah; Hamadeh; Hamidi, Samer; Hammami, Mouhanad; Handal, Alexis J; Hankey, Graeme J; Harb, Hilda L; Harikrishnan, Sivadasanpillai; Haro, Josep Maria; Hassanvand, Mohammad Sadegh; Hassen, Tahir Ahmed; Havmoeller, Rasmus; Hay, Roderick J; Hedayati, Mohammad T; Heredia-Pi, Ileana Beatriz; Heydarpour, Pouria; Hoek, Hans W; Hoffman, Daniel J; Horino, Masako; Horita, Nobuyuki; Hosgood, HDean; Hoy, Damian G; Hsairi, Mohamed; Huang, Hsiang; Huang, John J; Iburg, Kim Moesgaard; Idrisov, Bulat T; Innos, Kaire; Inoue, Manami; Jacobsen, Kathryn H; Jauregui, Alejandra; Jayatilleke, Achala Upendra; Jeemon, Panniyammakal; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jibat, Tariku; Jimenez-Corona, Aida; Jin, Ye; Jonas, Jost B; Kabir, Zubair; Kajungu, Dan K; Kalkonde, Yogeshwar; Kamal, Ritul; Kan, Haidong; Kandel, Amit; Karch, Andre; Karema, Corine Kakizi; Karimkhani, Chante; Kasaeian, Amir; Katibeh, Marzieh; Kaul, Anil; Kawakami, Norito; Kazi, Dhruv S; Keiyoro, Peter Njenga; Kemp, Andrew Haddon; Kengne, Andre Pascal; Keren, Andre; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khan, Abdur Rahman; Khan, Ejaz Ahmad; Khang, Young-Ho; Khoja, Tawfik Ahmed Muthafer; Khubchandani, Jagdish; Kieling, Christian; Kim, Cho-il; Kim, Daniel; Kim, Yun Jin; Kissoon, Niranjan; Kivipelto, Miia; Knibbs, Luke D; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kolte, Dhaval; Kopec, Jacek A; Koul, Parvaiz A; Koyanagi, Ai; Defo, Barthelemy Kuate; Kuchenbecker, Ricardo S; Bicer, Burcu Kucuk; Kuipers, Ernst J; Kumar, GAnil; Kwan, Gene F; Lalloo, Ratilal; Lallukka, Tea; Larsson, Anders; Latif, Asma Abdul; Lavados, Pablo M; Lawrynowicz, Alicia Elena Beatriz; Leasher, Janet L; Leigh, James; Leung, Ricky; Li, Yichong; Li, Yongmei; Lipshultz, Steven E; Liu, Patrick Y; Liu, Yang; Lloyd, Belinda K; Logroscino, Giancarlo; Looker, Katharine J; Lotufo, Paulo A; Lucas, Robyn M; Lunevicius, Raimundas; Lyons, Ronan A; El Razek, Hassan Magdy Abd; Mandavi, Mandi; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Marcenes, Wagner; Martinez-Raga, Jose; Masiye, Felix; Mason-Jones, Amanda J; Matzopoulos, Richard; Mayosi, Bongani M; McGrath, John J; Mckee, Martin; Meaney, Peter A; Mehari, Alem; Melaku, Yohannes Adama; Memiah, Peter; Memish, Ziad A; Mendoza, Walter; Meretoja, Atte; Meretoja, Tuomo J; Mesfin, Yonatan Moges; Mhimbira, Francis Apolinary; Miller, Ted R; Mills, Edward J; Mirarefin, Mojde; Mirrakhimov, Erkin M; Mitchell, Philip B; Mock, Charles N; Mohammad, Karzan Abdulmuhsin; Mohammadi, Alireza; Mohammed, Shafiu; Monasta, Lorenzo; Montanez Hernandez, Julio Cesar; Montico, Marcella; Moradi-Lakeh, Maziar; Mori, Rintaro; Mueller, Ulrich O; Mumford, John Everett; Murdoch, Michele E; Murthy, Gudlavalleti Venkata Satyanarayana; Nachega, Jean B; Naheed, Aliya; Naldi, Luigi; Nangia, Vinay; Newton, John N; Ng, Marie; Ngalesoni, Frida Namnyak; Le Nguyen, Quyen; Nisar, Muhammad Imran; Pete, Patrick Martial Nkamedjie; Nolla, Joan M; Norheim, Ole F; Norman, Rosana E; Norrving, Bo; Obermeyer, Carla Makhlouf; Ogbo, Felix Akpojene; Oh, In-Hwan; Oladimeji, Olanrewaju; Olivares, Pedro R; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Oren, Eyal; Ortiz, Alberto; Ota, Erika; Oyekale, Abayomi Samuel; Pa, Mahesh; Park, Eun-Kee; Parsaeian, Mahboubeh; Patten, Scott B; Patton, George C; Pedro, Joao Mario; Pereira, David M; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Phillips, Michael Robert; Piel, Frederic B; Pillay, Julian David; Pishgar, Farhad; Plass, Dietrich; Polinder, Suzanne; Popova, Svetlana; Poulton, Richie G; Pourmalek, Farshad; Prasad, Noela M; Qorbani, Mostafa; Rabiee, Rynaz HS; Radfar, Amir; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Sajjad Ur; Rai, Dheeraj; Rai, Rajesh Kumar; Rajsic, Sasa; Raju, Murugesan; Ram, Usha; Ranganathan, Kavitha; Refaat, Amany H; Reitsma, Marissa B; Remuzzi, Giuseppe; Resnikoff, Serge; Reynolds, Alex; Ribeiro, Antonio L; Ricci, Stefano; Roba, Hirbo Shore; Rojas-Rueda, David; Ronfani, Luca; Roshandel, Gholamreza; Roth, Gregory A; Roy, Ambuj; Sackey, Ben Benasco; Sagar, Rajesh; Sanabria, Juan R; Dolores Sanchez-Nino, Maria; Santos, Itamar S; Santos, Joao Vasco; Sarmiento-Suarez, Rodrigo; Sartorius, Benn; Satpathy, Maheswar; Savic, Miloje; Sawhney, Monika; Schmidt, Maria Ines; Schneider, Ione JC; Schutte, Aletta E; Schwebel, David C; Seedat, Soraya; Sepanlou, Sadaf G; Servan-Mori, Edson E; Shahraz, Saeid; Shaikh, Masood Ali; Sharma, Rajesh; She, Jun; Sheikhbahaei, Sara; Shen, Jiabin; Sheth, Kevin N; Shibuya, Kenji; Shigematsu, Mika; Shin, Min-Jeong; Shin, Rahman; Sigfusdottir, Inga Dora; Santos Silva, Diego Augusto; Silverberg, Jonathan I; Simard, Edgar P; Singh, Abhishek; Singh, Jasvinder A; Singh, Prashant Kumar; Skirbekk, Vegard; Skogen, Jens Christoffer; Soljak, Michael; Soreide, Kjetil; Sorensen, Reed JD; Sreeramareddy, Chandrashekhar T; Stathopoulou, Vasiliki; Steel, Nicholas; Stein, Dan J; Stein, Murray B; Steiner, Timothy J; Stovner, Lars Jacob; Stranges, Saverio; Stroumpoulis, Konstantinos; Sunguya, Bruno F; Sur, Patrick J; Swaminathan, Soumya; Sykes, Bryan L; Szoeke, Cassandra EI; Tabares-Seisdedos, Rafael; Landon, Nikhil; Tanne, David; Tavakkoli, Mohammad; Taye, Bineyam; Taylor, Hugh R; Ao, Braden JTe; Tegegne, Teketo Kassaw; Tekle, Dejen Yemane; Terkawi, Abdullah Sulieman; Tessema, Gizachew Assefa; Thakur, JS; Thomson, Alan J; Thorne-Lyman, Andrew L; Thrift, Amanda G; Thurston, George D; Tobe-Gai, Ruoyan; Tonelli, Marcello; Topor-Madry, Roman; Topouzis, Fotis; Tran, Bach Xuan; Dimbuene, Zacharie Tsala; Tsilimbaris, Miltiadis; Tura, Abera Kenay; Tuzcu, Emin Murat; Tyrovolas, Stefanos; Ukwaja, Kingsley N; Undurraga, Eduardo A; Uneke, Chigozie Jesse; Uthman, Olalekan A; van Gool, Coen H; van Os, Jim; Vasankari, Tommi; Vasconcelos, Ana Maria Nogales; Venketasubramanian, Narayanaswamy; Violante, Francesco S; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Wagner, Gregory R; Wallin, Mitchell T; Wang, Linhong; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Werdecker, Andrea; WestermaM, Ronny; Wijeratne, Tissa; Wilkinson, James D; Williams, Hywel C; Wiysonge, Charles Shey; Woldeyohannes, Solomon Meseret; Wolfe, Charles DA; Won, Sungho; Xu, Gelin; Yadav, Ajit Kumar; Yakob, Bereket; Yan, Lijing L; Yan, Yuichiro; Yaseri, Mehdi; Ye, Pengpeng; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Yu, Chuanhua; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zeeb, Hajo; Zodpey, Sanjay; Zonies, David; Zuhlke, Liesl Joanna; Zeeb, Hajo; Zodpey, Sanjay; Zonies, David; Zuhlke, Liesl Joanna; Vos, Theo; Lopez, Alan D; Murray, Christopher JL; GBD 2015 DALY & HALE
Background 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. Methods 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. Findings Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs off set 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. Interpretation 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
PMCID:5388857
PMID: 27733283
ISSN: 1474-547x
CID: 2374722
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
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Oh, In-Hwan; Oladimeji, Olanrewaju; Olivares, Pedro R; Olsen, Helen; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Opio, John Nelson; Oren, Eyal; Orozco, Ricardo; Ortiz, Alberto; Ota, Erika; Mahesh, PA; Pana, Adrian; Park, Eun-Kee; Parry, Charles D; Parsaeian, Mahboubeh; Patel, Tejas; Caicedo, Angel JPaternina; Patil, Snehal T; Patten, Scott B; Patton, George C; Pearce, Neil; Pereira, David M; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Phillips, Michael Robert; Piel, Frederic B; Pillay, Julian David; Plass, Dietrich; Polinder, Suzanne; Pond, Constance D; Pope, CArden; Pope, Daniel; Popova, Svetlana; Poulton, Richie G; Pourmalek, Farshad; Prasad, Noela M; Qorbani, Mostafa; Rabiee, Rynaz HS; Radfar, Amir; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Sajjad Ur; Rai, Rajesh Kumar; Rajsic, Sasa; Raju, Murugesan; Ram, Usha; Rana, Saleem M; Ranganathan, Kavitha; Rao, Puja; Razo Garcia, Christian Aspacia; Refaat, Amany H; Rehm, Colin D; Rehm, Jurgen; Reinig, Nikolas; Remuzzi, Giuseppe; Resnikoff, Serge; Ribeiro, Antonio L; Rivera, Juan A; Rolm, Hirbo Shore; Rodriguez, Anna; Rodriguez-Ramirez, Sonia; Rojas-Rueda, David; Roman, Yesenia; Ronfani, Luca; Roshandel, Gholamreza; Rothenbacher, Dietrich; Roy, Ambuj; Saleh, Muhammad Muhammad; Sanabria, Juan R; Dolores Sanchez-Nino, Maria; Sanchez-Pimienta, Tania G; Sandar, Logan; Santomauro, Damian F; Santos, Itamar S; Sarmiento-Suarez, Rodrigo; Sartorius, Benn; Satpathy, Maheswar; Savic, Miloje; Sawhney, Monika; Schmidhuber, Josef; Schmidt, Maria Ines; Schneider, Ione JC; Schoettker, Ben; Schutte, Aletta E; Schwebel, David C; Scott, James G; Seedat, Soraya; Sepanlou, Sadaf G; Servan-Mori, Edson E; Shaheen, Amira; Shahraz, Saeid; Shaikh, Masood Ali; Levy, Teresa Shamah; Sharma, Rajesh; She, Jun; Sheikhbahaei, Sara; Shen, Jiabin; Sheth, Kevin N; Shi, Peilin; Shibuya, Kenji; Shigematsu, Mika; Shin, Min-Jeong; Shiri, Rahman; Shishani, Kawkab; Shiue, Ivy; Shrime, Mark G; Sigfusdottir, Inga Dora; Silva, Diego Augusto Santos; Alves Silveira, Dayane Gabriele; Silverberg, Jonathan I; Simard, Edgar P; Sindi, Shireen; Singh, Abhishek; Singh, Jasvinder A; Singh, Prashant Kumar; Slepak, Erica Leigh; Soljak, Michael; Soneji, Samir; Sorensen, Reed JD; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stathopoulou, Vasiliki; Steckling, Nadine; Steel, Nicholas; Stein, Dan J; Stein, Murray B; Stockl, Heidi; Stranges, Saverio; Stroumpoulis, Konstantinos; Sunguya, Bruno F; Swaminathan, Soumya; Sykes, Bryan L; Szoeke, Cassandra EI; Tabares-Seisdedos, Rafael; Takahashi, Ken; Talongwa, Roberto Tchio; Landon, Nikhil; Tanne, David; Tavakkoli, Mohammad; Taye, Belaynew Wasie; Taylor, Hugh R; Tedla, Bemnet Amare; Tefera, Worku Mekonnen; Tegegne, Teketo Kassaw; Tekle, Dejen Yemane; Terkawi, Abdullah Sulieman; Thakur, JS; Thomas, Bernadette A; Thomas, Matthew Lloyd; Thomson, Alan J; Thorne-Lyman, Andrew L; Thrift, Amanda G; Thurston, George D; Tillmann, Taavi; Tobe-Gai, Ruoyan; Tobollik, Myriam; Topor-Madry, Roman; Topouzis, Fotis; Towbin, Jeffrey Allen; Bach Xuan Tran; Dimbuene, Zacharie Tsala; Tsilimparis, Nikolaos; Tura, Abera Kenay; Tuzcu, Emin Murat; Tyrovolas, Stefanos; Ukwaja, Kingsley N; Undurraga, Eduardo A; Uneke, Chigozie Jesse; Uthman, Olalekan A; van Donkelaar, Aaron; van Os, Jim; Varakin, Yuri Y; Vasankari, Tommi; Veerman, JLennert; Venketasubramanian, Narayanaswamy; Violante, Francesco S; Vollset, Stein Emil; Wagner, Gregory R; Waller, Stephen G; Wang, JianLi; Wang, Linhong; Wang, Yanping; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Werdecker, Andrea; Westerman, Ronny; Whiteford, Harvey A; Wijeratne, Tissa; Wiysonge, Charles Shey; Wolfe, Charles DA; Won, Sungho; Woolf, Anthony D; Wubshet, Mamo; Xavier, Denis; Xu, Gelin; Yadav, Ajit Kumar; Yakob, Bereket; Yalew, Ayalnesh Zemene; Yano, Yuichiro; Yaseri, Mehdi; Ye, Pengpeng; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Yu, Chuanhua; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zhu, Jun; Zipkin, Ben; Zodpey, Sanjay; Zuhlke, Liesl Joanna; Murray, Christopher JL; GBD 2015 Risk Factors
Background 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. Methods 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). Findings 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. Interpretation 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
PMCID:5388856
PMID: 27733284
ISSN: 1474-547x
CID: 2374732
Survey of International Members of the American Thoracic Society on Climate Change and Health
Sarfaty, Mona; Kreslake, Jennifer; Ewart, Gary; Guidotti, Tee L; Thurston, George D; Balmes, John R; Maibach, Edward W
The American Thoracic Society (ATS), in collaboration with George Mason University, surveyed international members of the society to assess perceptions, clinical experiences, and preferred policy responses related to global climate change. A recruitment email was sent by the ATS President in October 2015 to 5,013 international members. Subsequently, four reminder emails were sent to nonrespondents. Responses were received from 489 members in 68 countries; the response rate was 9.8%. Half of respondents reported working in countries in Asia (25%) or Europe (25%), with the remainder in South America (18%), North America (Canada and Mexico) (18%), Australia or New Zealand (9%), and Africa (6%). Survey estimate confidence intervals were +/- 5% or smaller. A high percentage of international ATS survey respondents judged that climate change is happening (96%), that it is driven by human activity (70%), and that it is relevant to patient care ("a great deal"/"a moderate amount") (80%). A majority of respondents also indicated they are already observing health impacts of climate change among their patients; most commonly as increases in chronic disease severity from air pollution (88%), allergic symptoms from exposure to plants or mold (72%), and severe weather injuries (69%). An even larger majority anticipated seeing these climate-related health impacts in the next two decades. Respondents further indicated that physicians and physician organizations should play an active role in educating patients, the public, and policy makers on the human health effects of climate change. International ATS respondents, like their counterparts in the U.S., observed that human health is already adversely affected by climate change, and support responses to address this situation.
PMID: 27726439
ISSN: 2325-6621
CID: 2278322
Ischemic Heart Disease Mortality and Long-Term Exposure to Source-Related Components of U.S. Fine Particle Air Pollution
Thurston, George D; Burnett, Richard T; Turner, Michelle C; Shi, Yuanli; Krewski, Daniel; Lall, Ramona; Ito, Kazuhiko; Jerrett, Michael; Gapstur, Susan M; Diver, W R; Pope, C A 3rd
BACKGROUND: Fine particulate matter (PM2.5) air pollution exposure has been identified as a global health threat. However, the types and sources of particles most responsible are not yet known. In this work, we sought to identify the causal characteristics and sources of air pollution underlying past published associations in the American Cancer Society's Cancer Prevention Study-II cohort between long-term PM2.5 exposure and Ischemic Heart Disease (IHD) mortality. METHODS: Individual risk factor data were evaluated for 445,860 adults in 100 U.S. metropolitan areas followed from 1982 to 2004 for vital status and cause of death. Using Cox proportional hazard models, IHD mortality hazard ratios (HRs) were derived for PM2.5, trace constituents, and pollution source-associated PM2.5, as derived from air monitoring at central stations throughout the nation during 2000-2005. RESULTS: Associations with IHD mortality varied by PM2.5 mass constituent and source. A coal combustion PM2.5 IHD HR = 1.05 (95% CI=1.02, 1.08) per microg/m3, versus an IHD HR = 1.01 (95% CI=1.00, 1.02) per microg/m3 PM2.5 mass, indicated a risk roughly five times higher for coal combustion PM2.5 than for PM2.5 mass in general, on a per microg/m3 PM2.5 basis. Diesel traffic-related elemental carbon (EC) soot was also associated with IHD mortality (HR = 1.03; 95% CI: 1.00, 1.06 per 0.26 mug/m3 EC increase). However, PM2.5 from both wind-blown soil and biomass combustion were not associated with IHD mortality. CONCLUSIONS: Long-term PM2.5 exposures from fossil fuel combustion, especially coal burning, but also from diesel traffic, were associated with increases in IHD mortality in this nationwide population. Results suggest that PM2.5 - mortality associations can vary greatly by source, and that the largest IHD health benefits per microg/m3 from PM2.5 air pollution control may be achieved via reductions of fossil fuel combustion exposures, especially from coal-burning sources.
PMCID:4892920
PMID: 26629599
ISSN: 1552-9924
CID: 1863482
Ambient Particulate Matter Air Pollution Exposure and Mortality in the NIH-AARP Diet and Health Cohort
Thurston, George D; Ahn, Jiyoung; Cromar, Kevin R; Shao, Yongzhao; Reynolds, Harmony R; Jerrett, Michael; Lim, Chris C; Shanley, Ryan; Park, Yikyung; Hayes, Richard B
BACKGROUND: Outdoor fine particulate matter (PM2.5) has been identified as a global health threat, but the number of large U.S. prospective cohort studies with individual participant data remains limited, especially at lower recent exposures. OBJECTIVES: To test the relationship between long-term exposure PM2.5 and death risk from all non-accidental causes, cardiovascular (CVD), and respiratory diseases in 517,041 men and women enrolled in the National Institutes of Health-AARP cohort. METHODS: Individual participant data were linked with residence PM2.5 exposure estimates across the continental U.S for a 2000-2009 follow up period when matching census-tract level PM2.5 exposure data were available. Participants enrolled ranged from 50-71 yrs. of age, residing in 6 U.S. States and 2 cities. Cox Proportional Hazard models yielded Hazard Ratio (HR) estimates per 10 microg/m3 of PM2.5 exposure. RESULTS: PM2.5 exposure was significantly associated with total mortality (HR= 1.03, 95% CI =1.00, 1.05) and CVD mortality (HR=1.10, 95% CI=1.05, 1.15), but the association with respiratory mortality was not statistically significant (HR=1.05, 95% CI=0.98,1.13). A significant association was found with respiratory mortality only among never smokers (HR=1.27; 95% CI: 1.03, 1.56). Associations with 10 microg/m3 PM2.5 exposures in yearly participant residential annual mean, or in metropolitan area-wide mean, were consistent with baseline exposure model results. Associations with PM2.5 were similar when adjusted for ozone exposures. Analyses of California residents alone also yielded statistically significant PM2.5 mortality HR's for total and CVD mortality. CONCLUSIONS: Long-term exposure to PM2.5 air pollution was associated with an increased risk of total and CVD mortality, providing an independent test of the PM2.5 - mortality relationship in a new large U.S. prospective cohort experiencing lower post-2000 PM2.5 exposure levels.
PMCID:4829984
PMID: 26370657
ISSN: 1552-9924
CID: 1779182
Influence Of Exposure Times On Pollution Related Mortality In The Nih-Aarp Cohort [Meeting Abstract]
Lim, C; Yinon, L; Hayes, R; Cromar, KR; Shao, Y; Ahn, J; Thurston, GD
ISI:000390749602240
ISSN: 1535-4970
CID: 2414572
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; 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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
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
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Skirbekk, Vegard; Slepak, Erica Leigh; Sliwa, Karen; Soneji, Samir; Soreide, Kjetil; Soshnikov, Sergey; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stanaway, Jeffrey D; Stathopoulou, Vasiliki; Stein, Dan J; Stein, Murray B; Steiner, Caitlyn; Steiner, Timothy J; Stevens, Antony; Stewart, Andrea; Stovner, Lars J; Stroumpoulis, Konstantinos; Sunguya, Bruno F; Swaminathan, Soumya; Swaroop, Mamta; Sykes, Bryan L; Tabb, Karen M; Takahashi, Ken; Tandon, Nikhil; Tanne, David; Tanner, Marcel; Tavakkoli, Mohammad; Taylor, Hugh R; Te Ao, Braden J; Tediosi, Fabrizio; Temesgen, Awoke M; Templin, Tara; Ten Have, Margreet; Tenkorang, Eric Y; Terkawi, Abdullah S; Thomson, Blake; Thorne-Lyman, Andrew L; Thrift, Amanda G; Thurston, George D; Tillmann, Taavi; Tonelli, Marcello; Topouzis, Fotis; Toyoshima, Hideaki; Traebert, Jefferson; Tran, Bach X; Trillini, Matias; Truelsen, Thomas; Tsilimbaris, Miltiadis; Tuzcu, Emin M; Uchendu, Uche S; Ukwaja, Kingsley N; Undurraga, Eduardo A; Uzun, Selen B; 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BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6.2 years (95% UI 5.6-6.6), from 65.3 years (65.0-65.6) in 1990 to 71.5 years (71.0-71.9) in 2013, HALE at birth rose by 5.4 years (4.9-5.8), from 56.9 years (54.5-59.1) to 62.3 years (59.7-64.8), total DALYs fell by 3.6% (0.3-7.4), and age-standardised DALY rates per 100 000 people fell by 26.7% (24.6-29.1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING: Bill & Melinda Gates Foundation.
PMCID:4673910
PMID: 26321261
ISSN: 1474-547x
CID: 2033262
