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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
Focus on Global Oral Health: What It Means To Be Globally Competent and Locally Relevant
Benzian, Habib
ORIGINAL:0011757
ISSN: 2472-0062
CID: 2477622
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; 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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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Ng, Marie; Ngalesoni, Frida N; Nguyen, Grant; Nisar, Muhammad I; Nolte, Sandra; Norheim, Ole F; Norman, Rosana E; Norrving, Bo; Nyakarahuka, Luke; Oh, In-Hwan; Ohkubo, Takayoshi; Ohno, Summer L; Olusanya, Bolajoko O; Opio, John Nelson; Ortblad, Katrina; Ortiz, Alberto; Pain, Amanda W; Pandian, Jeyaraj D; Panelo, Carlo Irwin A; Papachristou, Christina; Park, Eun-Kee; Park, Jae-Hyun; Patten, Scott B; Patton, George C; Paul, Vinod K; Pavlin, Boris I; Pearce, Neil; Pereira, David M; Perez-Padilla, Rogelio; Perez-Ruiz, Fernando; Perico, Norberto; Pervaiz, Aslam; Pesudovs, Konrad; Peterson, Carrie B; Petzold, Max; Phillips, Michael R; Phillips, Bryan K; Phillips, David E; Piel, Frederic B; Plass, Dietrich; Poenaru, Dan; Polinder, Suzanne; Pope, Daniel; Popova, Svetlana; Poulton, Richie G; Pourmalek, Farshad; Prabhakaran, Dorairaj; Prasad, Noela M; Pullan, Rachel L; Qato, Dima M; Quistberg, D Alex; Rafay, Anwar; Rahimi, Kazem; Rahman, Sajjad U; Raju, Murugesan; Rana, Saleem M; Razavi, Homie; Reddy, K Srinath; Refaat, Amany; Remuzzi, Giuseppe; Resnikoff, Serge; Ribeiro, Antonio L; Richardson, Lee; Richardus, Jan Hendrik; Roberts, D Allen; Rojas-Rueda, David; Ronfani, Luca; Roth, Gregory A; Rothenbacher, Dietrich; Rothstein, David H; Rowley, Jane T; Roy, Nobhojit; Ruhago, George M; Saeedi, Mohammad Y; Saha, Sukanta; Sahraian, Mohammad Ali; Sampson, Uchechukwu K A; Sanabria, Juan R; Sandar, Logan; Santos, Itamar S; Satpathy, Maheswar; Sawhney, Monika; Scarborough, Peter; Schneider, Ione J; Schottker, Ben; Schumacher, Austin E; Schwebel, David C; Scott, James G; Seedat, Soraya; Sepanlou, Sadaf G; Serina, Peter T; Servan-Mori, Edson E; Shackelford, Katya A; Shaheen, Amira; Shahraz, Saeid; Shamah Levy, Teresa; Shangguan, Siyi; She, Jun; Sheikhbahaei, Sara; Shi, Peilin; Shibuya, Kenji; Shinohara, Yukito; Shiri, Rahman; Shishani, Kawkab; Shiue, Ivy; Shrime, Mark G; Sigfusdottir, Inga D; Silberberg, Donald H; Simard, Edgar P; Sindi, Shireen; Singh, Abhishek; Singh, Jasvinder A; Singh, Lavanya; 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; Van Brakel, Wim H; Van De Vijver, Steven; van Gool, Coen H; Van Os, Jim; Vasankari, Tommi J; Venketasubramanian, N; Violante, Francesco S; Vlassov, Vasiliy V; Vollset, Stein Emil; Wagner, Gregory R; Wagner, Joseph; Waller, Stephen G; Wan, Xia; Wang, Haidong; Wang, Jianli; Wang, Linhong; Warouw, Tati S; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Wenzhi, Wang; Werdecker, Andrea; Westerman, Ronny; Whiteford, Harvey A; Wilkinson, James D; Williams, Thomas N; Wolfe, Charles D; Wolock, Timothy M; Woolf, Anthony D; Wulf, Sarah; Wurtz, Brittany; Xu, Gelin; Yan, Lijing L; Yano, Yuichiro; Ye, Pengpeng; Yentur, Gokalp K; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Yu, Chuanhua; Zaki, Maysaa E; Zhao, Yong; Zheng, Yingfeng; Zonies, David; Zou, Xiaonong; Salomon, Joshua A; Lopez, Alan D; Vos, Theo
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
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Vos, Theo; Barber, Ryan M; Bell, Brad; Bertozzi-Villa, Amelia; Biryukov, Stan; Bolliger, Ian; Charlson, Fiona; Davis, Adrian; Degenhardt, Louisa; Dicker, Daniel; Duan, Leilei; Erskine, Holly; Feigin, Valery L; Ferrari, Alize J; Fitzmaurice, Christina; Fleming, Thomas; Graetz, Nicholas; Guinovart, Caterina; Haagsma, Juanita; Hansen, Gillian M; Hanson, Sarah Wulf; Heuton, Kyle R; Higashi, Hideki; Kassebaum, Nicholas; Kyu, Hmwe; Laurie, Evan; Liang, Xiofeng; Lofgren, Katherine; Lozano, Rafael; MacIntyre, Michael F; Moradi-Lakeh, Maziar; Naghavi, Mohsen; Nguyen, Grant; Odell, Shaun; Ortblad, Katrina; Roberts, David Allen; Roth, Gregory A; Sandar, Logan; Serina, Peter T; Stanaway, Jeffrey D; Steiner, Caitlyn; Thomas, Bernadette; Vollset, Stein Emil; Whiteford, Harvey; Wolock, Timothy M; Ye, Pengpeng; Zhou, Maigeng; Avila, Marco A; Aasvang, Gunn Marit; Abbafati, Cristiana; Ozgoren, Ayse Abbasoglu; Abd-Allah, Foad; Aziz, Muna IAbdel; Abera, Semaw F; Aboyans, Victor; Abraham, Jerry P; Abraham, Biju; Abubakar, Ibrahim; Abu-Raddad, Laith J; Abu-Rmeileh, Niveen ME; Aburto, Tania C; Achoki, Tom; Ackerman, Ilana N; Adelekan, Ademola; Ademi, Zanfina; Adou, Arsene K; Adsuar, Josef C; Arnlov, Johan; Agardh, Emilie E; Al Khabouri, Mazin J; Alam, Sayed Saidul; Alasfoor, Deena; Albittar, Mohammed I; Alegretti, Miguel A; Aleman, Alicia V; Alemu, Zewdie A; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Alla, Francois; Allebeck, Peter; Allen, Peter J; AlMazroa, Mohammad AbdulAziz; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzman, Nelson; Ameli, Omid; Amini, Heresh; Ammar, Walid; Anderson, Benjamin O; Anderson, HRoss; Antonio, Carl Abelardo T; Anwari, Palwasha; Apfel, Henry; Arsenijevic, Valentain SArsic; Artaman, Al; Asghar, Rana J; Assadi, Reza; Atkins, Lydia S; Atkinson, Charles; Badawi, Alaa; Bahit, Maria C; Bakfalouni, Talal; Balakrishnan, Kalpana; Balalla, Shivanthi; Banerjee, Amitava; Barker-Collo, Suzanne L; Barquera, Simon; Barregard, Lars; Barrero, Lope H; Basu, Sanjay; Basu, Arindam; Baxter, Amanda; Beardsley, Justin; Bedi, Neeraj; Beghi, Ettore; Bekele, Tolesa; Bell, Michelle L; Benjet, Corina; Bennett, Derrick A; Bensenor, Isabela M; Benzian, Habib; Bernabe, Eduardo; Beyene, Tariku J; Bhala, Neeraj; Bhalla, Ashish; Bhutta, Zulfi Qar; Bienhoff, Kelly; Bikbov, Boris; Bin Abdulhak, Aref; Blore, Jed D; Blyth, Fiona M; Bohensky, Megan A; Basara, Berrak Bora; Borges, Guilherme; Bornstein, Natan M; Bose, Dipan; Boufous, Soufiane; Bourne, Rupert R; Boyers, Lindsay N; Brainin, Michael; Brauer, Michael; Brayne, Carol EG; Brazinova, Alexandra; Breitborde, Nicholas JK; Brenner, Hermann; Briggs, Adam DM; Brooks, Peter M; Brown, Jonathan; Brugha, Traolach S; Buchbinder, Rachelle; Buckle, Geoffrey C; Bukhman, Gene; Bulloch, Andrew G; Burch, Michael; Burnett, Richard; Cardenas, Rosario; Cabral, Norberto L; Nonato, Ismael RCampos; Campuzano, Julio C; Carapetis, Jonathan R; Carpenter, David O; Caso, Valeria; Castaneda-Orjuela, Carlos A; Catala-Lopez, Ferran; Chadha, Vineet K; Chang, Jung-Chen; Chen, Honglei; Chen, Wanqing; Chiang, Peggy P; Chimed-Ochir, Odgerel; Chowdhury, Rajiv; Christensen, Hanne; Christophi, Costas A; Chugh, Sumeet S; Cirillo, Massimo; Coggeshall, Megan; Cohen, Aaron; Colistro, Valentina; Colquhoun, Samantha M; Contreras, Alejandra G; Cooper, Leslie T; Cooper, Cyrus; Cooperrider, Kimberly; Coresh, Josef; Cortinovis, Monica; Criqui, Michael H; Crump, John A; Cuevas-Nasu, Lucia; Dandona, Rakhi; Dandona, Lalit; Dansereau, Emily; Dantes, Hector G; Dargan, Paul I; Davey, Gail; Davitoiu, Dragos V; Dayama, Anand; De la Cruz-Gongora, Vanessa; de la Vega, Shelley F; De Leo, Diego; del Pozo-Cruz, Borja; Dellavalle, Robert P; Deribe, Kebede; Derrett, Sarah; Des Jarlais, Don C; Dessalegn, Muluken; de Veber, Gabrielle A; Dharmaratne, Samath D; Diaz-Torne, Cesar; Ding, Eric L; Dokova, Klara; Dorsey, ER; Driscoll, Tim R; Duber, Herbert; Durrani, Adnan M; Edmond, Karen M; Ellenbogen, Richard G; Endres, Matthias; Ermakov, Sergey P; Eshrati, Babak; Esteghamati, Alireza; Estep, Kara; Fahimi, Saman; Farzadfar, Farshad; Fay, Derek FJ; Felson, David T; Fereshtehnejad, Seyed-Mohammad; Fernandes, Jefferson G; Ferri, Cluesa P; Flaxman, Abraham; Foigt, Nataliya; Foreman, Kyle J; Fowkes, FGerry R; Franklin, Richard C; Furst, Thomas; Futran, Neal D; Gabbe, Belinda J; Gankpe, Fortune G; Garcia-Guerra, Francisco A; Geleijnse, Johanna M; Gessner, Bradford D; Gibney, Katherine B; Gillum, Richard F; Ginawi, Ibrahim A; Giroud, Maurice; Giussani, Giorgia; Goenka, Shifalika; Goginashvili, Ketevan; Gona, Philimon; de Cosio, Teresita Gonzalez; Gosselin, Richard A; Gotay, Carolyn C; Goto, Atsushi; Gouda, Hebe N; Guerrant, Richard L; Gugnani, Harish C; Gunnell, David; Gupta, Rajeev; Gupta, Rahul; Gutierrez, Reyna A; Hafezi-Nejad, Nima; Hagan, Holly; Halasa, Yara; Hamadeh, Randah R; Hamavid, Hannah; Hammami, Mouhanad; Hankey, Graeme J; Hao, Yuantao; Harb, Hilda L; Haro, Josep Maria; Havmoeller, Rasmus; Hay, Roderick J; Hay, Simon; Hedayati, Mohammad T; Pi, Ileana BHeredia; Heydarpour, Pouria; Hijar, Martha; Hoek, Hans W; Hoffman, Howard J; Hornberger, John C; Hosgood, HDean; Hossain, Mazeda; Hotez, Peter J; Hoy, Damian G; Hsairi, Mohamed; Hu, Howard; Hu, Guoqing; Huang, John J; Huang, Cheng; Huiart, Laetitia; Husseini, Abdullatif; Iannarone, Marissa; Iburg, Kim M; Innos, Kaire; Inoue, Manami; Jacobsen, Kathryn H; Jassal, Simerjot K; Jeemon, Panniyammakal; Jensen, Paul N; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jonas, Jost B; Joseph, Jonathan; Juel, Knud; Kan, Haidong; Karch, Andre; Karimkhani, Chante; Karthikeyan, Ganesan; Katz, Ronit; Kaul, Anil; Kawakami, Norito; Kazi, Dhruv S; Kemp, Andrew H; Kengne, Andre P; Khader, Yousef S; Khalifa, Shams Eldin AH; Khan, Ejaz A; Khan, Gulfaraz; Khang, Young-Ho; Khonelidze, Irma; Kieling, Christian; Kim, Daniel; Kim, Sungroul; Kimokoti, Ruth W; Kinfu, Yohannes; Kinge, Jonas M; Kissela, Brett M; Kivipelto, Miia; Knibbs, Luke; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kosen, Soewarta; Kramer, Alexander; Kravchenko, Michael; Krishnamurthi, Rita V; Krishnaswami, Sanjay; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kuipers, Ernst J; Kulkarni, Veena S; Kumar, Kaushalendra; Kumar, GAnil; Kwan, Gene F; Lai, Taavi; Lalloo, Ratilal; Lam, Hilton; Lan, Qing; Lansingh, Van C; Larson, Heidi; Larsson, Anders; Lawrynowicz, Alicia EB; Leasher, Janet L; Lee, Jong-Tae; Leigh, James; Leung, Ricky; Levi, Miriam; Li, Bin; Li, Yichong; Li, Yongmei; Liang, Juan; Lim, Stephen; Lin, Hsien-Ho; Lind, Margaret; Lindsay, MPatrice; Lipshultz, Steven E; Liu, Shiwei; Lloyd, Belinda K; Ohno, Summer Lockett; Logroscino, Giancarlo; Looker, Katharine J; Lopez, Alan D; Lopez-Olmedo, Nancy; Lortet-Tieulent, Joannie; Lotufo, Paulo A; Low, Nicola; Lucas, Robyn M; Lunevicius, Raimundas; Lyons, Ronan A; Ma, Jixiang; Ma, Stefan; Mackay, Mark T; Majdan, Marek; Malekzadeh, Reza; Mapoma, Christopher C; Marcenes, Wagner; March, Lyn M; Margono, Chris; Marks, Guy B; Marzan, Melvin B; Masci, Joseph R; Mason-Jones, Amanda J; Matzopoulos, Richard G; Mayosi, Bongani M; Mazorodze, Tasara T; McGill, Neil W; McGrath, John J; McKee, Martin; McLain, Abby; McMahon, Brian J; Meaney, Peter A; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Mekonnen, Wubegzier; Melaku, Yohannes A; Meltzer, Michele; Memish, Ziad A; Mensah, George; Meretoja, Atte; Mhimbira, Francis A; Micha, Renata; Miller, Ted R; Mills, Edward J; Mitchell, Philip B; Mock, Charles N; Moffitt, Terrie E; Ibrahim, Norlinah Mohamed; Mohammad, Karzan A; Mokdad, Ali H; Mola, Glen L; Monasta, Lorenzo; Montico, Marcella; Montine, Thomas J; Moore, Ami R; Moran, Andrew E; Morawska, Lidia; Mori, Rintaro; Moschandreas, Joanna; Moturi, Wilkister N; Moyer, Madeline; Mozaffarian, Dariush; Mueller, Ulrich O; Mukaigawara, Mitsuru; Murdoch, Michele E; Murray, Joseph; Murthy, Kinnari S; Naghavi, Paria; Nahas, Ziad; Naheed, Aliya; Naidoo, Kovin S; Naldi, Luigi; Nand, Devina; Nangia, Vinay; Narayan, KMVenkat; Nash, Denis; Nejjari, Chakib; Neupane, Sudan P; Newman, Lori M; Newton, Charles R; Ng, Marie; Ngalesoni, Frida N; Nhung, Nguyen T; Nisar, Muhammad I; Nolte, Sandra; Norheim, Ole F; Norman, Rosana E; Norrving, Bo; Nyakarahuka, Luke; Oh, In Hwan; Ohkubo, Takayoshi; Omer, Saad B; Opio, John Nelson; Ortiz, Alberto; Pandian, Jeyaraj D; Panelo, Carlo Irwin A; Papachristou, Christina; Park, Eun-Kee; Parry, Charles D; Caicedo, Angel JPaternina; Patten, Scott B; Paul, Vinod K; Pavlin, Boris I; Pearce, Neil; Pedraza, Lilia S; Pellegrini, Carlos A; Pereira, David M; Perez-Ruiz, Fernando P; Perico, Norberto; Pervaiz, Aslam; Pesudovs, Konrad; Peterson, Carrie B; Petzold, Max; Phillips, Michael R; Phillips, David; Phillips, Bryan; Piel, Frederic B; Plass, Dietrich; Poenaru, Dan; Polanczyk, Guilherme V; Polinder, Suzanne; Pope, CA., III; Popova, Svetlana; Poulton, Richie G; Pourmalek, Farshad; Prabhakaran, Dorairaj; Prasad, Noela M; Qato, Dima; Quistberg, DA; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Sajjad Ur; Raju, Murugesan; Rakovac, Ivo; Rana, Saleem M; Razavi, Homie; Refaat, Amany; Rehm, Jurgen; Remuzzi, Giuseppe; Resnikoff, Serge; Ribeiro, Antonio L; Riccio, Patricia M; Richardson, Lee; Richardus, Jan Hendrik; Riederer, Anne M; Robinson, Margot; Roca, Anna; Rodriguez, Alina; Rojas-Rueda, David; Ronfani, Luca; Rothenbacher, Dietrich; Roy, Nobhojit; Ruhago, George M; Sabin, Nsanzimana; Sacco, Ralph L; Ksoreide, Kjetil; Saha, Sukanta; Sahathevan, Ramesh; Sahraian, Mohammad Ali; Sampson, Uchechukwu; Sanabria, Juan R; Sanchez-Riera, Lidia; Santos, Itamar S; Satpathy, Maheswar; Saunders, James E; Sawhney, Monika; Saylan, Mete I; Scarborough, Peter; Schoettker, Ben; Schneider, Ione JC; Schwebel, David C; Scott, James G; Seedat, Soraya; Sepanlou, Sadaf G; Serdar, Berrin; Servan-Mori, Edson E; Shackelford, Katya; Shaheen, Amira; Shahraz, Saeid; Levy, Teresa Shamah; Shangguan, Siyi; She, Jun; Sheikhbahaei, Sara; Shepard, Donald S; Shi, Peilin; Shibuya, Kenji; Shinohara, Yukito; Shiri, Rahman; Shishani, Kawkab; Shiue, Ivy; Shrime, Mark G; Sigfusdottir, Inga D; Silberberg, Donald H; Simard, Edgar P; Sindi, Shireen; Singh, Jasvinder A; Singh, Lavanya; Skirbekk, Vegard; Sliwa, Karen; Soljak, Michael; Soneji, Samir; Soshnikov, Sergey S; Speyer, Peter; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stoeckl, Heidi; Stathopoulou, Vasiliki Kalliopi; Steckling, Nadine; Stein, Murray B; Stein, Dan J; Steiner, Timothy J; Stewart, Andrea; Stork, Eden; Stovner, Lars J; Stroumpoulis, Konstantinos; Sturua, Lela; Sunguya, Bruno F; Swaroop, Mamta; Sykes, Bryan L; Tabb, Karen M; Takahashi, Ken; Tan, Feng; Tandon, Nikhil; Tanne, David; Tanner, Marcel; Tavakkoli, Mohammad; Taylor, Hugh R; Ao, Braden JTe; Temesgen, Awoke Misganaw; Ten Have, Margreet; Tenkorang, Eric Yeboah; Terkawi, Abdullah Sulieman; Theadom, Alice M; Thomas, Elissa; Thorne-Lyman, Andrew L; Thrift, Amanda G; Tleyjeh, Imad M; Tonelli, Marcello; Topouzis, Fotis; Towbin, Jeffrey A; Toyoshima, Hideaki; Traebert, Jefferson; Tran, Bach X; Trasande, Leonardo; Trillini, Matias; Truelsen, Thomas; Trujillo, Ulises; Tsilimbaris, Miltiadis; Tuzcu, Emin M; Ukwaja, Kingsley N; Undurraga, Eduardo A; Uzun, Selen B; van Brakel, Wim H; de Vijver, Steven van; Van Dingenen, Rita; van Gool, Coen H; Varakin, Yuri Y; Vasankari, Tommi J; Vavilala, Monica S; Veerman, Lennert J; Velasquez-Melendez, Gustavo; Venketasubramanian, Narayanaswamy; Vijayakumar, Lakshmi; Villalpando, Salvador; Violante, Francesco S; Vlassov, Vasiliy V; Waller, Stephen; Wallin, Mitchell T; Wan, Xia; Wang, Linhong; Wang, JianLi; Wang, Yanping; Warouw, Tati S; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Werdecker, Andrea; Wessells, KRyan R; Westerman, Ronny; Wilkinson, James D; Williams, Hywel C; Williams, Thomas N; Woldeyohannes, Solomon M; Wolfe, Charles DA; Wong, John Q; Wong, Haidong; Woolf, Anthony D; Wright, Jonathan L; Wurtz, Brittany; Xu, Gelin; Yang, Gonghuan; Yano, Yuichiro; Yenesew, Muluken A; Yentur, Gokalp K; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa; Yu, Chuanhua; Kim, Kim Yun; Zaki, Maysaa El Sayed; Zhang, Yong; Zhao, Zheng; Zhao, Yong; Zhu, Jun; Zonies, David; Zunt, Joseph R; Salomon, Joshua A; Murray, Christopher JL; Global Burden Dis Study
BACKGROUND:Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. METHODS:Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. FINDINGS/RESULTS:Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. INTERPRETATION/CONCLUSIONS:Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries. FUNDING/BACKGROUND:Bill & Melinda Gates Foundation.
PMCID:4561509
PMID: 26063472
ISSN: 1474-547x
CID: 3048832
Political priority of oral health in Italy: an analysis of reasons for national neglect
Benedetti, Guido; Stauf, Nicole; Strohmenger, Laura; Campus, Guglielmo; Benzian, Habib
PURPOSE: Oral health remains a neglected area and its political priority on most national agendas is low. This analysis aimed to identify the political priority of oral health in Italy. BACKGROUND: Italian public health services are decentralised at the regional level and are financed by both central and local authorities. Despite certain legally guaranteed public oral health services, access to oral health care seems to be inhomogeneous. METHODS: Appraisal of the political priority of oral health in Italy uses the Political Power Framework as proposed by Shiffman and Smith. RESULTS AND DISCUSSION: There is no clear mandate for leadership or coordination within the oral health sector, resulting in fragmentation and in dominance of the private sector. As a consequence, oral diseases are mainly addressed through a curative rather than a preventive public health approach. Current, systematic and representative data are lacking. Therefore, the real burden of oral diseases is unknown and thus cannot be addressed adequately. Evidence-based, cost-effective and sustainable population-wide public dental health interventions are not implemented on a large scale, and growing inequities in terms of access to care are not seen as a concern. CONCLUSION: Lack of relevant policies with a public health focus, absence of systematic oral health surveillance and limited access to care for large population groups are strong indicators that oral health is not a political priority. However, opportunities in the wider political environment could be used to facilitate analysis, discussion and change in order to improve political priority of oral health in Italy.
PMID: 25393606
ISSN: 0020-6539
CID: 1562092
A competency matrix for global oral health
Benzian, Habib; Greenspan, John S; Barrow, Jane; Hutter, Jeffrey W; Loomer, Peter M; Stauf, Nicole; Perry, Dorothy A
The Lancet Commission on Education of Health Professionals for the 21(st) Century calls for enhancing health education for the needs and challenges of the 21st century to improve health status globally. To complement the Lancet report, this article makes recommendations for including core global health competencies in the education of health care professionals and specific groups of the public who are relevant to oral health in a global context in order to tackle the burden of oral diseases. Experts from various professional backgrounds developed global oral health competencies for four target groups: Group 1 was defined as dental students, residents/trainee specialists (or equivalent), and dentists; Group 2 was community health workers, dental hygienists, and dental therapists (or the equivalent); Group 3 was health professionals such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists; and Group 4 was non-health professionals in the public arena such as parents, teachers, decision makers, key opinion leaders, and health and consumer advocates. Key competencies for members of each of the four target groups are presented in a matrix. The suggested competency matrix shows that many other health professions and groups in society have potentially crucial roles in the prevention, control, and management of oral diseases globally. Workforce models including a wider range of professionals working together as a team will be needed to tackle the burden of oral diseases in an integrated way in the broader context of non-communicable diseases. Further discussion and research should be conducted to validate or improve the competencies proposed here with regard to their relevance, appropriateness, and completeness.
PMID: 25838005
ISSN: 1930-7837
CID: 1519712
Adequate Evidence to Challenge the Paradigm of Dental Caries Prevention in Early Age?
van Palenstein Helderman, Wim H; Groeneveld, Arie; van der Heijden, Geert J; van Loveren, Cor; Holmgren, Christopher J; Benzian, Habib
Disease prevention at early ages is a fundamental public health principle and particularly relevant for dental caries, the most common noncommunicable disease (NCD) of humankind. Current oral health promotion is based on the assumption that lower caries levels in childhood continue into later life, and thus preventive use of fluorides must start at an early age. Bernabe and Sheiham1 came to different conclusions in a recent article "Age, Period, and Cohort Trends in Caries of Permanent Teeth in Four Developed Countries." (Am J Public Health. Published online ahead of print February 25, 2015: e1-e2. doi:10.2105/AJPH.2015.302601).
PMCID:4358169
PMID: 25713944
ISSN: 0090-0036
CID: 1472852
A Silent Public Health Crisis: Untreated Caries and Dental Infections Among 6- and 12-Year-Old Children in the Philippine National Oral Health Survey 2006
Monse, Bella; Benzian, Habib; Araojo, Juan; Holmgren, Christopher; van Palenstein Helderman, Wim; Naliponguit, Ella-Cecilia; Heinrich-Weltzien, Roswitha
The oral health status of 6- and 12-year-old Filipino children was assessed in a representative national sample of 2030 6-year-old and 2022 12-year-old children, using WHO Basic METHODS: for Oral Health Surveys (4th edition, 1997) and the PUFA (pulpal involvement [P/p], ulceration caused by dislocated tooth fragments [U/u], fistula [F/f], and abscess [A/a]) index. A subsample of 242 12-year-old children was included to assess backward comparability between the 1998 Oral Health Survey that used WHO Basic Methods (3rd edition, 1987). The results showed that 97% of 6-year-old children had caries (mean dmft 8.4), 85% showed dental infection (mean pufa 3.4), 20% reported pain when examined. In all, 82% of 12-year-old children had caries (mean DMFT 2.9), 56% prevalence of pulp involvement (mean PUFA 1.0), and 16% reported pain when examined. Differences in methodology between the 1998 and the 2006 surveys are likely to have had an effect on the observed reduction in DMFT, indicating that the real caries prevalence had not changed much and remains very high.
PMID: 23239751
ISSN: 1010-5395
CID: 1318352
Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
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BACKGROUND: Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. METHODS: We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. FINDINGS: Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. INTERPRETATION: For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade. FUNDING: Bill & Melinda Gates Foundation.
PMCID:4340604
PMID: 25530442
ISSN: 1474-547x
CID: 1514472
