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Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, Gonzalez-Medina D, Barber R, Huynh C, Dicker D, Templin T, Wolock TM, Ozgoren AA, Abd-Allah F, Abera SF, Abubakar I, Achoki T, Adelekan A, Ademi Z, Adou AK, Adsuar JC, Agardh EE, Akena D, Alasfoor D, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Al Kahbouri MJ, Alla F, Allen PJ, AlMazroa MA, Alsharif U, Alvarez E, Alvis-Guzmán N, Amankwaa AA, Amare AT, Amini H, Ammar W, Antonio CAT, Anwari P, Arnlöv J, Arsenijevic VSA, Artaman A, Asad MM, Asghar RJ, Assadi R, Atkins LS, Badawi A, Balakrishnan K, Basu A, Basu S, Beardsley J, Bedi N, Bekele T, Bell ML, Bernabe E, Beyene TJ, Bhutta Z, Bin Abdulhak A, Blore JD, Basara BB, Bose D, Breitborde N, Cárdenas R, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavlin A, Chang JC, Che X, Christophi CA, Chugh SS, Cirillo M, Colquhoun SM, Cooper LT, Cooper C, da Costa Leite I, Dandona L, Dandona R, Davis A, Dayama A, Degenhardt L, De Leo D, del Pozo-Cruz B, Deribe K, Dessalegn M, deVeber GA, Dharmaratne SD, Dilmen U, Ding EL, Dorrington RE, Driscoll TR, Ermakov SP, Esteghamati A, Faraon EJA, Farzadfar F, Felicio MM, Fereshtehnejad SM, de Lima GMF, Forouzanfar MH, França EB, Gaffikin L, Gambashidze K, Gankpé FG, Garcia AC, Geleijnse JM, Gibney KB, Giroud M, Glaser EL, Goginashvili K, Gona P, González-Castell D, Goto A, Gouda HN, Gugnani HC, Gupta R, Gupta R, Hafezi-Nejad N, Hamadeh RR, Hammami M, Hankey GJ, Harb HL, Havmoeller R, Hay SI, Pi IBH, Hoek HW, Hosgood HD, Hoy DG, Husseini A, Idrisov BT, Innos K, Inoue M, Jacobsen KH, Jahangir E, Jee SH, Jensen PN, Jha V, Jiang G, Jonas JB, Juel K, Kabagambe EK, Kan H, Karam NE, Karch A, Karema CK, Kaul A, Kawakami N, Kazanjan K, Kazi DS, Kemp AH, Kengne AP, Kereselidze M, Khader YS, Khalifa SEAH, Khan EA, Khang YH, Knibbs L, Kokubo Y, Kosen S, Defo BK, Kulkarni C, Kulkarni VS, Kumar GA, Kumar K, Kumar RB, Kwan G, Lai T, Lalloo R, Lam H, Lansingh VC, Larsson A, Lee JT, Leigh J, Leinsalu M, Leung R, Li X, Li Y, Li Y, Liang J, Liang X, Lim SS, Lin HH, Lipshultz SE, Liu S, Liu Y, Lloyd BK, London SJ, Lotufo PA, Ma J, Ma S, Machado VMP, Mainoo NK, Majdan M, Mapoma CC, Marcenes W, Marzan MB, Mason-Jones AJ, Mehndiratta MM, Mejia-Rodriguez F, Memish ZA, Mendoza W, Miller TR, Mills EJ, Mokdad AH, Mola GL, Monasta L, de la Cruz Monis J, Hernandez JCM, Moore AR, Moradi-Lakeh M, Mori R, Mueller UO, Mukaigawara M, Naheed A, Naidoo KS, Nand D, Nangia V, Nash D, Nejjari C, Nelson RG, Neupane SP, Newton CR, Ng M, Nieuwenhuijsen MJ, Nisar MI, Nolte S, Norheim OF, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orisakwe OE, Pandian JD, Papachristou C, Park JH, Caicedo AJP, Patten SB, Paul VK, Pavlin BI, Pearce N, Pereira DM, Pesudovs K, Petzold M, Poenaru D, Polanczyk GV, Polinder S, Pope D, Pourmalek F, Qato D, Quistberg DA, Rafay A, Rahimi K, Rahimi-Movaghar V, ur Rahman S, Raju M, Rana SM, Refaat A, Ronfani L, Roy N, Pimienta TGS, Sahraian MA, Salomon JA, Sampson U, Santos IS, Sawhney M, Sayinzoga F, Schneider IJC, Schumacher A, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shakh-Nazarova M, Sheikhbahaei S, Shibuya K, Shin HH, Shiue I, Sigfusdottir ID, Silberberg DH, Silva AP, Singh JA, Skirbekk V, Sliwa K, Soshnikov SS, Sposato LA, Sreeramareddy CT, Stroumpoulis K, Sturua L, Sykes BL, Tabb KM, Talongwa RT, Tan F, Teixeira CM, Tenkorang EY, Terkawi AS, Thorne-Lyman AL, Tirschwell DL, Towbin JA, Tran BX, Tsilimbaris M, Uchendu US, Ukwaja KN, Undurraga EA, Uzun SB, Vallely AJ, van Gool CH, Vasankari TJ, Vavilala MS, Venketasubramanian N, Villalpando S, Violante FS, Vlassov VV, Vos T, Waller S, Wang H, Wang L, Wang X, Wang Y, Weichenthal S, Weiderpass E, Weintraub RG, Westerman R, Wilkinson JD, Woldeyohannes SM, Wong JQ, Wordofa MA, Xu G, Yang YC, Yano Y, Yentur GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Jin KY, El Sayed Zaki M, Zhao Y, Zheng Y, Zhou M, Zhu J, Zou XN, Lopez AD, Naghavi M, Murray CJL, Lozano R. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384:980-1004. [PMID: 24797575 PMCID: PMC4255481 DOI: 10.1016/s0140-6736(14)60696-6] [Citation(s) in RCA: 1016] [Impact Index Per Article: 101.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. METHODS We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. FINDINGS 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. INTERPRETATION Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Pediatric Anesthesiology and Pain Medicine, Seattle Children's Hospital, School of Medicine, Seattle, WA, USA.
| | | | | | | | - Caitlyn Steiner
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Kyle R Heuton
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Ryan Barber
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Chantal Huynh
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Daniel Dicker
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Tara Templin
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | | | - Semaw Ferede Abera
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - François Alla
- School of Public Health, University of Lorraine, Nancy, France
| | | | | | | | - Elena Alvarez
- Spanish Observatory on Drugs, Government Delegation for the National Plan on Drugs, Madrid, Spain; Ministry of Health, Social Services and Equality, Madrid, Spain
| | | | | | - Azmeraw T Amare
- Department of Epidemiology, University of Groningen, Groningen, Netherlands; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hassan Amini
- Kurdistan Environmental Health Research Centre, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, Iran
| | | | - Carl A T Antonio
- College of Public Health, University of the Philippines Manila, Manila, Philippines
| | | | | | | | | | | | - Rana J Asghar
- Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan
| | - Reza Assadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lydia S Atkins
- Ministry Of Health, Wellness, Human Services and Gender Relations, Sans Souci, Castries, Saint Lucia
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | | | - Arindam Basu
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | | | | | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | | | | | | | | | | | | | - Jed D Blore
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Ferrán Catalá-López
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency, Madrid, Spain
| | - Alanur Cavlin
- Hacettepe University Institute of Population Studies, Ankara, Turkey
| | | | - Xuan Che
- National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | | | | | | | | | | | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Lalit Dandona
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India
| | | | | | | | | | | | | | | | - Muluken Dessalegn
- Africa Medical and Research Foundation in Ethiopia, Addis Ababa, Ethiopia
| | | | | | - Uğur Dilmen
- General Directorate of Health Research, Ankara, Turkey
| | - Eric L Ding
- Harvard School of Public Health, Boston, MA, USA
| | | | | | - Sergei Petrovich Ermakov
- The Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | | | - Ketevan Gambashidze
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | - Ana C Garcia
- Public Health Unit of Primary Health Care Group of Almada-Seixal, Almada, Setúbal, Portugal
| | | | | | | | | | | | - Philimon Gona
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Atsushi Goto
- Department of Diabetes Research, National Centre for Global Health and Medicine, Tokyo, Japan
| | - Hebe N Gouda
- University of Queensland, Brisbane, QLD, Australia
| | | | - Rahul Gupta
- Kanawha Charleston Health Department, Charleston, WV, USA
| | | | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mouhanad Hammami
- Wayne County Department of Health and Human Services, Detroit, MI, USA
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | | | | | | | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | - Damian G Hoy
- School of Population Health, QLD, Australia; Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
| | | | | | - Kaire Innos
- National Institute for Health Development, Tallinn, Estonia
| | | | | | | | - Sun Ha Jee
- Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | | | - Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Guohong Jiang
- Tianjin Centres for Diseases Control and Prevention, Tianjin, China
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Knud Juel
- National Institute of Public Health, Copenhagen, Denmark
| | | | | | | | - André Karch
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | - Anil Kaul
- Oklahoma State University, Tulsa, OK, USA
| | | | - Konstantin Kazanjan
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Dhruv S Kazi
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Maia Kereselidze
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | | | | | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Luke Knibbs
- University of Queensland, Brisbane, QLD, Australia
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Soewarta Kosen
- Centre for Community Empowerment, Health Policy and Humanities, National Institute of Health Research and Development, Jakarta, Indonesia
| | | | - Chanda Kulkarni
- Rajrajeshwari Medical College and Hospital, Bangalore, India
| | | | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | | | - Ravi B Kumar
- Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, India
| | - Gene Kwan
- Boston Medical Centre, Boston, MA, USA
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Ratilal Lalloo
- Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry, University of Adelaide, Adelaide, SA, Australia
| | - Hilton Lam
- Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
| | - Van C Lansingh
- International Agency for the Prevention of Blindness and Vision 2020, Weston, FL, USA
| | | | | | | | - Mall Leinsalu
- National Institute for Health Development, Tallinn, Estonia
| | | | - Xiaohong Li
- National Centre for Birth Defects Monitoring of China, Chengdu, China
| | - Yichong Li
- National Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China
| | | | - Juan Liang
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaofeng Liang
- Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | - Shiwei Liu
- National Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China
| | - Yang Liu
- University of the East Ramon Magsaysay Memorial Medical Centre, Quezon City, Philippines
| | | | - Stephanie J London
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | | | - Jixiang Ma
- National Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China
| | - Stefan Ma
- Ministry of Health Singapore, Singapore, Singapore
| | | | | | - Marek Majdan
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | | | | | | | | | | | | | | | | | - Ted R Miller
- Pacific Institute for Research and Evaluation, Calverton, MD, USA
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Lorenzo Monasta
- Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy
| | | | | | | | - Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Iran University of Medical Sciences, Department of Community Medicine, Tehran, Iran
| | - Rintaro Mori
- National Centre for Child Health and Development, Setagaya, Tokyo, Japan
| | | | | | - Aliya Naheed
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | | | | | - Denis Nash
- School of Public Health, State University of New York, New York, NY, USA
| | | | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Sudan Prasad Neupane
- Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo, Norway
| | - Charles R Newton
- Kenya Medical Research Institute Wellcome Trust Programme, Kilifi, Kenya
| | - Marie Ng
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | - Sandra Nolte
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | - John Nelson Opio
- Lira District Local Government, Lira Municipal Council, Lira, Uganda
| | - Orish Ebere Orisakwe
- Toxicology Unit, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt, Nigeria
| | | | | | - Jae-Hyun Park
- Sungkyunkwan University School of Medicine, Suwon, South Korea
| | | | | | - Vinod K Paul
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Neil Pearce
- London School of Hygiene & Tropical Medicine, London, UK
| | - David M Pereira
- 3B's Research Group in Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, and ICVS/3B's PT Government Associate Laboratory, Braga Portugal
| | | | - Max Petzold
- Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | | | - Suzanne Polinder
- Erasmus Medical Center, Department of Public Health, Rotterdam, Netherlands
| | - Dan Pope
- University of Liverpool, Liverpool, UK
| | | | - Dima Qato
- College of Pharmacy, Chicago, IL, USA
| | | | | | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Saleem M Rana
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | | | - Luca Ronfani
- Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Trieste, Italy
| | - Nobhojit Roy
- Bhaba Atomic Research Center Hospital, Mumbai, India
| | | | | | | | | | | | | | | | | | | | | | | | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Sara Sheikhbahaei
- Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ivy Shiue
- Heriot-Watt University, Edinburgh, UK
| | | | | | - Andrea P Silva
- Instituto Nacional de Epidemiología Dr Juan H Jara, Mar del Plata, Buenos Aires, Argentina
| | | | | | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Cape Town, South Africa
| | - Sergey S Soshnikov
- Federal Research Institute for Health Organisation and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | | | | | - Lela Sturua
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Bryan L Sykes
- Department of Criminology, Law and Society (and Sociology), University of California Irvine, Irvine, CA, USA
| | | | | | - Feng Tan
- National Institute of Occupational Health and Poison Control, Beijing, China
| | | | | | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | - Jeffrey A Towbin
- Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - Bach X Tran
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Kingsley N Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | | | | | | | - Coen H van Gool
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | | | | | | | | | | | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Stephen Waller
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Linhong Wang
- National Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China
| | - XiaoRong Wang
- Shandong University Affiliated Jinan Central Hospital, Jinan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, China
| | | | | | - Robert G Weintraub
- University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | | | | | | | - John Q Wong
- Ateneo School of Medicine and Public Health, City of Pasig, Manila, Philippines
| | | | - Gelin Xu
- Nanjing University School of Medicine, Jinling Hospital, Nanjing, China
| | - Yang C Yang
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuichiro Yano
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | | | - Paul Yip
- University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | | | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Global Health Institute, School of Public Health, Wuhan University, Wuhan, China
| | - Kim Yun Jin
- TCM Medical Tk, Nusajaya, Johor Bahru, Malaysia
| | | | - Yong Zhao
- Chongqing Medical University, Chongqing, China
| | - Yingfeng Zheng
- Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Maigeng Zhou
- National Centre for Chronic and Non-Communicable Disease Control and Prevention, Beijing, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiao Nong Zou
- Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Alan D Lopez
- University of Melbourne, Melbourne, VIC, Australia
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Rafael Lozano
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; National Institute of Public Health, Cuernavaca, Mexico
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