Searched for: school:SOM
Department/Unit:Population Health
Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
Kassebaum, N J; Barber, R M; Dandona, L; Hay, S I; Larson, H J; Lim, S S; Lopez, A D; Mokdad, A H; Naghavi, M; Pinho, C; Steiner, C; Vos, T; Wang, H; Achoki, T; Anderson, G M; Arora, M; Biryukov, S; Blore, J D; Carter, A; Casey, D C; Coates, M M; Coggeshall, M; Dicker, D J; Dossou, E; Fleming, T; Fraser, M S; Friedman, J; Fullman, N; Graetz, N; Hancock, J; Huynh, C; Iannarone, M; Kemmer, L; Kulikoff, X R; Kutz, M J; Liu, P Y; Marquez, N; Misganaw, A; Mooney, M D; Moradi-Lakeh, M; Ng, M; Nguyen, G; Pain, A; Shackelford, K A; Silpakit, N; Sligar, A; Smith, J M; Sorensen, R J D; Wagner, J A; Wolock, T; Zhou, M; Murray, C J L; Ebel, B E; Futran, N D; Harun, K M; Bhutta, Z A; Nisar, M I; Akseer, N; Jeemon, P; Dandona, R; Goenka, S; Kumar, G A; Gething, P W; Bisanzio, D; Deribew, A; Cooper, C; Ali, R; Bennett, D A; Jha, V; Rahimi, K; Kinfu, Y; Murthy, G V S; Liu, S; Wang, L; Liang, X; Yu, S; Azzopardi, P; Gibney, K B; Meretoja, A; Szoeke, C E I; Alam, K; Colquhoun, S M; Weintraub, R G; Wijeratne, T; Lozano, R; Campos-Nonato, I R; Campuzano, J C; Gomez-Dantes, H; Lamadrid-Figueroa, H; Mejia-Rodriguez, F; Montanez, Hernandez J C; Montero, P; Mensah, G A; Salomon, J A; Thorne-Lyman, A L; Ajala, O N; Barnighausen, T; Ding, E L; Farvid, M S; Fitchett, J R A; Abajobir, A A; Knibbs, L D; Lalloo, R; Alam, N K M; Guo, Y; Abate, K H; Gebrehiwot, T T; Gebremedhin, A T; Abbas, K M; Abd-Allah, F; Abdallat, M A; Abdulle, A M; Abera, S F; Melaku, Y A; Tesfay, F H; Aregay, A F; Bayou, T A; Betsu, B D; Gebremedhin, M; Gebru, A A; Hailu, G B; Tekle, T; Yalew, A Z; Yebyo, H G; Aboyans, V; Abubakar, I; Aldridge, R W; Banerjee, A; AbuRmeileh, N M; Adebiyi, A O; Adelekan, A L; Ojelabi, F A; Adedeji, I A; Adou, A K; Afanvi, K A; Badawi, A; Agarwal, A; Ahmad, Kiadaliri A; Akinyemiju, T F; Schwebel, D C; Singh, J A; Al-Aly, Z; Kemp, A H; Leigh, J; Mekonnen, A B; Alasfoor, D; Aldhahri, S F; Terkawi, A S; Alhabib, S; Alkerwi, A; Alla, F; Al-Raddadi, R; Alsharif, U; Alvarez, Martin E; Alvis-Guzman, N; Amare, A T; Ciobanu, L G; Tessema, G A; Setegn, T; Amberbir, A; Amegah, A K; Kudom, A A; Ammar, W; Harb, H L; Amrock, S M; Andersen, H H; Antoine, R M; Antonio, C A T; Faraon, E J A; Arnlov, J; Larsson, A; Arsic, Arsenijevic V S; Barac, A; Artaman, A; Asayesh, H; Atique, S; Avokpaho, E F G A; Awasthi, A; Ayala, Quintanilla B P; Bacha, U; Bahit, M C; Balakrishnan, K; Barker-Collo, S L; Mohammed, S; Basu, S; Bayou, Y T; Bazargan-Hejazi, S; Beardsley, J; Bedi, N; Bekele, T; Bell, M L; Biroscak, B J; Huang, J J; Santos, I S; Bensenor, I M; Lotufo, P A; Berhane, A; Wolfe, C D; Bernabe, E; Beyene, A S; Biadgilign, S; Bikbov, B; Bin, Abdulhak A A; Bjertness, E; Htet, A S; Brainin, M; Brazinova, A; Majdan, M; Shen, J; Breitborde, N J K; Brugha, T S; Butt, Z A; Cardenas, R; Fereshtehnejad, S; Kivipelto, M; Weiderpass, E; Havmoeller, R; Sindi, S; Castaneda-Orjuela, C A; CastanedaOrjuela, C A; Castro, R E; Catala-Lopez, F; Cavalleri, F; Colistro, V; Chang, H; Chang, J; Chavan, L; Chibueze, C E; Chisumpa, V H; Mapoma, C C; Masiye, F; Choi, J J; Chowdhury, R; Christopher, D J; Cirillo, M; Cooper, L T; Dahiru, T; Damasceno, A; Danawi, H; Refaat, A H; das, Neves J; Santos, J V; De, Leo D; Dellavalle, R P; Deribe, K; Hailu, A D; Tefera, W; Giref, A Z; Jibat, T; Temam, Shifa G; Des, Jarlais D C; Dharmaratne, S D; Dubey, M; Rahman, M H U; Ram, U; Singh, A; Yadav, A K; Vollset, S E; Ellingsen, C L; Savic, M; Skirbekk, V; Elyazar, I; Ermakov, S P; Soshnikov, S; Eshrati, B; Farzadfar, F; Kasaeian, A; Pishgar, F; Esteghamati, A; Hafezi-Nejad, N; Sheikhbahaei, S; Khosravi, A; Malekzadeh, R; Roshandel, G; Sepanlou, S G; Rahimi-Movaghar, V; Farid, T A; Khan, A R; Farinha, C S E S; Faro, A; Fernandes, J C; Fischer, F; Foigt, N; Franca, E B; Franklin, R C; Furst, T; Majeed, A; Gambashidze, K; Kazanjan, K; Kereselidze, M; Khonelidze, I; Shakh-Nazarova, M; Sturua, L; Gamkrelidze, A; Gebre, T; Geleijnse, J M; Giroud, M; Gishu, M D; Tura, A K; Glaser, E; Gona, P; Goodridge, A; Gopalani, S V; Goto, A; Gugnani, H C; Gupta, R; Gupta, V; Norheim, O F; Hamadeh, R R; Hamidi, S; Handal, A J; Hankey, G J; Harikrishnan, S; Hoek, H W; Horino, M; Horita, N; Hosgood, H D; Hoy, D G; Hu, G; Huang, H; Huybrechts, I; Iburg, K M; Idrisov, B T; Iyer, V J; Jacobsen, K H; Jahanmehr, N; Jakovljevic, M B; Javanbakht, M; Jayatilleke, A U; Jee, S H; Lal, D K; Zodpey, S; Jiang, G; Jiang, Y; Jonas, J B; Kabir, Z; Kamal, R; Kesavachandran, C N; She, J; Kan, H; Karch, A; Karletsos, D; Kaul, A; Kawakami, N; Shibuya, K; Kayibanda, J F; Kazi, D S; Keiyoro, P N; Kengne, A P; Wiysonge, C S; Sliwa, K; Keren, A; Khader, Y S; Khan, E A; Khang, Y H; Won, S; Khubchandani, J; Kim, Y J; Kokubo, Y; Kosen, S; Koul, P A; Koyanagi, A; Krishnaswami, S; Kuate, Defo B; Kucuk, Bicer B; Lam, H; Lan, Q; Laryea, D O; Leung, R; Li, Y; Lipshultz, S E; Wilkinson, J D; Simard, E P; Liu, Y; Phillips, M R; Xiao, Q; Lloyd, B K; Lunevicius, R; Pope, D; Ma, S; Magdy, Abd El Razek H; Magdy, Abd El Razek M; Marcenes, W; Meaney, P A; Margolis, D J; Marzan, M B; Mason-Jones, A J; Mazorodze, T T; Mehari, A; Mehndiratta, M M; Woldeyohannes, S M; Tedla, B A; Memish, Z A; Mendoza, W; Meretoja, T J; Mhimbira, F A; Miller, T R; Mills, E J; Mohamed, Ibrahim N; Mohammad, K A; Mohammadi, A; Mola, G L D; Monasta, L; Montico, M; Ronfani, L; Monis, J D; Moore, A R; MoradiLakeh, M; Morawska, L; Norman, R E; Mori, R; Werdecker, A; Mueller, U O; Westerman, R; Murthy, S; Pourmalek, F; Nachega, J B; Paternina, Caicedo A J; Seedat, S; Tran, B X; Naheed, A; Naldi, L; Remuzzi, G; Nand, D; Nangia, V; Nash, D; Neupane, S; Newton, J N; Ngalesoni, F N; Nguhiu, P; Nguyen, Q L; Nomura, M; Nyakarahuka, L; Obermeyer, C M; Ogbo, F A; Oh, I; Olivares, P R; Olusanya, B O; Olusanya, J O; Opio, J N; Oren, E; Ota, E; Oyekale, A S; Mahesh, P A; Papantoniou, N; Stathopoulou, V; Park, E; Park, H; Patten, S B; Paul, V K; Roy, A; Sagar, R; Satpathy, M; Pereira, D M; Cortinovis, M; Perico, N; Pesudovs, K; Petzold, M; Pillay, J D; Polinder, S; Qorbani, M; Rafay, A; Rahman, M; Rahman, S U; Rai, R K; Ranabhat, C L; Rangaswamy, T; Rao, P V; Resnikoff, S; Rojas-Rueda, D; Ruhago, G M; Sunguya, B F; Saleh, M M; Sanabria, J R; Sanchez-Nino, M D; Sarmiento-Suarez, R; Sartorius, B; Sawhney, M; Saylan, M I; Schneider, I J C; Silva, D A S; Servan-Mori, E E; Shaikh, M A; Sharma, R; Shin, M; Yoon, S; Shiri, R; Shishani, K; Shiue, I; Sigfusdottir, I D; Silveira, D G A; Silverberg, J I; Yano, Y; Singh, O P; Singh, P K; Singh, V; Soneji, S; Soriano, J B; Sposato, L A; Sreeramareddy, C T; Stroumpoulis, K; Swaminathan, S; Sykes, B L; Tabares-Seisdedos, R; Tabb, K M; Talongwa, R T; Tavakkoli, M; Taye, B; Endries, A Y; Thomson, A J; Tobe-Gai, R; Topor-Madry, R; Towbin, J A; Tsala, Dimbuene Z; Tyrovolas, S; Ukwaja, K N; Uthman, O A; Vasankari, T; Venketasubramanian, N; Violante, F S; Vladimirov, S K; Vlassov, V V; Weichenthal, S; Wubshet, M; Xu, G; Yakob, B; Yip, P; Yonemoto, N; Younis, M Z; Yu, C; Zaidi, Z; Zaki, M E; Zeeb, H; Zhao, Y; Zuhlke, L J
Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation
PMCID:5224694
PMID: 27733286
ISSN: 1474-547x
CID: 2621422
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
Chronic Kidney Disease and Risk for Gastrointestinal Bleeding in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
Ishigami, Junichi; Grams, Morgan E; Naik, Rakhi P; Coresh, Josef; Matsushita, Kunihiro
BACKGROUND AND OBJECTIVES:Patients on dialysis are known to have higher risk for gastrointestinal (GI) bleeding. However, data on mild to moderate CKD, particularly elevated albuminuria, are limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:Among 11,088 participants in the Atherosclerosis Risk in Communities (ARIC) Study, we investigated the association of eGFR and urinary albumin-to-creatinine ratio (ACR) with risk for hospitalization with GI bleeding. Kidney measures were assessed at visit four (1996-1998), and follow-up was continued through 2011. RESULTS:(HR, 7.06; 95% CI, 3.91 to 12.76). Compared with ACR<10 mg/g, risk for GI bleeding became significantly higher in mild albuminuria with ACR 10-29 mg/g (HR, 1.36; 95% CI, 1.08 to 1.69), and was nearly double in moderate and severe albuminuria (HR, 2.13; 95% CI, 1.66 to 2.71 for ACR 30-299 mg/g, and HR, 2.07; 95% CI, 1.33 to 3.22 for ACR≥300 mg/g). These results were largely consistent in demographic and clinical subgroups and independent of incident cardiovascular events or dialysis during follow-up. CONCLUSIONS:Individuals with even mild to moderate CKD warrant clinical attention regarding the risk of hospitalization with GI bleeding.
PMCID:5053788
PMID: 27515592
ISSN: 1555-905x
CID: 5100512
Adapting a weight management tool for Latina women: a usability study of the Veteran Health Administration's MOVE!23 tool
Perez, Hector R; Nick, Michael W; Mateo, Katrina F; Squires, Allison; Sherman, Scott E; Kalet, Adina; Jay, Melanie
BACKGROUND: Obesity disproportionately affects Latina women, but few targeted, technology-assisted interventions that incorporate tailored health information exist for this population. The Veterans Health Administration (VHA) uses an online weight management tool (MOVE!23) which is publicly available, but was not designed for use in non-VHA populations. METHODS: We conducted a qualitative study to determine how interactions between the tool and other contextual elements impacted task performance when the target Latina users interacted with MOVE!23. We sought to identify and classify specific facilitators and barriers that might inform design changes to the tool and its context of use, and in turn promote usability. Six English-speaking, adult Latinas were recruited from an inner city primary care clinic and a nursing program at a local university in the United States to engage in a "Think-Aloud" protocol while using MOVE!23. Sessions were recorded, transcribed, and coded to identify interactions between four factors that contribute to usability (Tool, Task, User, Context). RESULTS: Five themes influencing usability were identified: Technical Ability and Technology Preferences; Language Confusion and Ambiguity; Supportive Tool Design and Facilitator Guidance; Relevant Examples; and Personal Experience. Features of the tool, task, and other contextual factors failed to fully support participants at times, impeding task completion. Participants interacted with the tool more readily when its language was familiar and content was personally relevant. When faced with ambiguity and uncertainty, they relied on the tool's visual cues and examples, actively sought relevant personal experiences, and/or requested facilitator support. CONCLUSIONS: The ability of our participants to successfully use the tool was influenced by the interaction of individual characteristics with those of the tool and other contextual factors. We identified both tool-specific and context-related changes that could overcome barriers to the use of MOVE!23 among Latinas. Several general considerations for the design of eHealth tools are noted.
PMCID:5053210
PMID: 27716279
ISSN: 1472-6947
CID: 2274312
Effect of Drug Interactions and Adherence to Warfarin Therapy on Patients-Reply
Dodson, John A; Gaziano, J Michael
PMID: 27557090
ISSN: 2380-6591
CID: 2221552
Prevalence and Predictors of Obesity-Related Counseling Provided by Outpatient Psychiatrists in the United States
Rogers, Erin S; Sherman, Scott E; Malaspina, Dolores; Jay, Melanie
OBJECTIVE: This study sought to identify rates and predictors of obesity counseling performed by outpatient psychiatrists in the United States. METHODS: The 2005-2010 National Ambulatory Medical Care Surveys provided data from 7,309 outpatient psychiatry visits. Logistic regression was used to examine associations between patient, visit, and practice characteristics and outcomes. RESULTS: Most (81%) visits occurred in a private practice setting. Nine percent (N=657) of visits included measurement of patient body mass index (BMI); 30% of these visits were with patients who met the obesity criterion (BMI >/=30.0 kg/m2). Among visits with obese patients, 16% included exercise counseling, 22% included weight reduction counseling, and 24% included diet or nutrition counseling. Patients with obesity were more likely than patients without obesity to receive diet or nutrition counseling (p<.05) and weight reduction counseling (p<.05), but not exercise counseling. Black patients were significantly less likely to receive any form of counseling (p<.05). CONCLUSIONS: There is a significant need to improve psychiatrists' obesity counseling.
PMID: 27364811
ISSN: 1557-9700
CID: 2273502
Disparities within the Disparity - Determining HIV Risk Factors among Latino Gay and Bisexual Men Attending a Community-Based Clinic in Los Angeles, California
Beymer, Matthew R; Weiss, Robert E; Halkitis, Perry N; Kapadia, Farzana; Ompad, Danielle C; Bourque, Linda; Bolan, Robert K
BACKGROUND: Latino gay, bisexual, and other men who have sex with men (MSM) in the United States have a 50% greater incidence of HIV when compared to White MSM. Previous studies have analyzed factors contributing to condomless anal intercourse (CAI) among Latino MSM, but few studies have followed cohorts of HIV-negative Latino MSM to determine circumstances for HIV infection. Informed by Syndemics Theory, we examine behavioral, biological, and contextual factors associated with HIV infection for Latino MSM. METHODS: Risk assessment and HIV testing data were analyzed for all initially HIV-negative, Latino MSM (n = 3,111) visiting a community-based clinic in Los Angeles, California from January 2009 to June 2014. Survival analyses were used to determine characteristics of Latino MSM who became HIV-positive during the study timeframe. RESULTS: Similar to previous studies of MSM, self-reported history of Chlamydia, Gonorrhea and/or Syphilis (aHR: 1.97; CI: 1.28-3.04), receptive CAI (aHR: 1.7; CI: 1.16-2.49), and methamphetamine use (aHR: 1.99; CI: 1.15-3.43) predicted HIV infection. In addition, originating from Central America (aHR: 2.31; CI: 1.41-3.79), Latino ethnicity of the last sex partner (aHR: 1.67; CI: 1.16-2.39), and experiencing intimate partner violence (IPV) (aHR: 1.73; CI: 1.13-2.64) were also associated with HIV infection among Latino MSM. CONCLUSIONS: This is the first study to show independent associations between IPV and HIV infection among Latino MSM. This study shows that psychosocial conditions such as IPV fuel HIV incidence among Latino MSM, and psychosocial interventions should be considered to reduce HIV disparities among Latino MSM.
PMCID:5025341
PMID: 27163174
ISSN: 1944-7884
CID: 2107562
Perceived social support and mental health states in a clinic-based sample of older HIV positive adults
Kapadia, Farzana; Levy, Michael; Griffin-Tomas, Marybec; Greene, Richard E.; Halkitis, Sophia N.; Urbina, Antonio; Halkitis, Perry N.
Despite a high prevalence of mental health problems in older, HIV+ adults (aged ≥ 50), few studies have examined the relationship between perceived social support and mental health burdens in this group. In a clinic-based sample of 100 adults, 23% and 29% met criteria for one and more than one mental health burden, respectively. In multivariable binary logistic models, perceived receipt of positive and emotional social support as well as overall support was inversely associated with the presence of mental health burdens. There is a need for additional investigation of how social support can help mitigate mental health burdens among HIV+ older adults.
SCOPUS:84981745165
ISSN: 1538-1501
CID: 2821672
Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort study
Cook, Stephanie H; Halkitis, Perry N; Kapadia, Farzana
This study examines how romantic relationship cognitions are associated with changes of condomless anal sex among emerging adult gay and bisexual men. The sample was drawn from four waves of a prospective cohort study ( N = 598; Mage = 18.2). Results suggest that condomless anal sex increased over the emerging adulthood period. Romantic relationship fear was associated with increased receptive condomless anal sex. Perceptions of greater romantic relationship control increased the likelihood of having insertive and receptive condomless anal sex. Findings suggest that romantic relationship cognitions are important to consider when understanding longitudinal changes in condomless anal sex in this population.
PMID: 28810356
ISSN: 1461-7277
CID: 3332682
Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Mokdad, Ali H; Forouzanfar, Mohammad Hossein; Daoud, Farah; El Bcheraoui, Charbel; Moradi-Lakeh, Maziar; Khalil, Ibrahim; Afshin, Ashkan; Tuffaha, Marwa; Charara, Raghid; Barber, Ryan M; Wagner, Joseph; Cercy, Kelly; Kravitz, Hannah; Coates, Matthew M; Robinson, Margaret; Estep, Kara; Steiner, Caitlyn; Jaber, Sara; Mokdad, Ali A; O'Rourke, Kevin F; Chew, Adrienne; Kim, Pauline; El Razek, Mohamed Magdy Abd; Abdalla, Safa; Abd-Allah, Foad; Abraham, Jerry P; Abu-Raddad, Laith J; Abu-Rmeileh, Niveen M E; Al-Nehmi, Abdulwahab A; Akanda, Ali S; Al Ahmadi, Hanan; Al Khabouri, Mazin J; Al Lami, Faris H; Al Rayess, Zulfa A; Alasfoor, Deena; AlBuhairan, Fadia S; Aldhahri, Saleh F; Alghnam, Suliman; Alhabib, Samia; Al-Hamad, Nawal; Ali, Raghib; Ali, Syed Danish; Alkhateeb, Mohammad; AlMazroa, Mohammad A; Alomari, Mahmoud A; Al-Raddadi, Rajaa; Alsharif, Ubai; Al-Sheyab, Nihaya; Alsowaidi, Shirina; Al-Thani, Mohamed; Altirkawi, Khalid A; Amare, Azmeraw T; Amini, Heresh; Ammar, Walid; Anwari, Palwasha; Asayesh, Hamid; Asghar, Rana; Assabri, Ali M; Assadi, Reza; Bacha, Umar; Badawi, Alaa; Bakfalouni, Talal; Basulaiman, Mohammed O; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Bhakta, Amit R; Bhutta, Zulfiqar A; Bin Abdulhak, Aref A; Boufous, Soufiane; Bourne, Rupert R A; Danawi, Hadi; Das, Jai; Deribew, Amare; Ding, Eric L; Durrani, Adnan M; Elshrek, Yousef; Ibrahim, Mohamed E; Eshrati, Babak; Esteghamati, Alireza; Faghmous, Imad A D; Farzadfar, Farshad; Feigl, Andrea B; Fereshtehnejad, Seyed-Mohammad; Filip, Irina; Fischer, Florian; Gankpe, Fortune G; Ginawi, Ibrahim; Gishu, Melkamu Dedefo; Gupta, Rahul; Habash, Rami M; Hafezi-Nejad, Nima; Hamadeh, Randah R; Hamdouni, Hayet; Hamidi, Samer; Harb, Hilda L; Hassanvand, Mohammad Sadegh; Hedayati, Mohammad T; Heydarpour, Pouria; Hsairi, Mohamed; Husseini, Abdullatif; Jahanmehr, Nader; Jha, Vivekanand; Jonas, Jost B; Karam, Nadim E; Kasaeian, Amir; Kassa, Nega Assefa; Kaul, Anil; Khader, Yousef; Khalifa, Shams Eldin A; Khan, Ejaz A; Khan, Gulfaraz; Khoja, Tawfik; Khosravi, Ardeshir; Kinfu, Yohannes; Defo, Barthelemy Kuate; Balaji, Arjun Lakshmana; Lunevicius, Raimundas; Obermeyer, Carla Makhlouf; Malekzadeh, Reza; Mansourian, Morteza; Marcenes, Wagner; Farid, Habibolah Masoudi; Mehari, Alem; Mehio-Sibai, Abla; Memish, Ziad A; Mensah, George A; Mohammad, Karzan A; Nahas, Ziad; Nasher, Jamal T; Nawaz, Haseeb; Nejjari, Chakib; Nisar, Muhammad Imran; Omer, Saad B; Parsaeian, Mahboubeh; Peprah, Emmanuel K; Pervaiz, Aslam; Pourmalek, Farshad; Qato, Dima M; Qorbani, Mostafa; Radfar, Amir; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Sajjad Ur; Rai, Rajesh K; Rana, Saleem M; Rao, Sowmya R; Refaat, Amany H; Resnikoff, Serge; Roshandel, Gholamreza; Saade, Georges; Saeedi, Mohammad Y; Sahraian, Mohammad Ali; Saleh, Shadi; Sanchez-Riera, Lidia; Satpathy, Maheswar; Sepanlou, Sadaf G; Setegn, Tesfaye; Shaheen, Amira; Shahraz, Saeid; Sheikhbahaei, Sara; Shishani, Kawkab; Sliwa, Karen; Tavakkoli, Mohammad; Terkawi, Abdullah S; Uthman, Olalekan A; Westerman, Ronny; Younis, Mustafa Z; El Sayed Zaki, Maysaa; Zannad, Faiez; Roth, Gregory A; Wang, Haidong; Naghavi, Mohsen; Vos, Theo; Al Rabeeah, Abdullah A; Lopez, Alan D; Murray, Christopher J L
BACKGROUND: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. METHODS: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically. FINDINGS: The leading cause of death in the region in 2013 was ischaemic heart disease (90.3 deaths per 100 000 people), which increased by 17.2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186.7 deaths per 100 000 people) in 2013, which decreased by 26.9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83.3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3.7% to 7.5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. INTERPRETATION: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts. FUNDING: Bill & Melinda Gates Foundation.
PMID: 27568068
ISSN: 2214-109x
CID: 2281432
