Searched for: Department/Unit:Population Health
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
Murray, Christopher J L; Barber, Ryan M; Foreman, Kyle J; Abbasoglu Ozgoren, Ayse; Abd-Allah, Foad; Abera, Semaw F; Aboyans, Victor; Abraham, Jerry P; Abubakar, Ibrahim; Abu-Raddad, Laith J; Abu-Rmeileh, Niveen M; Achoki, Tom; Ackerman, Ilana N; Ademi, Zanfina; Adou, Arsene K; Adsuar, Jose C; Afshin, Ashkan; Agardh, Emilie E; Alam, Sayed Saidul; Alasfoor, Deena; Albittar, Mohammed I; Alegretti, Miguel A; Alemu, Zewdie A; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Alla, Francois; Allebeck, Peter; Almazroa, Mohammad A; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzman, Nelson; Amare, Azmeraw T; Ameh, Emmanuel A; Amini, Heresh; Ammar, Walid; Anderson, H Ross; Anderson, Benjamin O; Antonio, Carl Abelardo T; Anwari, Palwasha; Arnlov, Johan; Arsic Arsenijevic, Valentina S; Artaman, Al; Asghar, Rana J; Assadi, Reza; Atkins, Lydia S; Avila, Marco A; Awuah, Baffour; Bachman, Victoria F; Badawi, Alaa; Bahit, Maria C; Balakrishnan, Kalpana; Banerjee, Amitava; Barker-Collo, Suzanne L; Barquera, Simon; Barregard, Lars; Barrero, Lope H; Basu, Arindam; Basu, Sanjay; Basulaiman, Mohammed O; Beardsley, Justin; Bedi, Neeraj; Beghi, Ettore; Bekele, Tolesa; Bell, Michelle L; Benjet, Corina; Bennett, Derrick A; Bensenor, Isabela M; Benzian, Habib; Bernabe, Eduardo; Bertozzi-Villa, Amelia; Beyene, Tariku J; Bhala, Neeraj; Bhalla, Ashish; Bhutta, Zulfiqar A; Bienhoff, Kelly; Bikbov, Boris; Biryukov, Stan; Blore, Jed D; Blosser, Christopher D; Blyth, Fiona M; Bohensky, Megan A; Bolliger, Ian W; Bora Basara, Berrak; Bornstein, Natan M; Bose, Dipan; Boufous, Soufiane; Bourne, Rupert R A; Boyers, Lindsay N; Brainin, Michael; Brayne, Carol E; Brazinova, Alexandra; Breitborde, Nicholas J K; Brenner, Hermann; Briggs, Adam D; Brooks, Peter M; Brown, Jonathan C; Brugha, Traolach S; Buchbinder, Rachelle; Buckle, Geoffrey C; Budke, Christine M; Bulchis, Anne; Bulloch, Andrew G; Campos-Nonato, Ismael R; Carabin, Helene; Carapetis, Jonathan R; Cardenas, Rosario; 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; Chiang, Peggy P; Chimed-Ochir, Odgerel; Chowdhury, Rajiv; Christensen, Hanne; Christophi, Costas A; Cirillo, Massimo; Coates, Matthew M; Coffeng, Luc E; Coggeshall, Megan S; Colistro, Valentina; Colquhoun, Samantha M; Cooke, Graham S; Cooper, Cyrus; Cooper, Leslie T; Coppola, Luis M; Cortinovis, Monica; Criqui, Michael H; Crump, John A; Cuevas-Nasu, Lucia; Danawi, Hadi; Dandona, Lalit; Dandona, Rakhi; Dansereau, Emily; Dargan, Paul I; Davey, Gail; Davis, Adrian; Davitoiu, Dragos V; Dayama, Anand; De Leo, Diego; Degenhardt, Louisa; Del Pozo-Cruz, Borja; Dellavalle, Robert P; Deribe, Kebede; Derrett, Sarah; Des Jarlais, Don C; Dessalegn, Muluken; Dharmaratne, Samath D; Dherani, Mukesh K; Diaz-Torne, Cesar; Dicker, Daniel; Ding, Eric L; Dokova, Klara; Dorsey, E Ray; Driscoll, Tim R; Duan, Leilei; Duber, Herbert C; Ebel, Beth E; Edmond, Karen M; Elshrek, Yousef M; Endres, Matthias; Ermakov, Sergey P; Erskine, Holly E; Eshrati, Babak; Esteghamati, Alireza; Estep, Kara; Faraon, Emerito Jose A; Farzadfar, Farshad; Fay, Derek F; Feigin, Valery L; Felson, David T; Fereshtehnejad, Seyed-Mohammad; Fernandes, Jefferson G; Ferrari, Alize J; Fitzmaurice, Christina; Flaxman, Abraham D; Fleming, Thomas D; Foigt, Nataliya; Forouzanfar, Mohammad H; Fowkes, F Gerry R; Paleo, Urbano Fra; Franklin, Richard C; Furst, Thomas; Gabbe, Belinda; Gaffikin, Lynne; Gankpe, Fortune G; Geleijnse, Johanna M; Gessner, Bradford D; Gething, Peter; Gibney, Katherine B; Giroud, Maurice; Giussani, Giorgia; Gomez Dantes, Hector; Gona, Philimon; Gonzalez-Medina, Diego; Gosselin, Richard A; Gotay, Carolyn C; Goto, Atsushi; Gouda, Hebe N; Graetz, Nicholas; Gugnani, Harish C; Gupta, Rahul; Gupta, Rajeev; Gutierrez, Reyna A; Haagsma, Juanita; Hafezi-Nejad, Nima; Hagan, Holly; Halasa, Yara A; Hamadeh, Randah R; Hamavid, Hannah; Hammami, Mouhanad; Hancock, Jamie; Hankey, Graeme J; Hansen, Gillian M; Hao, Yuantao; Harb, Hilda L; Haro, Josep Maria; Havmoeller, Rasmus; Hay, Simon I; Hay, Roderick J; Heredia-Pi, Ileana B; Heuton, Kyle R; Heydarpour, Pouria; Higashi, Hideki; Hijar, Martha; Hoek, Hans W; Hoffman, Howard J; Hosgood, H Dean; Hossain, Mazeda; Hotez, Peter J; Hoy, Damian G; Hsairi, Mohamed; Hu, Guoqing; Huang, Cheng; Huang, John J; Husseini, Abdullatif; Huynh, Chantal; Iannarone, Marissa L; Iburg, Kim M; Innos, Kaire; Inoue, Manami; Islami, Farhad; Jacobsen, Kathryn H; Jarvis, Deborah L; Jassal, Simerjot K; Jee, Sun Ha; Jeemon, Panniyammakal; Jensen, Paul N; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jonas, Jost B; Juel, Knud; Kan, Haidong; Karch, Andre; Karema, Corine K; Karimkhani, Chante; Karthikeyan, Ganesan; Kassebaum, Nicholas J; Kaul, Anil; Kawakami, Norito; Kazanjan, Konstantin; Kemp, Andrew H; Kengne, Andre P; Keren, Andre; Khader, Yousef S; Khalifa, Shams Eldin A; Khan, Ejaz A; Khan, Gulfaraz; Khang, Young-Ho; Kieling, Christian; Kim, Daniel; Kim, Sungroul; Kim, Yunjin; Kinfu, Yohannes; Kinge, Jonas M; Kivipelto, Miia; Knibbs, Luke D; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kosen, Soewarta; Krishnaswami, Sanjay; Kuate Defo, Barthelemy; Kucuk Bicer, Burcu; Kuipers, Ernst J; Kulkarni, Chanda; Kulkarni, Veena S; Kumar, G Anil; Kyu, Hmwe H; Lai, Taavi; Lalloo, Ratilal; Lallukka, Tea; Lam, Hilton; Lan, Qing; Lansingh, Van C; Larsson, Anders; Lawrynowicz, Alicia E B; Leasher, Janet L; Leigh, James; Leung, Ricky; Levitz, Carly E; Li, Bin; Li, Yichong; Li, Yongmei; Lim, Stephen S; Lind, Maggie; Lipshultz, Steven E; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K; Lofgren, Katherine T; Logroscino, Giancarlo; Looker, Katharine J; Lortet-Tieulent, Joannie; Lotufo, Paulo A; Lozano, Rafael; Lucas, Robyn M; Lunevicius, Raimundas; Lyons, Ronan A; Ma, Stefan; Macintyre, Michael F; Mackay, Mark T; Majdan, Marek; Malekzadeh, Reza; Marcenes, Wagner; Margolis, David J; Margono, Christopher; Marzan, Melvin B; Masci, Joseph R; Mashal, Mohammad T; Matzopoulos, Richard; Mayosi, Bongani M; Mazorodze, Tasara T; Mcgill, Neil W; Mcgrath, John J; Mckee, Martin; Mclain, Abigail; Meaney, Peter A; Medina, Catalina; Mehndiratta, Man Mohan; Mekonnen, Wubegzier; Melaku, Yohannes A; Meltzer, Michele; Memish, Ziad A; Mensah, George A; Meretoja, Atte; Mhimbira, Francis A; Micha, Renata; Miller, Ted R; Mills, Edward J; Mitchell, Philip B; Mock, Charles N; Mohamed Ibrahim, Norlinah; Mohammad, Karzan A; Mokdad, Ali H; Mola, Glen L D; Monasta, Lorenzo; Montanez Hernandez, Julio C; Montico, Marcella; Montine, Thomas J; Mooney, Meghan D; Moore, Ami R; Moradi-Lakeh, Maziar; Moran, Andrew E; Mori, Rintaro; Moschandreas, Joanna; Moturi, Wilkister N; Moyer, Madeline L; Mozaffarian, Dariush; Msemburi, William T; Mueller, Ulrich O; Mukaigawara, Mitsuru; Mullany, Erin C; Murdoch, Michele E; Murray, Joseph; Murthy, Kinnari S; Naghavi, Mohsen; Naheed, Aliya; Naidoo, Kovin S; Naldi, Luigi; Nand, Devina; Nangia, Vinay; Narayan, K M Venkat; Nejjari, Chakib; Neupane, Sudan P; Newton, Charles R; 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 comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Forouzanfar, Mohammad H; Alexander, Lily; Anderson, H Ross; Bachman, Victoria F; Biryukov, Stan; Brauer, Michael; Burnett, Richard; Casey, Daniel; Coates, Matthew M; Cohen, Aaron; Delwiche, Kristen; Estep, Kara; Frostad, Joseph J; Astha, K C; Kyu, Hmwe H; Moradi-Lakeh, Maziar; Ng, Marie; Slepak, Erica Leigh; Thomas, Bernadette A; Wagner, Joseph; Aasvang, Gunn Marit; Abbafati, Cristiana; Abbasoglu Ozgoren, Ayse; Abd-Allah, Foad; Abera, Semaw F; Aboyans, Victor; Abraham, Biju; Abraham, Jerry Puthenpurakal; Abubakar, Ibrahim; Abu-Rmeileh, Niveen M E; Aburto, Tania C; Achoki, Tom; Adelekan, Ademola; Adofo, Koranteng; Adou, Arsene K; Adsuar, Jose C; Afshin, Ashkan; Agardh, Emilie E; Al Khabouri, Mazin J; Al Lami, Faris H; Alam, Sayed Saidul; Alasfoor, Deena; Albittar, Mohammed I; Alegretti, Miguel A; Aleman, Alicia V; Alemu, Zewdie A; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Ali, Mohammed K; Alla, Francois; Allebeck, Peter; Allen, Peter J; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzman, Nelson; Amankwaa, Adansi A; Amare, Azmeraw T; Ameh, Emmanuel A; Ameli, Omid; Amini, Heresh; Ammar, Walid; Anderson, Benjamin O; Antonio, Carl Abelardo T; Anwari, Palwasha; Argeseanu Cunningham, Solveig; Arnlov, Johan; Arsenijevic, Valentina S Arsic; Artaman, Al; Asghar, Rana J; Assadi, Reza; Atkins, Lydia S; Atkinson, Charles; Avila, Marco A; Awuah, Baffour; Badawi, Alaa; Bahit, Maria C; Bakfalouni, Talal; Balakrishnan, Kalpana; Balalla, Shivanthi; Balu, Ravi Kumar; Banerjee, Amitava; Barber, Ryan M; Barker-Collo, Suzanne L; Barquera, Simon; Barregard, Lars; Barrero, Lope H; Barrientos-Gutierrez, Tonatiuh; Basto-Abreu, Ana C; Basu, Arindam; Basu, Sanjay; Basulaiman, Mohammed O; Batis Ruvalcaba, Carolina; Beardsley, Justin; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L; Benjet, Corina; Bennett, Derrick A; Benzian, Habib; Bernabe, Eduardo; Beyene, Tariku J; Bhala, Neeraj; Bhalla, Ashish; Bhutta, Zulfiqar A; Bikbov, Boris; Bin Abdulhak, Aref A; Blore, Jed D; Blyth, Fiona M; Bohensky, Megan A; Bora Basara, Berrak; Borges, Guilherme; Bornstein, Natan M; Bose, Dipan; Boufous, Soufiane; Bourne, Rupert R; Brainin, Michael; Brazinova, Alexandra; Breitborde, Nicholas J; Brenner, Hermann; Briggs, Adam D M; Broday, David M; Brooks, Peter M; Bruce, Nigel G; Brugha, Traolach S; Brunekreef, Bert; Buchbinder, Rachelle; Bui, Linh N; Bukhman, Gene; Bulloch, Andrew G; Burch, Michael; Burney, Peter G J; Campos-Nonato, Ismael R; Campuzano, Julio C; Cantoral, Alejandra J; Caravanos, Jack; Cardenas, Rosario; Cardis, Elisabeth; Carpenter, David O; Caso, Valeria; Castaneda-Orjuela, Carlos A; Castro, Ruben E; Catala-Lopez, Ferran; Cavalleri, Fiorella; Cavlin, Alanur; Chadha, Vineet K; Chang, Jung-Chen; Charlson, Fiona J; Chen, Honglei; Chen, Wanqing; Chen, Zhengming; Chiang, Peggy P; Chimed-Ochir, Odgerel; Chowdhury, Rajiv; Christophi, Costas A; Chuang, Ting-Wu; Chugh, Sumeet S; Cirillo, Massimo; Classen, Thomas K D; Colistro, Valentina; Colomar, Mercedes; Colquhoun, Samantha M; Contreras, Alejandra G; Cooper, Cyrus; Cooperrider, Kimberly; Cooper, Leslie T; Coresh, Josef; Courville, Karen J; Criqui, Michael H; Cuevas-Nasu, Lucia; Damsere-Derry, James; Danawi, Hadi; Dandona, Lalit; Dandona, Rakhi; Dargan, Paul I; Davis, Adrian; Davitoiu, Dragos V; Dayama, Anand; de Castro, E Filipa; De la Cruz-Gongora, Vanessa; De Leo, Diego; de Lima, Graca; Degenhardt, Louisa; del Pozo-Cruz, Borja; Dellavalle, Robert P; Deribe, Kebede; Derrett, Sarah; Des Jarlais, Don C; Dessalegn, Muluken; deVeber, Gabrielle A; Devries, Karen M; Dharmaratne, Samath D; Dherani, Mukesh K; Dicker, Daniel; Ding, Eric L; Dokova, Klara; Dorsey, E Ray; Driscoll, Tim R; Duan, Leilei; Durrani, Adnan M; Ebel, Beth E; Ellenbogen, Richard G; Elshrek, Yousef M; Endres, Matthias; Ermakov, Sergey P; Erskine, Holly E; Eshrati, Babak; Esteghamati, Alireza; Fahimi, Saman; Faraon, Emerito Jose A; Farzadfar, Farshad; Fay, Derek F J; Feigin, Valery L; Feigl, Andrea B; Fereshtehnejad, Seyed-Mohammad; Ferrari, Alize J; Ferri, Cleusa P; Flaxman, Abraham D; Fleming, Thomas D; Foigt, Nataliya; Foreman, Kyle J; Paleo, Urbano Fra; Franklin, Richard C; Gabbe, Belinda; Gaffikin, Lynne; Gakidou, Emmanuela; Gamkrelidze, Amiran; Gankpe, Fortune G; Gansevoort, Ron T; Garcia-Guerra, Francisco A; Gasana, Evariste; Geleijnse, Johanna M; Gessner, Bradford D; Gething, Pete; Gibney, Katherine B; Gillum, Richard F; Ginawi, Ibrahim A M; Giroud, Maurice; Giussani, Giorgia; Goenka, Shifalika; Goginashvili, Ketevan; Gomez Dantes, Hector; Gona, Philimon; Gonzalez de Cosio, Teresita; Gonzalez-Castell, Dinorah; Gotay, Carolyn C; Goto, Atsushi; Gouda, Hebe N; Guerrant, Richard L; Gugnani, Harish C; Guillemin, Francis; Gunnell, David; Gupta, Rahul; Gupta, Rajeev; Gutierrez, Reyna A; Hafezi-Nejad, Nima; Hagan, Holly; Hagstromer, Maria; Halasa, Yara A; Hamadeh, Randah R; Hammami, Mouhanad; Hankey, Graeme J; Hao, Yuantao; Harb, Hilda L; Haregu, Tilahun Nigatu; Haro, Josep Maria; Havmoeller, Rasmus; Hay, Simon I; Hedayati, Mohammad T; Heredia-Pi, Ileana B; Hernandez, Lucia; Heuton, Kyle R; Heydarpour, Pouria; Hijar, Martha; Hoek, Hans W; Hoffman, Howard J; Hornberger, John C; Hosgood, H Dean; Hoy, Damian G; Hsairi, Mohamed; Hu, Guoqing; Hu, Howard; Huang, Cheng; Huang, John J; Hubbell, Bryan J; Huiart, Laetitia; Husseini, Abdullatif; Iannarone, Marissa L; Iburg, Kim M; Idrisov, Bulat T; Ikeda, Nayu; Innos, Kaire; Inoue, Manami; Islami, Farhad; Ismayilova, Samaya; Jacobsen, Kathryn H; Jansen, Henrica A; Jarvis, Deborah L; Jassal, Simerjot K; Jauregui, Alejandra; Jayaraman, Sudha; Jeemon, Panniyammakal; Jensen, Paul N; Jha, Vivekanand; Jiang, Fan; Jiang, Guohong; Jiang, Ying; Jonas, Jost B; Juel, Knud; Kan, Haidong; Kany Roseline, Sidibe S; Karam, Nadim E; Karch, Andre; Karema, Corine K; Karthikeyan, Ganesan; Kaul, Anil; Kawakami, Norito; Kazi, Dhruv S; Kemp, Andrew H; Kengne, Andre P; Keren, Andre; Khader, Yousef S; Khalifa, Shams Eldin Ali Hassan; Khan, Ejaz A; Khang, Young-Ho; Khatibzadeh, Shahab; Khonelidze, Irma; Kieling, Christian; Kim, Daniel; Kim, Sungroul; Kim, Yunjin; Kimokoti, Ruth W; Kinfu, Yohannes; Kinge, Jonas M; Kissela, Brett M; Kivipelto, Miia; Knibbs, Luke D; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kose, M Rifat; Kosen, Soewarta; Kraemer, Alexander; Kravchenko, Michael; Krishnaswami, Sanjay; Kromhout, Hans; Ku, Tiffany; Kuate Defo, Barthelemy; Kucuk Bicer, Burcu; Kuipers, Ernst J; Kulkarni, Chanda; Kulkarni, Veena S; Kumar, G Anil; Kwan, Gene F; Lai, Taavi; Lakshmana Balaji, Arjun; Lalloo, Ratilal; Lallukka, Tea; Lam, Hilton; Lan, Qing; Lansingh, Van C; Larson, Heidi J; Larsson, Anders; Laryea, Dennis O; Lavados, Pablo M; Lawrynowicz, Alicia E; Leasher, Janet L; Lee, Jong-Tae; Leigh, James; Leung, Ricky; Levi, Miriam; Li, Yichong; Li, Yongmei; Liang, Juan; Liang, Xiaofeng; Lim, Stephen S; Lindsay, M Patrice; Lipshultz, Steven E; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K; Logroscino, Giancarlo; London, Stephanie J; Lopez, Nancy; Lortet-Tieulent, Joannie; Lotufo, Paulo A; Lozano, Rafael; Lunevicius, Raimundas; Ma, Jixiang; Ma, Stefan; Machado, Vasco M P; MacIntyre, Michael F; Magis-Rodriguez, Carlos; Mahdi, Abbas A; Majdan, Marek; Malekzadeh, Reza; Mangalam, Srikanth; Mapoma, Christopher C; Marape, Marape; Marcenes, Wagner; Margolis, David J; Margono, Christopher; Marks, Guy B; Martin, Randall V; Marzan, Melvin B; Mashal, Mohammad T; Masiye, Felix; Mason-Jones, Amanda J; Matsushita, Kunihiro; Matzopoulos, Richard; Mayosi, Bongani M; Mazorodze, Tasara T; McKay, Abigail C; McKee, Martin; McLain, Abigail; Meaney, Peter A; Medina, Catalina; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Mekonnen, Wubegzier; Melaku, Yohannes A; Meltzer, Michele; Memish, Ziad A; Mendoza, Walter; Mensah, George A; Meretoja, Atte; Mhimbira, Francis Apolinary; Micha, Renata; Miller, Ted R; Mills, Edward J; Misganaw, Awoke; Mishra, Santosh; Mohamed Ibrahim, Norlinah; Mohammad, Karzan A; Mokdad, Ali H; Mola, Glen L; Monasta, Lorenzo; Montanez Hernandez, Julio C; Montico, Marcella; Moore, Ami R; Morawska, Lidia; Mori, Rintaro; Moschandreas, Joanna; Moturi, Wilkister N; Mozaffarian, Dariush; Mueller, Ulrich O; Mukaigawara, Mitsuru; Mullany, Erin C; Murthy, Kinnari S; Naghavi, Mohsen; Nahas, Ziad; Naheed, Aliya; Naidoo, Kovin S; Naldi, Luigi; Nand, Devina; Nangia, Vinay; Narayan, K M Venkat; Nash, Denis; Neal, Bruce; Nejjari, Chakib; Neupane, Sudan P; Newton, Charles R; Ngalesoni, Frida N; Ngirabega, Jean de Dieu; Nguyen, Grant; Nguyen, Nhung T; Nieuwenhuijsen, Mark J; Nisar, Muhammad I; Nogueira, Jose R; Nolla, Joan M; Nolte, Sandra; Norheim, Ole F; Norman, Rosana E; Norrving, Bo; Nyakarahuka, Luke; Oh, In-Hwan; Ohkubo, Takayoshi; Olusanya, Bolajoko O; Omer, Saad B; Opio, John Nelson; Orozco, Ricardo; Pagcatipunan, Rodolfo S Jr; Pain, Amanda W; Pandian, Jeyaraj D; Panelo, Carlo Irwin A; Papachristou, Christina; Park, Eun-Kee; Parry, Charles D; Paternina Caicedo, Angel J; Patten, Scott B; Paul, Vinod K; Pavlin, Boris I; Pearce, Neil; Pedraza, Lilia S; Pedroza, Andrea; Pejin Stokic, Ljiljana; Pekericli, Ayfer; Pereira, David M; Perez-Padilla, Rogelio; Perez-Ruiz, Fernando; Perico, Norberto; Perry, Samuel A L; Pervaiz, Aslam; Pesudovs, Konrad; Peterson, Carrie B; Petzold, Max; Phillips, Michael R; Phua, Hwee Pin; Plass, Dietrich; Poenaru, Dan; Polanczyk, Guilherme V; Polinder, Suzanne; Pond, Constance D; Pope, C Arden; Pope, Daniel; Popova, Svetlana; Pourmalek, Farshad; Powles, John; Prabhakaran, Dorairaj; Prasad, Noela M; Qato, Dima M; Quezada, Amado D; Quistberg, D Alex A; Racape, Lionel; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Sajjad Ur; Raju, Murugesan; Rakovac, Ivo; Rana, Saleem M; Rao, Mayuree; Razavi, Homie; Reddy, K Srinath; Refaat, Amany H; Rehm, Jurgen; Remuzzi, Giuseppe; Ribeiro, Antonio L; Riccio, Patricia M; Richardson, Lee; Riederer, Anne; Robinson, Margaret; Roca, Anna; Rodriguez, Alina; Rojas-Rueda, David; Romieu, Isabelle; Ronfani, Luca; Room, Robin; Roy, Nobhojit; Ruhago, George M; Rushton, Lesley; Sabin, Nsanzimana; Sacco, Ralph L; Saha, Sukanta; Sahathevan, Ramesh; Sahraian, Mohammad Ali; Salomon, Joshua A; Salvo, Deborah; Sampson, Uchechukwu K; Sanabria, Juan R; Sanchez, Luz Maria; Sanchez-Pimienta, Tania G; Sanchez-Riera, Lidia; Sandar, Logan; Santos, Itamar S; Sapkota, Amir; Satpathy, Maheswar; Saunders, James E; Sawhney, Monika; Saylan, Mete I; Scarborough, Peter; Schmidt, Jurgen C; Schneider, Ione J C; Schottker, Ben; Schwebel, David C; Scott, James G; Seedat, Soraya; Sepanlou, Sadaf G; Serdar, Berrin; Servan-Mori, Edson E; Shaddick, Gavin; Shahraz, Saeid; Levy, Teresa Shamah; Shangguan, Siyi; She, Jun; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin H; Shinohara, Yukito; Shiri, Rahman; Shishani, Kawkab; Shiue, Ivy; Sigfusdottir, Inga D; Silberberg, Donald H; Simard, Edgar P; Sindi, Shireen; Singh, Abhishek; Singh, Gitanjali M; Singh, Jasvinder A; Skirbekk, Vegard; Sliwa, Karen; Soljak, Michael; Soneji, Samir; Soreide, Kjetil; Soshnikov, Sergey; Sposato, Luciano A; Sreeramareddy, Chandrashekhar T; Stapelberg, Nicolas J C; Stathopoulou, Vasiliki; Steckling, Nadine; Stein, Dan J; Stein, Murray B; Stephens, Natalie; Stockl, Heidi; Straif, Kurt; Stroumpoulis, Konstantinos; Sturua, Lela; Sunguya, Bruno F; Swaminathan, Soumya; Swaroop, Mamta; Sykes, Bryan L; Tabb, Karen M; Takahashi, Ken; Talongwa, Roberto T; Tandon, Nikhil; Tanne, David; Tanner, Marcel; Tavakkoli, Mohammad; Te Ao, Braden J; Teixeira, Carolina M; Tellez Rojo, Martha M; Terkawi, Abdullah S; Texcalac-Sangrador, Jose Luis; Thackway, Sarah V; Thomson, Blake; Thorne-Lyman, Andrew L; Thrift, Amanda G; Thurston, George D; Tillmann, Taavi; Tobollik, Myriam; Tonelli, Marcello; Topouzis, Fotis; Towbin, Jeffrey A; Toyoshima, Hideaki; Traebert, Jefferson; Tran, Bach X; Trasande, Leonardo; Trillini, Matias; Trujillo, Ulises; Dimbuene, Zacharie Tsala; Tsilimbaris, Miltiadis; Tuzcu, Emin Murat; Uchendu, Uche S; Ukwaja, Kingsley N; Uzun, Selen B; van de Vijver, Steven; Van Dingenen, Rita; van Gool, Coen H; van Os, Jim; Varakin, Yuri Y; Vasankari, Tommi J; Vasconcelos, Ana Maria N; Vavilala, Monica S; Veerman, Lennert J; Velasquez-Melendez, Gustavo; Venketasubramanian, N; Vijayakumar, Lakshmi; Villalpando, Salvador; Violante, Francesco S; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Wagner, Gregory R; Waller, Stephen G; Wallin, Mitchell T; Wan, Xia; Wang, Haidong; Wang, JianLi; Wang, Linhong; Wang, Wenzhi; Wang, Yanping; Warouw, Tati S; Watts, Charlotte H; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Werdecker, Andrea; Wessells, K Ryan; Westerman, Ronny; Whiteford, Harvey A; Wilkinson, James D; Williams, Hywel C; Williams, Thomas N; Woldeyohannes, Solomon M; Wolfe, Charles D A; Wong, John Q; Woolf, Anthony D; Wright, Jonathan L; Wurtz, Brittany; Xu, Gelin; Yan, Lijing L; Yang, Gonghuan; Yano, Yuichiro; Ye, Pengpeng; Yenesew, Muluken; Yentur, Gokalp K; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Younoussi, Zourkaleini; Yu, Chuanhua; Zaki, Maysaa E; Zhao, Yong; Zheng, Yingfeng; Zhou, Maigeng; Zhu, Jun; Zhu, Shankuan; Zou, Xiaonong; Zunt, Joseph R; Lopez, Alan D; Vos, Theo; Murray, Christopher J
BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. FINDINGS: All risks combined account for 57.2% (95% uncertainty interval [UI] 55.8-58.5) of deaths and 41.6% (40.1-43.0) of DALYs. Risks quantified account for 87.9% (86.5-89.3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11.3 million deaths and 241.4 million DALYs, high systolic blood pressure for 10.4 million deaths and 208.1 million DALYs, child and maternal malnutrition for 1.7 million deaths and 176.9 million DALYs, tobacco smoke for 6.1 million deaths and 143.5 million DALYs, air pollution for 5.5 million deaths and 141.5 million DALYs, and high BMI for 4.4 million deaths and 134.0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. FUNDING: Bill & Melinda Gates Foundation.
PMCID:4685753
PMID: 26364544
ISSN: 1474-547x
CID: 2033272
Dementia and other neurocognitive disorders: An overview
Chapter by: Galvin, JE; Kelleher, ME
in: Psychosocial Studies of the Individual's Changing Perspectives in Alzheimer's Disease by
pp. 104-130
ISBN: 9781466684799
CID: 2026172
Ovarian cancer risk factors by histologic subtypes: Evidence for etiologic heterogeneity [Meeting Abstract]
Wentzensen, N A; Poole, E; Arslan, A A; Patel, A V; Setiawan, V W; Visvanathan, K; Weiderpass, E; White, E; Adami, H -O; Brinton, L A; Bernstein, L; Buring, J; Butler, L M; Chamosa, S; Clendenen, T V; Dossus, L; Fortner, R; Gapstur, S M; Gaudet, M M; Gram, I T; Hartge, P; Hoffman-Bolton, J; Idahl, A; Jones, M; Kaaks, R; Kirsh, V; Koh, W -P; Lacey, J V; Lee, I -M; Lundin, E; Merritt, M; Peters, U; Poynter, J; Rinaldi, S; Robien, K; Rohan, T; Sandler, D P; Schouten, L J; Sjoholm, L; Sieri, S; Swerdlow, A; Tjonneland, A; Trabert, B; Wilkens, L; Wolk, A; Yang, H P; Zeleniuch-Jacquotte, A; Tworoger, S S
Background: A subset of high grade serous carcinomas may arise from the fallopian tube, while some endometrioid and clear cell carcinomas may derive from endometrial tissue. Previous studies have suggested differences in ovarian cancer risk factors by histologic subtypes, but had limited sample sizes. In the Ovarian Cancer Cohort Consortium (OC3), we evaluated associations of reproductive, hormonal, demographic and lifestyle factors, and family history of cancer with ovarian cancer subtypes. Identification of potential differences in associations among subtypes is important for clarifying ovarian cancer etiology and for developing novel prevention and risk prediction approaches. Methods: Among over 1.2 million women from 21 cohort studies, 4,347 ovarian cancers with histology information were identified during follow-up (3223 serous, 555 endometrioid, 316 mucinous, 253 clear cell). We used competing risks Cox proportional hazards regression to compute risk factor associations by histologic subtype. Models were stratified on study and year of birth and adjusted for age, parity and oral contraceptive use; subtype heterogeneity was evaluated by a likelihood ratio test. Unsupervised hierarchical clustering was used to evaluate patterns of risk factors by histology. Results: Most risk factors showed significant heterogeneity across histologic subtypes. Higher parity was most strongly associated with lower risks of endometrioid (RR per child: 0.79; 95%CI: 0.74-0.85) and clear cell (RR: 0.69; 95%CI: 0.61-0.78) carcinomas (p-het<0.0001). Age at menopause was positively and tubal ligation was inversely associated only with endometrioid and clear cell carcinomas (p-het = 0.02 and 0.003, respectively). Long-term menopausal hormone use (>5 years) was associated with endometrioid carcinomas (RR: 2.23; 95% CI: 1.46-3.42) and serous carcinomas (RR: 1.66; 95% CI: 1.44-1.92), and inversely associated with clear cell carcinomas (RR: 0.43; 95% CI: 0.20-0.91; p-het = 0.001). Family history of breast cancer was associated with increased risk of serous carcinomas (RR:1.13; 95% CI:1.02-1.27) and endometrioid carcinomas (RR: 1.44; 95% CI: 1.12-1.87; p-het = 0.02). Smoking (per 20 pack years) showed a positive association with mucinous carcinomas (RR: 1.38; 95% CI: 1.09-1.75) and an inverse association with clear cell carcinomas (RR:0.62; 95% CI: 0.46-0.85; p-het = 0.001). In unsupervised hierarchical clustering, serous and mucinous carcinomas clustered in one group and endometrioid and clear cell carcinomas in the other. Conclusion: Our results demonstrate heterogeneous associations of risk factors with ovarian cancer subtypes, supporting the hypothesis that the subtypes develop through different pathways. Most established risk factors were more strongly associated with non-serous carcinomas, suggesting that risk prediction may be more challenging for serous cancers, the most fatal subtype
EMBASE:72191442
ISSN: 0008-5472
CID: 2015492
Depression, Control, and Climate: An Examination of Factors Impacting Teaching Quality in Preschool Classrooms
Sandilos, Lia E; Cycyk, Lauren M; Hammer, Carol Scheffner; Sawyer, Brook E; Lopez, Lisa; Blair, Clancy
RESEARCH FINDINGS: This study investigated the relationship of preschool teachers' self-reported depressive symptomatology, perception of classroom control, and perception of school climate to classroom quality as measured by the Classroom Assessment Scoring System Pre-K. The sample consisted of 59 urban preschool classrooms serving low-income and linguistically diverse students in the northeastern and southeastern United States. Results of hierarchical linear modeling revealed that teachers' individual reports of depressive symptomatology were significantly and negatively predictive of the observed quality of their instructional support and classroom organization. PRACTICE OR POLICY: The findings of this study have implications for increasing access to mental health supports for teachers in an effort to minimize depressive symptoms and potentially improve classroom quality.
PMCID:4765382
PMID: 26924914
ISSN: 1040-9289
CID: 2009592
More than one in five older veterans are hospitalized for bleeding following initiation of warfarin for atrial fibrillation [Meeting Abstract]
Dodson, J A; Petrone, A; Gagnon, D; Tinetti, M E; Krumholz, H M; Gaziano, J M
Introduction: Clinicians are hesitant to prescribe oral anticoagulants to older adults with atrial fibrillation (AF) due to concerns over bleeding risk. Hypothesis: As many data on bleeding events are from trials of rigorously selected patients, we hypothesized that major bleeding events (requiring hospitalization) would be more common than previously reported. Methods: We created a retrospective cohort of 31,951 Veterans with AF aged >75 years who were new referrals to VA anticoagulation clinics (warfarin) from 1/1/02 - 12/31/12. Patients with comorbid conditions requiring warfarin (e.g. pulmonary embolus) were excluded. Data were extracted from the VA electronic medical record and linked with Medicare claims data for subsequent hospitalizations. The primary outcome was any hospitalization for bleeding. We identified bleeding subtypes by source, and compared characteristics of patients with and without bleeding hospitalizations. Results: Mean population age was 81.1 years, 98.1% were male, and 8.4% were nonwhite. Over a median follow-up period of 2.62 years, 7288 patients (22.8%) were hospitalized for bleeding. There were 12,004 total bleeding events; overall, 980 (13.4%) patients experienced multiple events. The most common bleeding sources (first event) were gastrointestinal (50.8%), genitourinary (21.6%), and intracranial (9.4%) (Figure). The median time to first bleeding event was 1.59 years. Patients hospitalized for bleeding were more likely to have coronary disease (48.4% vs. 40.9%, P<0.01); COPD (28.4% vs. 24.7%, P<0.01); chronic kidney disease (17.8% vs. 16.0%, P<0.01); CHF (34.7% vs. 29.5%, P<0.01), and labile INR (63.3% vs. 53.7%, P<0.01). The rate of hospitalization for stroke over the same time period was 5.0%. Conclusions: After initiating warfarin, over one in five older Veterans are hospitalized for bleeding, most commonly from a gastrointestinal source. Comorbidity burden and labile INR place these patients at increased risk
EMBASE:72181821
ISSN: 0009-7322
CID: 1946202
Integrating text messaging in a safety-net office-based buprenorphine program: A feasibility study [Meeting Abstract]
Tofighi, B; Grossman, E; Bereket, S; Aphinyanaphongs, Y; Lee, J D
Aims: (1) Assess feasibility of a text message appointment reminder (TMR) intervention (2) Determine the clinical impact of the TMR on appointment adherence Methods: A 52-item survey was administered to 100 patients in an urban, public sector, office-based buprenorphine program between June 2013 and March 2014. Survey domains included: demographic characteristics, communication patterns, and content preferences for supportive, informational, and relapse prevention TM interventions. A TMR was then sent 7, 4, 1 day prior to the patients' upcoming appointment followed by a 16 item survey that assessed satisfaction and feedback for the TM reminders (n = 72). Results: Respondents were predominately African-American (42%), unemployed or reliant on public assistance (68%), and lacked permanent housing (52%). MP ownership was common (93%) with the caveat of a high turnover of phones (2) and phone numbers (2) in the past year. Most reported TM use (93%) and comfort with sending TM (79%). The feasibility survey demonstrated satisfaction with the TMR (100%) and most preferred receiving text reminders (88%) in place of telephone reminders at 6 months. There was no significant difference between participants receiving the TMR compared to patients that did not receive the reminders. Conclusions: TM based interventions are an acceptable and feasible strategy for enhancing the delivery of care in a safety net, office-based buprenorphine program
EMBASE:72176978
ISSN: 0376-8716
CID: 1946352
A qualitative investigation comparing sexual effects of alcohol and marijuana among adults [Meeting Abstract]
Palamar, J J; Acosta, P; Falb, V; Ompad, D C
Aims: Alcohol and marijuana (cannabis) are the two most commonly used psychoactive drugs and each appears to have its own unique sexual effects on users. With marijuana use increasing in the United States, along with more liberal state-level policies, it is important to examine and compare sexual effects and sexual risk behavior associated with these drugs in order to inform prevention of HIV, other sexually transmitted infections and unplanned pregnancy. Methods: We conducted semi-structured interviews with 24 racially and ethnically diverse adults in New York City (mean age = 27.4, SD = 5.8). To be eligible, subjects must have (1) been between ages 18-35, (2) had sex while high on marijuana in the last 12 months, (3) had sex while not high on marijuana in the last 12 months; and (4) must not have used any other illicit drug in the last 12 months. All subjects self-identified as heterosexual and HIV-negative, and 50% were female. Results: Thematic analysis yielded various themes. Many subjects described differences between the two drugs with regard to interactions and contexts in use before sex, partner choice, perceived attractiveness of self and others, disinhibition, adverse sexual effects and sexual dysfunction, and dose effects. Differences were also commonly described regarding libido, length and intensity of sex and orgasm, specific sexual behaviors (including risk behavior), and feelings such as regret after sex. Compared to marijuana, alcohol was more likely to be associated with atypical partner choice and lead to regret. Illegality of marijuana sometimes facilitated intimate encounters. Conclusions: Results can inform prevention efforts regarding specific sexual risks and allow us to design more realistic prevention programs and interventions to guide potential users to make safer choices
EMBASE:72176837
ISSN: 0376-8716
CID: 1941082
Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration
Jay, Melanie; Mateo, Katrina F; Squires, Allison P; Kalet, Adina L; Sherman, Scott E
BACKGROUND: Obesity affects 37 % of patients at Veterans Health Administration (VHA) medical centers. The VHA offers an intensive weight management program (MOVE!) but less than 10 % of eligible patients ever attend. However, VHA patients see their primary care provider about 3.6 times per year, supporting the development of primary care-based weight management interventions. To address gaps in the literature regarding Veterans' experiences with weight management and determine whether and how to develop a primary care-based weight management intervention to both improve obesity counseling and increase attendance to MOVE!, we conducted a qualitative study to assess: 1) Veterans' personal experiences with healthy weight-related behavior change (including barriers and facilitators to behavior change and experiences with primary care providers, staff, and the MOVE! program), and 2) potential new approaches to improve weight management within primary care at the VHA including goal setting and technology. METHODS: Overweight/obese VHA patients (aged 18-75, BMI greater than 30 or greater than 25 with at least 1 co-morbidity) were recruited for focus group sessions stratified by gender, MOVE! referral, and attendance. Each session was facilitated by a trained moderator, audio-recorded, and professionally transcribed. Using an iterative coding approach, two coders separately reviewed and coded transcripts, and met frequently to negotiate codes and synthesize emerging themes. RESULTS: Of 161 eligible patients, 54 attended one of 6 focus groups (2 female, 4 male, 9-11 participants per session): 63 % were male, 46 % identified as African-American, 32 % White/Caucasian, 74 % were college-educated or higher, and 61 % reported having attended MOVE!. We identified two major themes: Impact of Military Service and Promotion and Sustainability of Healthy Behaviors. After service in a highly structured military environment, Veterans had difficulty maintaining weight on their own. They perceived physical activity as having more impact than diet, but chronic pain was a barrier. We identified individual/interpersonal-, community/environment-, and healthcare system-related factors affecting healthy behaviors. We also received input about Veteran's preferences and experiences with technology and setting health goals. CONCLUSIONS: Unique factors influence weight management in Veterans. Findings will inform development of a technology-assisted weight management intervention with tailored counseling and goal-setting within primary care at the VHA.
PMCID:4736653
PMID: 26855786
ISSN: 2052-9538
CID: 1937002
Mortality Attributable to Low Levels of Education in the United States
Krueger, Patrick M; Tran, Melanie K; Hummer, Robert A; Chang, Virginia W
BACKGROUND: Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. METHODS: We use the National Health Interview Survey data (1986-2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. RESULTS: If adults aged 25-85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. CONCLUSIONS: Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality.
PMCID:4496052
PMID: 26153885
ISSN: 1932-6203
CID: 1927362
