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Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00757-8. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Torborg A, Meyer H, El Fiky M, Fawzy M, Elhadi M, Ademuyiwa AO, Osinaike BB, Hewitt-Smith A, Nabukenya MT, Bisegerwa R, Bouaoud S, Abdoun M, El Adib AR, Kifle Belachew F, Gebre M, Taye DB, Kechiche N, Fadalla T, Abdallah B, Chaibou MS, Nyarko MYA, Ki KB, Shalongo S, Mulwafu W, Thomson E, Traore MM, Ndonga A, Bittaye M, Samateh AL, Munlemvo DM, Kalongo JJ, Coulibaly Y, Coulibaly Y, Ravelojaona V, ANDRIAMANARIVO L, RAHERISON AR, RANDRIAMIZAO HMR, RAMKALAWAN K, Omar MA, Ndikontar R, Joseph D, Dahir S, Mohamed M, Ali Daoud H, Ndarukwa P, OTIOBANDA GF, Banguti P, Neil K, Derbew M, Fanny M, Smalle I, Taylor EH, Duvenage H, Hardy A, Kluyts H, Pearse R, Biccard B, AARON OI, Abd Elazeem Mohammed HAS, Abdalkarim B, Abdalla A, Abdallah MAA, Abdeewi S, Abdel Ghafar T, Abdelaleem A, Abdelaleem IA, Abdelgader K, Abdelgadir W, Abdelhafez M, Abdelhalim A, Abdelkabir M, Abdelkader Osman M, Abdelkarim M, Abdelkarim M, Abdelmohsen SM, Abdelnassir M, Abdelrahman ASM, Abdelwahed AE, Abdelzaher M, Abderrahim BA, Abdoulaye T, Abdulai S, Abdulghaffar YA, Abdullah F, Abdullahi LB, Abdullahi M, Abdulrazik S, Abdulsalam KI, Abdulwahed E, Abdus-Salam R, ABE TOLUSHE, Abera Mulugeta G, Aboelghait AA, Abol Oyoun N, Aboubekr B, Abraham M, Abu M, Abuagila AA, Abubakar M, Abugilah M, Abuzeid IA, Achouri D, Acquah SA, Adam NBA, ADAMU AUWAL, Adamu KM, ADAMU MUHAMMAD, ADAMU S, Adane SG, Adeaga M, Adebayo S, Adedire A, Adegoke PA, Ademuyiwa AO, Adeniyi AA, Adeoye I, Aderibigbe G, ADEROUNMU A, ADEYEMI WILLIAMS, ADEYEMO A, Adigun T, Adika ED, ADISA AO, Adjei E, Adjepong-Tandoh EK, Ads AM, ADUMAH DCC, ADUMAH LO, Adzamli I, Afari J, Afedo W, Affan A, AFOLAYAN AO, Agaba S, Agbeno E, Agbonrofo P, Aghadi I, AGU EDITH, Agyen T, Agyen-Mensah K, Ahensan D, Ahmad MH, AHMED A, Ahmed L, Ahmed NYAA, Ahmed R, Ahmed Jroush M, ahmed maghur H, AHOGNI GG, Ait Yahia S, Aji N, Aji SA, Akerele W, Akhideno I, Akinmokun I, AKINNIYI AT, Akinniyi A, AKINYEMI S, Akitoye OA, AKPAETTE IC, Akuma TJ, Akuokor D, Akwei CNA, Al 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Ebrahem OKA, Ebrahim Z, Edena ME, Effa Ngono R, Egbuchulem K, Egdeer A, Eguma SA, Ehimhantie M, EJIOFOR OC, Ejuma LO, Ekenze S, Ekhmaj RA, Ekor O, EKPA S, Ekpemo CS, Ekudo J, Ekwunife OH, El Koraichi A, El Magrahi H, El Mejrab M, El Sadek R, El YOUBI H, Eladani O, Elamesh SAH, Elamien M, Elamin Elnour MA, Elbadawy MA, Elbaseet H, Elderwy AA, Elebute O, Elgamal M, Elgenidy A, Elghareeb A, Elgherwi L, Elhadad R, Elhadi A, Elhassan M, Elkhouly AM, Ellebedy M, ELMAJRI MOHAMEDFUAD, Elmandouh O, Elmandouh R, Elmorsi R, ELOMBILA M, Elsadek M, Elsalhawy S, Elsayem K, Elshafiey M, El-Sharkawi M, Elshazly M, Eltaub D, Eltayeb AA, Eltayeb MEZ, Eltegani Abdalla A, ElWakeel M, Embu H, Emoru A, Enicker B, Enti D, Entsua-Mensah K, Eseile SI, Essuman VA, Et-taghy H, Etwire V, Eyaman KD, Ezbeida M, EZEKIEL ANTHONYSABO, Ezidiegwu SU, Ezomike UO, FABOYA O, Fadlalmola H, FAGBAYIMU OM, Faida H, FALL K, Farahat S, Faraj A, Faraj N, Farghaly A, Farhat KOA, Farinyaro AU, Fathi Bani G, Fattah A, Fawzy M, Fening N, Fentahun Emrie A, Fidieley M, Fikadu Keneni D, Fischer M, Flint M, Fodo N, Fofana N, Fokeerah N, Folami E, Folokwe S, Fonternel D, Fosi Kamga G, Fotso LK, Fourtounas M, Frankish L, Gabier I, Gacii VM, Gaffoor MS, Gagara M, GALADIMA HA, Gamubaka R, Ganey M, Ganiyu OO, Gasa N, Gatheru AP, Gawu VS, Gaya SSD, GAYE I, Gebremichael Ganta A, Gelaw KG, Geldenhuys L, Getachew Tegegn A, Ghemmied M, Ghmagh R, GILES AHEREZA, Ginsburg RG, Girma K, Gjam F, Glover-Addy H, Gobin V, Gomeh P, Gomez D, Gorelyk A, Gossaye A, Govender V, Grant J, Grayson BL, Grobbelaar M, Gueye KR, GUIRO H, Gumede S, Gurure D, Gusibat A, Gyeke-Boafo NK, HACHEMI S, Haddis K, Haidar A, Haif A, Hameed-Ikram S, Hamid H, Hamukwaya D, Hanson NA, Hanzi J, Hardcastle T, Harissou A, Hasan A, Hasan HB, Hasan NB, Hashi AS, Hashish AA, Hassaan I, Hassan S, Hassan SA, Hassan T, Hassan Z, Hassane ML, Hassanein M, Hawu Y, Haywood D, Heelan H, Hendricks N, Hillah A, Hlela Q, HMAMOUCHI B, Hoko Z, Honny D, Honore S, Houidi S, Human T, Hussain E, Hussain Kona MH, Hussein Y, Ibekwe TS, Ibiyemi A, IBIYEYE TAIBAT, Ibrahim IA, Ibrahim LI, Ibrahim S, Ibrahim Abubakar A, Ibrahim Alain T, Idipo F, Idoko G, Idowu O, Idris MEA, Igaga EN, Iindongo E, IITULA P, IKOTUN O, ILLE G, Imposo DH, Invernizzi J, Irungu E, Isbayqah AM, Isbayqah EM, Ismael G, Ismail AM, Itambi AM, Jabang JN, Jaga R, Jaganath U, Jaiteh L, Jallow CS, James O, Javed S, Jithoo S, Jlidi S, Joel L, Johnson M, JONES TAIWO, Jooma Z, Joomye S, Joosab M, JOUINI R, Jubail MJ, Juggoo C, Jumbi TM, Kaabar N, Kabirou M, Kabiru AM, Kabre BY, Kache S, Kacimi SEO, KADAS ABUBAKARSAIDU, KAHANSIM B, Kalipa M, Kalongo JJK, Kalu NE, Kamate B, Kamwangen GM, Kandjimi M, Kanjana-Zondo N, Kankpeyeng L, Kapalamula T, Karadji S, Kargbo MA, Karghul M, Kaskar R, Kasker R, Kasobya F, Kassem O, Kateregga G, Kayima P, Kedwany AM, Ken-Amoah S, Kenneth TK, KERISSE ANEH, KERKENI Y, Khairi R, Khaled M, Khalifa E, Khalifa MS, Khalil MK, Khattab MSI, Khodary AR, Khumalo BF, Khumalo P, Kigayi JP, Kimutai TK, KINDO B, KIRFI ABDULLAHIMUSA, Koggoh P, Koko AA, Kopieniak M, Kotagiri C, Kotey E, Kouicem AT, Kpangkpari R, Kudoh V, Kufonya N, Kuhn W, Kutor J, Kwakye A, Kynes JM, Lambrechts L, Lamiri R, LANRE OLOKONASIRUDEEN, Larvie P, Lateef AK, LATRECHE S, Lawal T, Leballo G, Lebereki S, Lee D, Leeb G, Leonard T, LEYONO-MAWANDZA PDG, Likongo TB, Limalia Z, LIMAN HARUNAUSMAN, Loae N, Lompoli BNE, Lusungu D, M.Mokhtar FALZ, Madany MEDM, Maddy RJ, Madombwe G, Mafabi S, Magashi MK, Maharaj S, Mahfouz SM, Mahlare KRV, Mahmoud F, Maikassoua M, Maison P, Maiwald D, Makhoba P, Makinita SG, Makou epse Tolefac M, Malau TK, Mamathuntsha TG, Mamo TN, Mamuda A, Mandundzo P, Mangray H, Mani S, Manneh EK, Mansour NM, Manyere DV, Mapurisa A, Mare P, Martin ME, Mashaal A, Mashaya S, Masilela PB, Mathebula R, Mathinya T, Matlala TK, Matlou M, Matos-Puig R, Matoug S, Maudarbocus MJ, Mavesere HP, Mavila J, Mayet S, Maygag M, Mbatha N, Mbatudde R, Mbiya Kapinga A, Mbuyamba J, Mbuyi AT, Mdlalose N, Prowling M, Mejeni N, Mekonnen Ejigu Y, Merghani S, Metogo JEN, Mhiri R, Mhone L, Michael A, Miko AM, Milad A, Mishra R, Mjadu L, Mkhontwana N, Mlambo N, Mncwango Z, Mngoma G, Mnguni M, Modekwe VI, Mogane P, Moghazy R, Mogotsi K, Mohalal MS, Mohamed AAA, Mohamed M, Mohamed MEE, Mohamed SA, Mohamedkheir MA, Mohammad AL, Mohammad AD, Mohammad AM, Mohammed A, Mohammed M, Mohammed RI, Mohammed R, Mohammed TSA, Mohammedosman D, Mohsen SM, Molla Getahun A, Moloisi M, Monib FA, Moodley K, Moopanar M, Morgan F, Moris B, Morna M, Moses V, Mostafa MM, Motiang M, Motseoile T, Motshabi P, MOUSSAOUI N, Mpoto DB, MPOY EMY MONKESSA CM, MRARA BUSISIWE, Mshelbwala PM, Msherghi A, Msibi T, Mubunda RK, Muhammad AB, Muhammad S, Muhanguzi J, Muhindo R, Mukenga MM, Mukuna PM, Mulewa D, Munanzvi KS, Mungur L, Munubi A, Munyalo FS, Muriithi JM, Musa AA, Musa K, Musa MAE, Musana F, Musewu TD, Musiitwa AK, Mwangi CM, Mwepu IM, Mwepu MI, Mwika PM, Mwiti TM, Myeni P, Mzoneli N, Naana R, Nabukenya G, Nabunya S, Naidoo A, Naidoo V, Naidu P, Nakyanzi C, Nambi E, Nampawu MJ, Nampiina G, Namutebi H, Nana B, Nanda JSY, Nanimambi J, Nantongo B, Napolitano L, Naser A, Nassar AS, Nassar MS, Nasser N, Nawezo JG, NDIAYE A, NDIAYE CAT, Ndiaye F, Ndibarekera SH, Ndjoko SM, Ndlovu M, Nduwayezu R, Negash S, Nehema S, Neil K, Neizer M, NEJMI S, Nezam-Parast M, Ng How Tseung K, Ngcelwane T, Ngene I, Nghidinwa H, Ngissah R, Ngock GFFN, Ngouane D, Ngumi Z, Nibret Y, NIENGO OUTSOUTA G, Njie M, NJOKANMA RA, Nkhata L, Nkhuna NT, Nkosi N, Nkosi S, Nkwembe CM, Nnaji C, Nneji-Akazie T, Nongqo N, Nortey M, Noutakdie Tochie J, Nsaful J, Nsimire BB, Nte SK, Ntshingila C, Ntsie NP, Ntsoane D, Ntumy MY, Nuer-Allornuvor G, Nuhu S, Nutsuklo P, Nwachukwu CU, NWAFULUME NNAEMEKA, Nwangwu E, Nwankwo EP, Nyame CA, Nyamekye E, Nyankah E, Nyoka-Mokgalong C, Oase D, Obande JO, Obbeng A, Obeng-Adjei GI, Obianyo I, Obianyo NE, Obiechina S, OBRI AI, ODI TEMITOPE, Odingo J, Oelofsen S, Ofori E, Ofori-Adjei D, Ogaji IM, Ogundoyin OO, OGUNLEYE OLABISI, OGUNS A, Ogunsua O, Ohemeng-Mensah E, Ojediran O, Ojediran O, Ojewuyi A, Ojewuyi O, Ojo A, OJO OO, Ojo O, Okedare A, Okenwa SC, Oko AG, Okojie N, Okonkwo LN, Okoth P, Okunlola AI, Okunlola CK, Okurut M, Oladimeji M, Oladiran A, Olagunju GR, Olajide ARL, Olajide AT, Olang PR, Olayinka O, Olori S, Olulana D, Olulana DI, Olusanya B, Omar DE, Omar MA, Onakpoya U, ONeil M, Onen H, ONYEKA C, Oosthuizen A, Opandoh I, Opiyo S, Oppong J, Orewole TO, Orji M, Osagie O, Osagie OT, Osaheni O, Osama Sleem A, Osawa FO, Osei F, Osei-Nketiah S, Osei-Poku D, Osman A, Osman Ahmed M, Osman Suliman SO, Otchere K, Othman AAA, Othman E, Othman M, Otim P, Otim T, Otman RH, Otoki V, OUDJHIH M, OUEDRAOGO I, OUEDRAOGO PJ, Ousmane Hamady I, Ouyahia A, OWOJUYIGBE A, Owoo C, Owoo P, Owusu Boamah M, Oyedele A, Oyedepo O, Oyegbola C, Panday J, Parker EUE, Parker I, Parker RK, Pembe JN, Percivale B, Pereko J, Pérez M, Perumal N, Pillay L, Pretorius R, Prinsloo R, Pryce C, Puryag A, QUADRI OR, Quansah K, Quarcoopome C, Quarshie A, Quartson E, Quashie-Sam J, Rabiu A, Rabiu T, Rahma M, Rahman GA, Rais M, Rajah C, Rakotondrainibe A, Ramakrishnan R, Ramatou S, Ramdawon B, Ramdhani K, Ramkaun Y, RAPHAEL OSELE, Raslan HMA, Redelinghuys C, Riffi O, Rikhotso H, Roberts CAP, Robertson C, Roland N, Roos J, S. Abdalgadir E, Saad A, Saad MM, Saad El-Tanekhy A, Saadi C, Saadu T, Saber M, Sabir Yassin FM, Sabo VY, Sabra TA, Saeid DA, Safar A, Sagboze S, Sahnoun L, Salahu BM, Salami K, Salawu AI, Saleh H, Saleh IA, Saleh KM, Salele AM, Salem F, Salem O, Salih MAIA, Salisu I, Sall M, SAMB CF, Sangak IA, Sanoussi NM, Sanya D, Sanyang AB, Sarpong P, SARR JN, Schnaubelt R, Searyoh K, SECK NF, Secka AS, Seif M, Seilbea Y, Semret Hailu B, Sepenu P, Sewlall J, Seyi-Olajide J, Shai S, Shalaby AMO, SHAPHAT IBRAHIM, Shava G, Sheidu Owuda A, Sheshe AA, Shetiwy M, Shezi N, Shihab MH, Shitakumuna H, Shitaye N, Shitta AH, Sholadoye TT, Shouasha P, Shu'aibu NG, Shuiap NM, Sibeko B, Sikhakhane S, Sikwete G, Sime Gizaw H, Simelane N, Simon E, Singh U, SIRAJALDIN A, Siriboe E, Siyothula T, Siyotula T, Smart-Yeboah A, SMITH S, Solala S, Soliman EA, Solo CE, Sombéwendin Charles I, Sonaike M, Songden DZ, Sottie D, Soualili Z, Soula E, Souleymane S, SOWANDE OA, Spytko A, Srir DOM, Ssebuguzi L, Stegmann GF, Strauss L, Struwig E, Succi M, Suleiman AR, Suliman M, Swartz M, Taha TM, Takai IU, Takou BH, Takrouney MH, Takure A, TALABI AO, Tall M, Taute C, Tawfik M, Taylor J, Tembe DS, Temesgen F, Tesfaye E, Theko D, Thiart M, Thompson R, Thuer L, Tientcheu Fabrice T, Tilahun ZB, Tilahun Woldetsadik T, Timo M, Timotews N, Tjiyokola D, Tolani MA, TOUABTI S, Traoré D, Tsegha LJ, Tseli M, Tumuhimbise C, Tumukunde J, Tunkara SFS, Turshan L, Turton E, Uchendu CC, UDIE GU, UDOSEN JE, Ugalahi M, Ugwu EM, UGWU IE, Ugwu JO, Ugwunne CA, Ukpabio UE, Umar AM, UMEH CL, Ungen R, Usang U, Usenbo T, Usman MI, UWAYESU R, Van Aswegen B, van der Byl A, van der Linde P, van der Walt S, van Schalkwyk HP, van Tonder C, van Vuuren S, van Wyk J, van Zyl S, Wabule A, Wacays A, Waheed Mowafy G, Waisiko B, Walawah D, Walithandia E, Wamwaki J, Wataaka N, Wessels N, Wessels N, Williams E, WILLIAMS O, Woldegiorgis A, Wolfaardt G, Wondossen M, Woodun R, Workineh ST, Wubetu S, Yahia M, Yakubu H, Yakubu SY, Yalewu DZ, YAMEOGO TAC, Yeboah F, YENYI AHUKA LONGOMBE T, Younes E, Young C, Younis N, Younus TYI, YUSUF STEPHEN, Zaki F, Zbida I, Zenda T, ZERIZER Y, Zingoni K, Zitouni H, ZONGO PV, Zubi A, Zulu N, Zulu N, Yakubu H, Yakubu SY, Yalewu DZ, YAMEOGO TAC, Yeboah F, YENYI AHUKA LONGOMBE T, Younes E, Young C, Younis N, Younus TYI, YUSUF STEPHEN, Zaki F, Zbida I, Zenda T, ZERIZER Y, Zingoni K, Zitouni H, ZONGO PV, Zubi A, Zulu N, Zulu N. Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study. Lancet 2024; 403:1482-1492. [PMID: 38527482 DOI: 10.1016/s0140-6736(24)00103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa. METHODS This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407. FINDINGS We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals). INTERPRETATION Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4-14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue. FUNDING Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda.
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Avan A, Feigin VL, Bennett DA, Steinmetz JD, Hachinski V, Stranges S, Owolabi MO, Aali A, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abd-Allah F, Abdollahzade S, Abidi H, Abolhassani H, Abualhasan A, Abu-Gharbieh E, Abu-Rmeileh NME, Abu-Zaid A, Ahmad A, Ahmadi S, Ahmed LA, Ajami M, Al Hamad H, Alanezi FM, Alanzi TM, Alimohamadi Y, Aljunid SM, Al-Raddadi RM, Amiri S, Arabloo J, Arulappan J, Arumugam A, Asadi-Pooya AA, Athar M, Athari SS, Atout MMW, Azadnajafabad S, Azangou-Khyavy M, Azari Jafari A, Azzam AY, Baghcheghi N, Bagherieh S, Baltatu OC, Bazmandegan G, Bhojaraja VS, Bijani A, Bitaraf S, Calina D, Darwish AH, Djalalinia S, Doheim MF, Dorostkar F, Eini E, El Nahas N, El Sayed I, Elhadi M, Elmonem MA, Eskandarieh S, Faghani S, Fallahzadeh A, Farahmand M, Ghafourifard M, Ghamari SH, Gholami A, Ghozy S, Goleij P, Hadei M, Hafezi-Nejad N, Haj-Mirzaian A, Halwani R, Hamidi S, Hasaballah AI, Hassan A, Hedna K, Hegazy MI, Heidari-Soureshjani R, Hosseini MS, Hoveidamanesh S, Jahrami H, Jamshidi E, Javaheri T, Jayapal SK, Kalankesh LR, Kalhor R, Kamiab Z, Keykhaei M, Khader YS, Khan M, Khan MAB, Khatatbeh, Khayat Kashani HR, Khosravi A, Kompani F, Koohestani HR, Larijani B, Lasrado S, Magdy Abd El Razek M, Malekpour MR, Malik AA, Mansournia MA, Mardi P, Maroufi SF, Masoudi S, Mayeli M, Mehrabi Nasab E, Menezes RG, Mirmoeeni S, Mirza-Aghazadeh-Attari M, Mobarakabadi M, Mohammadi E, Mohammadi S, Mohan S, Mokdad AH, Momtazmanesh S, Montazeri F, Moradi Sarabi M, Moraga P, Morovatdar N, Motaghinejad M, Naghavi M, Natto ZS, Nejadghaderi SA, Noroozi N, Okati-Aliabad H, Pazoki Toroudi H, Perna S, Piradov MA, Pourahmadi M, Rafiei A, Rahimi-Movaghar V, Rahmani AM, Rahmani S, Rahmanian V, Rajabpour-Sanati A, Rao CR, Rashidi MM, Rawassizadeh R, Razeghian-Jahromi I, Redwan EMM, Rezaee M, Rezaei N, Rezaei N, Rezaei N, Rezaeian M, Rikhtegar R, Saad AMA, Saddik B, Sadeghi M, Sadeghian S, Saeedi Moghaddam S, Sahebkar A, Salahi S, Salahi S, Samy AM, Sanadgol N, Sarveazad A, Sathian B, Saylan M, Shahbandi A, Shahrokhi S, Shams-Beyranvand M, Shanawaz M, Sharifi-Rad J, Sheikhi RA, Shetty JK, Shobeiri P, Shorofi SA, Siabani S, Tabatabaei SM, Taheri Abkenar Y, Taheri Soodejani M, Temsah MH, Vakilian A, Valadan Tahbaz S, Valizadeh R, Vaziri S, Vo B, Yahyazadeh Jabbari SH, Yesiltepe M, Zaki N, Zare I, Zare Dehnavi A, Zoladl M. The burden of neurological conditions in north Africa and the Middle East, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019. Lancet Glob Health 2024:S2214-109X(24)00093-7. [PMID: 38604203 DOI: 10.1016/s2214-109x(24)00093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The burden of neurological conditions in north Africa and the Middle East is increasing. We aimed to assess the changes in the burden of neurological conditions in this super-region to aid with future decision making. METHODS In this analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 data, we examined temporal trends of disability-adjusted life-years (DALYs; deaths and disabilities combined), deaths, incident cases, and prevalent cases of 14 major neurological conditions and eight subtypes in 21 countries in the north Africa and the Middle East super-region. Additionally, we assessed neurological DALYs due to 22 potentially modifiable risk factors, within four levels of classification, during the period 1990-2019. We used a Bayesian modelling estimation approach, and generated 95% uncertainty intervals (UIs) for final estimates on the basis of the 2·5th and 97·5th percentiles of 1000 draws from the posterior distribution. FINDINGS In 2019, there were 441·1 thousand (95% UI 347·2-598·4) deaths and 17·6 million (12·5-24·7) neurological DALYs in north Africa and the Middle East. The leading causes of neurological DALYs were stroke, migraine, and Alzheimer's disease and other dementias (hereafter dementias). In north Africa and the Middle East in 2019, 85·8% (82·6-89·1) of stroke and 39·9% (26·4-54·7) of dementia age-standardised DALYs were attributable to modifiable risk factors. North Africa and the Middle East had the highest age-standardised DALY rates per 100 000 population due to dementia (387·0 [172·0-848·5]), Parkinson's disease (84·4 [74·7-103·2]), and migraine (601·4 [107·0-1371·8]) among the global super-regions. Between 1990 and 2019, there was a decrease in the age-standardised DALY rates related to meningitis (-75·8% [-81·1 to -69·5]), tetanus (-88·2% [-93·9 to -76·1]), stroke (-32·0% [-39·1 to -23·3]), intracerebral haemorrhage (-51·7% [-58·2 to -43·8]), idiopathic epilepsy (-26·2% [-43·6 to -1·1]), and subarachnoid haemorrhage (-62·8% [-71·6 to -41·0]), but for all other neurological conditions there was no change. During 1990-2019, the number of DALYs due to dementias, Parkinson's disease, multiple sclerosis, ischaemic stroke, and headache disorder (ie, migraine and tension-type headache) more than doubled in the super-region, and the burden of years lived with disability (YLDs), incidence, and prevalence of multiple sclerosis, motor neuron disease, Parkinson's disease, and ischaemic stroke increased both in age-standardised rate and count. During this period, the absolute burden of YLDs due to head and spinal injuries almost doubled. INTERPRETATION The increasing burden of neurological conditions in north Africa and the Middle East accompanies the increasing ageing population. Stroke and dementia are the primary causes of neurological disability and death, primarily attributable to common modifiable risk factors. Synergistic, systematic, lifetime, and multi-sectoral interventions aimed at preventing or mitigating the burden are needed. FUNDING Bill & Melinda Gates Foundation. TRANSLATIONS For the Persian, Arabic and Turkish translations of the abstract see Supplementary Materials section.
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Dhahri A, Laifi J, Gouadria S, Elhadi M, Dhahri E, Hlil EK. Correction: Correction: Influence of Ni content on structural, magnetocaloric and electrical properties in manganite La 0.6Ba 0.2Sr 0.2Mn 1-xNi xO 3 (0 ≤ x ≤ 0.1) type perovskites. RSC Adv 2024; 14:11121. [PMID: 38590350 PMCID: PMC10999905 DOI: 10.1039/d4ra90015d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
[This corrects the article DOI: 10.1039/D3RA90093B.][This corrects the article DOI: 10.1039/D1RA07059B.].
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Affiliation(s)
- Ahmed Dhahri
- Department of Physics, College of Science and Humanities - Dawadmi, Shaqra University Riyadh Saudi Arabia
- Laboratoire de Physique Appliquée, Faculté des Sciences de Sfax, Université de Sfax Tunisia
| | - J Laifi
- Physics Department, College of Science, Jouf University P.O. Box: 2014 Sakaka Saudi Arabia
| | - Soumaya Gouadria
- Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University P.O. Box 84428 Riyadh 11671 Saudi Arabia
| | - M Elhadi
- Department of Physics, College of Science and Humanities - Dawadmi, Shaqra University Riyadh Saudi Arabia
| | - E Dhahri
- Laboratoire de Physique Appliquée, Faculté des Sciences de Sfax, Université de Sfax Tunisia
| | - E K Hlil
- Univ. Grenoble Alpes, CNRS, Grenoble INP, Institut Néel 38000 Grenoble France
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MS, Bobirca AV, Bodolica V, Bodunrin AO, Bogale EK, Bogale KA, Bohlouli S, Bolarinwa OA, Boloor A, Bonakdar Hashemi M, Bonny A, Bora K, Bora Basara B, Borhany H, Borzutzky A, Bouaoud S, Boustany A, Boxe C, Boyko EJ, Brady OJ, Braithwaite D, Brant LC, Brauer M, Brazinova A, Brazo-Sayavera J, Breitborde NJK, Breitner S, Brenner H, Briko AN, Briko NI, Britton G, Brown J, Brugha T, Bulamu NB, Bulto LN, Buonsenso D, Burns RA, Busse R, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cao Y, Capodici A, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalheiro CG, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Cederroth CR, Cegolon L, Cembranel F, Cenderadewi M, Cercy KM, Cerin E, Cevik M, Chadwick J, Chahine Y, Chakraborty C, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Chang CK, Chang JC, Chanie GS, Charalampous P, Chattu 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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Bourne RRA, Jonas JB, Friedman D, Nangia V, Bron A, Tapply I, Fernandes AG, Cicinelli MV, Arrigo A, Leveziel N, Resnikoff S, Taylor HR, Sedighi T, Bikbov MM, Braithwaite T, Cheng CY, Congdon N, Del Monte MA, Ehrlich JR, Fricke T, Furtado JM, Gazzard G, George R, Hartnett ME, Kahloun R, Kempen JH, Khairallah M, Khanna RC, Kim JE, Lansingh VC, Leasher J, Naidoo KS, Nowak M, Pesudovs K, Peto T, Ramulu P, Topouzis F, Tsilimbaris M, Wang YX, Wang N, Flaxman S, Bourne RRA, Jonas JB, Casson RJ, Friedman DS, Nangia V, Bron AM, Tapply I, Fernandes AG, Cicinelli MV, Leveziel N, Briant PS, Vos T, Resnikoff S, Abate YH, Abate MD, Dolatabadi ZA, Abdollahi M, Aboagye RG, Abu-Gharbieh E, Aburuz S, Adnani QES, Aghamiri S, Ahinkorah BO, Ahmad D, Ahmadieh H, Ahmadzadeh H, Ahmed A, Alfaar AS, Alinia C, Almidani L, Amu H, Androudi S, Anil A, Arabloo J, Areda D, Ashraf T, Bagherieh S, Baltatu OC, Baran MF, Barrow A, Bashiri A, Bayileyegn NS, Bazvand F, Berhie AY, Bhatti JS, Bikbov M, Birck MG, Bitra VR, Bozic MM, Braithwaite T, Burkart K, Bustanji Y, Butt ZA, Cenderadewi M, Chattu VK, Coberly K, Dadras O, Dai X, Dascalu AM, Dastiridou A, Devanbu VGC, Dhimal M, Diaz D, Do THP, Do TC, Dziedzic AM, Ehrlich JR, Ekholuenetale M, Elhadi M, Emamian MH, Emamverdi M, Farrokhpour H, Fetensa G, Fischer F, Forouhari A, Fowobaje KR, Furtado JM, Gandhi AP, Gebregergis MWW, Goulart BNG, Gudeta MD, Gupta S, Gupta VK, Gupta VB, Heidari G, Hong SH, Huynh HH, Ibitoye SE, Ilic IM, Immurana M, Jayapal SK, Joseph N, Joshua CE, Kahloun R, Kandel H, Karaye IM, Kasraei H, Kebebew GM, Kempen JH, KhalafAlla MT, Khanal S, Khatib MN, Krishan K, Lahariya C, Leasher JL, Lim SS, Marzo RR, Maugeri A, Meng Y, Mestrovic T, Mishra M, Mohamed NS, Mojiri-forushani H, Mokdad AH, Momeni-Moghaddam H, Montazeri F, Mulita A, Murray CJL, Foodani MN, Naik GR, Natto ZS, Nayak BP, Negaresh M, Negash H, Nguyen DH, Oancea B, Olagunju AT, Olatubi MI, Osman WMS, Osuagwu UL, Padubidri JR, Panda-Jonas S, Pardhan S, Park S, Patel J, Perianayagam A, Pesudovs K, Pham HT, Prates EJS, Qattea I, Rahim F, Rahman M, Rapaka D, Rawaf S, Rezaei N, Roy P, Saddik B, Saeed U, Safi SZ, Safi S, Sakshaug JW, Saleh MA, Samuel VP, Samy AM, Saravanan A, Seylani A, Shaikh MA, Shamim MA, Shannawaz M, Shashamo BB, Shayan M, Shittu A, Siddig EE, Singh JA, Solomon Y, Sousa RARC, Tabatabaei SM, Tabish M, Ticoalu JHV, Toma TM, Tsatsakis A, Tsegay GM, Valizadeh R, Viskadourou M, Wassie GT, Wickramasinghe ND, Yon DK, You Y, Flaxman S, Steinmetz JD. Global estimates on the number of people blind or visually impaired by glaucoma: A meta-analysis from 2000 to 2020. Eye (Lond) 2024:10.1038/s41433-024-02995-5. [PMID: 38565601 DOI: 10.1038/s41433-024-02995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/20/2023] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by glaucoma and their proportion of the total number of vision-impaired individuals. METHODS A systematic review and meta-analysis of published population studies and grey literature from 2000 to 2020 was carried out to estimate global and regional trends in number of people with vision loss due to glaucoma. Moderate or severe vision loss (MSVI) was defined as visual acuity of 6/60 or better but <6/18 (moderate) and visual acuity of 3/60 or better but <6/60 (severe vision loss). Blindness was defined as presenting visual acuity <3/60. RESULTS Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa. Between 2000 and 2020, global age-standardized prevalence of glaucoma-related blindness among adults ≥50 years decreased by 26.06% among males (95% UI: 25.87, 26.24), and by 21.75% among females (95% UI: 21.54, 21.96), while MSVI due to glaucoma increased by 3.7% among males (95% UI: 3.42, 3.98), and by 7.3% in females (95% UI: 7.01, 7.59). CONCLUSIONS Within the last two decades, glaucoma has remained a major cause of blindness globally and regionally.
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Steinmetz JD, Seeher KM, Schiess N, Nichols E, Cao B, Servili C, Cavallera V, Cousin E, Hagins H, Moberg ME, Mehlman ML, Abate YH, Abbas J, Abbasi MA, Abbasian M, Abbastabar H, Abdelmasseh M, Abdollahi M, Abdollahi M, Abdollahifar MA, Abd-Rabu R, Abdulah DM, Abdullahi A, Abedi A, Abedi V, Abeldaño Zuñiga RA, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Aboyans V, Abrha WA, Abualhasan A, Abu-Gharbieh E, Aburuz S, Adamu LH, Addo IY, Adebayo OM, Adekanmbi V, Adekiya TA, Adikusuma W, Adnani QES, Adra S, Afework T, Afolabi AA, Afraz A, Afzal S, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad S, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed JQ, Ahmed LA, Ahmed MB, Ahmed SA, Ajami M, Aji B, Ajumobi O, Akade SE, Akbari M, Akbarialiabad H, Akhlaghi S, Akinosoglou K, Akinyemi RO, Akonde M, Al Hasan SM, Alahdab F, AL-Ahdal TMA, Al-amer RM, Albashtawy M, AlBataineh MT, Aldawsari KA, Alemi H, Alemi S, Algammal AM, Al-Gheethi AAS, Alhalaiqa FAN, Alhassan RK, Ali A, Ali EA, Ali L, Ali MU, Ali MM, Ali R, Ali S, Ali SSS, Ali Z, Alif SM, Alimohamadi Y, Aliyi AA, Aljofan M, Aljunid SM, Alladi S, Almazan JU, Almustanyir S, Al-Omari B, Alqahtani JS, Alqasmi I, Alqutaibi AY, Al-Shahi Salman R, Altaany Z, Al-Tawfiq JA, Altirkawi KA, Alvis-Guzman N, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Amani R, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Amusa GA, Amzat J, Ancuceanu R, Anderlini D, Anderson DB, Andrei CL, Androudi S, Angappan D, Angesom TW, Anil A, Ansari-Moghaddam A, Anwer R, Arafat M, Aravkin AY, Areda D, Ariffin H, Arifin H, Arkew M, Ärnlöv J, Arooj M, Artamonov AA, Artanti KD, Aruleba RT, Asadi-Pooya AA, Asena TF, Asghari-Jafarabadi M, Ashraf M, Ashraf T, Atalell KA, Athari SS, Atinafu BTT, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Avan A, Ayala Quintanilla BP, Ayatollahi H, Ayinde OO, Ayyoubzadeh SM, Azadnajafabad S, Azizi Z, Azizian K, Azzam AY, Babaei M, Badar M, Badiye AD, Baghdadi S, Bagherieh S, Bai R, Baig AA, Balakrishnan S, Balalla S, Baltatu OC, Banach M, Bandyopadhyay S, Banerjee I, Baran MF, Barboza MA, Barchitta M, Bardhan M, Barker-Collo SL, Bärnighausen TW, Barrow A, Bashash D, Bashiri H, Bashiru HA, Basiru A, Basso JD, Basu S, Batiha AMM, Batra K, Baune BT, Bedi N, Begde A, Begum T, Behnam B, Behnoush AH, Beiranvand M, Béjot Y, Bekele A, Belete MA, Belgaumi UI, Bemanalizadeh M, Bender RG, Benfor B, Bennett DA, Bensenor IM, Berice B, Bettencourt PJG, Beyene KA, Bhadra A, Bhagat DS, Bhangdia K, Bhardwaj N, Bhardwaj P, Bhargava A, Bhaskar S, Bhat AN, Bhat V, Bhatti GK, Bhatti JS, Bhatti R, Bijani A, Bikbov B, Bilalaga MM, Biswas A, Bitaraf S, Bitra VR, Bjørge T, Bodolica V, Bodunrin AO, Boloor A, Braithwaite D, Brayne C, Brenner H, Briko A, Bringas Vega ML, Brown J, Budke CM, Buonsenso D, Burkart K, Burns RA, Bustanji Y, Butt MH, Butt NS, Butt ZA, Cabral LS, Caetano dos Santos FL, Calina D, Campos-Nonato IR, Cao C, Carabin H, Cárdenas R, Carreras G, Carvalho AF, Castañeda-Orjuela CA, Casulli A, Catalá-López F, Catapano AL, Caye A, Cegolon L, Cenderadewi M, Cerin E, Chacón-Uscamaita PRU, Chan JSK, Chanie GS, Charan J, Chattu VK, Chekol Abebe E, Chen H, Chen J, Chi G, Chichagi F, Chidambaram SB, Chimoriya R, Ching PR, Chitheer A, Chong YY, Chopra H, Choudhari SG, Chowdhury EK, Chowdhury R, Christensen H, Chu DT, Chukwu IS, Chung E, Coberly K, Columbus A, Comachio J, Conde J, Cortesi PA, Costa VM, Couto RAS, Criqui MH, Cruz-Martins N, Dabbagh Ohadi MA, Dadana S, Dadras O, Dai X, Dai Z, D'Amico E, Danawi HA, Dandona L, Dandona R, Darwish AH, Das S, Das S, Dascalu AM, Dash NR, Dashti M, De la Hoz FP, de la Torre-Luque A, De Leo D, Dean FE, Dehghan A, Dehghan A, Dejene H, Demant D, Demetriades AK, Demissie S, Deng X, Desai HD, Devanbu VGC, Dhama K, Dharmaratne SD, Dhimal M, Dias da Silva D, Diaz D, Dibas M, Ding DD, Dinu M, Dirac MA, Diress M, Do TC, Do THP, Doan KDK, Dodangeh M, Doheim MF, Dokova KG, Dongarwar D, Dsouza HL, Dube J, Duraisamy S, Durojaiye OC, Dutta S, Dziedzic AM, 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R, Tabatabaei SM, Tabatabai S, Tabish M, Taheri M, Tahvildari A, Tajbakhsh A, Tampa M, Tamuzi JJLL, Tan KK, Tang H, Tareke M, Tarigan IU, Tat NY, Tat VY, Tavakoli Oliaee R, Tavangar SM, Tavasol A, Tefera YM, Tehrani-Banihashemi A, Temesgen WA, Temsah MH, Teramoto M, Tesfaye AH, Tesfaye EG, Tesler R, Thakali O, Thangaraju P, Thapa R, Thapar R, Thomas NK, Thrift AG, Ticoalu JHV, Tillawi T, Toghroli R, Tonelli M, Tovani-Palone MR, Traini E, Tran NM, Tran NH, Tran PV, Tromans SJ, Truelsen TC, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tualeka AR, Tufa DG, Ubah CS, Udoakang AJ, Ulhaq I, Umair M, Umakanthan S, Umapathi KK, Unim B, Unnikrishnan B, Vaithinathan AG, Vakilian A, Valadan Tahbaz S, Valizadeh R, Van den Eynde J, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Vellingiri B, Venketasubramanian N, Verras GI, Vervoort D, Villafañe JH, Villani L, Vinueza Veloz AF, Viskadourou M, Vladimirov SK, Vlassov V, Volovat SR, Vu LT, Vujcic IS, Wagaye B, Waheed Y, Wahood W, Walde MT, Wang F, Wang S, Wang Y, Wang YP, Waqas M, Waris A, Weerakoon KG, Weintraub RG, Weldemariam AH, Westerman R, Whisnant JL, Wickramasinghe DP, Wickramasinghe ND, Willekens B, Wilner LB, Winkler AS, Wolfe CDA, Wu AM, Wulf Hanson S, Xu S, Xu X, Yadollahpour A, Yaghoubi S, Yahya G, Yamagishi K, Yang L, Yano Y, Yao Y, Yehualashet SS, Yeshaneh A, Yesiltepe M, Yi S, Yiğit A, Yiğit V, Yon DK, Yonemoto N, You Y, Younis MZ, Yu C, Yusuf H, Zadey S, Zahedi M, Zakham F, Zaki N, Zali A, Zamagni G, Zand R, Zandieh GGZ, Zangiabadian M, Zarghami A, Zastrozhin MS, Zeariya MGM, Zegeye ZB, Zeukeng F, Zhai C, Zhang C, Zhang H, Zhang Y, Zhang ZJ, Zhao H, Zhao Y, Zheng P, Zhou H, Zhu B, Zhumagaliuly A, Zielińska M, Zikarg YT, Zoladl M, Murray CJL, Ong KL, Feigin VL, Vos T, Dua T. Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 2024; 23:344-381. [PMID: 38493795 PMCID: PMC10949203 DOI: 10.1016/s1474-4422(24)00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. FUNDING Bill & Melinda Gates Foundation.
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de Lange DW, Soliman IW, Leaver S, Boumendil A, Haas LEM, Watson X, Boulanger C, Szczeklik W, Artigas A, Morandi A, Andersen F, Jung C, Moreno R, Walther S, Oeyen S, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Guidet B, Flaatten H. The association of premorbid conditions with 6-month mortality in acutely admitted ICU patients over 80 years. Ann Intensive Care 2024; 14:46. [PMID: 38555336 PMCID: PMC10981642 DOI: 10.1186/s13613-024-01246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/08/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Premorbid conditions influence the outcome of acutely ill adult patients aged 80 years and over who are admitted to the ICU. The aim of this study was to determine the influence of such premorbid conditions on 6 month survival. METHODS Prospective cohort study in 242 ICUs from 22 countries including patients 80 years or above, admitted over a 6 months period to an ICU between May 2018 and May 2019. Only emergency (acute) ICU admissions in adult patients ≥ 80 years of age were eligible. Patients who were admitted after planned/elective surgery were excluded. We measured the Clinical Frailty Scale (CFS), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), disability with the Katz activities of daily living (ADL) score, comorbidities and a Polypharmacy Score (CPS). RESULTS Overall, the VIP2 study included 3920 patients. During ICU stay 1191 patients died (30.9%), and another 436 patients (11.1%) died after ICU discharge but within the first 30 days of admission, and an additional 895 patients died hereafter but within the first 6 months after admission (22.8%). The 6 months mortality was 64%. The median CFS was 4 (IQR 3-6). Frailty (CFS ≥ 5) was present in 26.6%. Cognitive decline (IQCODE above 3.5) was found in 30.2%. The median IQCODE was 3.19. A Katz ADL of 4 or less was present in 27.7%. Patients who surviving > 6 months were slightly younger (median age survivors 84 with IQR 81-86) than patients dying within the first 6 months (median age 84, IQR 82-87, p = 0.013), were less frequently frail (CFS > 5 in 19% versus 34%, p < 0.01) and were less dependent based on their Katz activities of daily living measurement (median Katz score 6, IQR 5-6 versus 6 points, IQR 3-6, p < 0.01). CONCLUSIONS We found that Clinical Frailty Scale, age, and SOFA at admission were independent prognostic factors for 6 month mortality after ICU admission in patients age 80 and above. Adding other geriatric syndromes and scores did not improve the model. This information can be used in shared-decision making. CLINICALTRIALS gov: NCT03370692.
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Affiliation(s)
- Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Ivo W Soliman
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Susannah Leaver
- Department of critical care, St George's Hospital London, London, UK
| | - Ariane Boumendil
- AP-HP, Hôpital Saint-Antoine, service de reanimation, F75012, Paris, France
| | - Lenneke E M Haas
- Department of Intensive Care, Diakonessen Hospital, Utrecht, The Netherlands
| | - Ximena Watson
- Department of critical care, St George's Hospital London, London, UK
| | - Carol Boulanger
- Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Antonio Artigas
- Department of Intensive Care Medecine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
- Critical Care Department, Sagrado Corazon-General de Cataluña University Hospitals, Quiron Salud, Barcelona, Spain
| | - Alessandro Morandi
- Department of Rehabilitation Hospital Ancelle di Cremona, Cremona, Italy
- Geriatric Research Group, Brescia, Italy
| | - Finn Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- NTNU, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Faculdada de Ciências de Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Sten Walther
- Linkoping University Hospital, Linkoping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, service de reanimation, 75012, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
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Ledesma JR, Ma J, Zhang M, Basting AVL, Chu HT, Vongpradith A, Novotney A, LeGrand KE, Xu YY, Dai X, Nicholson SI, Stafford LK, Carter A, Ross JM, Abbastabar H, Abdoun M, Abdulah DM, Aboagye RG, Abolhassani H, Abrha WA, Abubaker Ali H, Abu-Gharbieh E, Aburuz S, Addo IY, Adepoju AV, Adhikari K, Adnani QES, Adra S, Afework A, Aghamiri S, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad S, Ahmadzade AM, Ahmed H, Ahmed M, Ahmed A, Akinosoglou K, AL-Ahdal TMA, Alam N, Albashtawy M, AlBataineh MT, Al-Gheethi AAS, Ali A, Ali EA, Ali L, Ali Z, Ali SSS, Allel K, Altaf A, Al-Tawfiq JA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amani R, Amusa GA, Amzat J, Andrews JR, Anil A, Anwer R, Aravkin AY, Areda D, Artamonov AA, Aruleba RT, Asemahagn MA, Atre SR, Aujayeb A, Azadi D, Azadnajafabad S, Azzam AY, Badar M, Badiye AD, Bagherieh S, Bahadorikhalili S, Baig AA, Banach M, Banik B, Bardhan M, Barqawi HJ, Basharat Z, Baskaran P, Basu S, Beiranvand M, Belete MA, Belew MA, Belgaumi UI, Beloukas A, Bettencourt PJG, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhargava A, Bhat V, Bhatti JS, Bhatti GK, Bikbov B, Bitra VR, Bjegovic-Mikanovic V, Buonsenso D, Burkart K, Bustanji Y, Butt ZA, Camargos P, Cao Y, Carr S, Carvalho F, Cegolon L, Cenderadewi M, Cevik M, Chahine Y, Chattu VK, Ching PR, Chopra H, Chung E, Claassens MM, Coberly K, Cruz-Martins N, Dabo B, Dadana S, Dadras O, Darban I, Darega Gela J, Darwesh AM, Dashti M, Demessa BH, Demisse B, Demissie S, Derese AMA, Deribe K, Desai HD, Devanbu VGC, Dhali A, Dhama K, Dhingra S, Do THP, Dongarwar D, Dsouza HL, Dube J, Dziedzic AM, Ed-Dra A, Efendi F, Effendi DE, Eftekharimehrabad A, Ekadinata N, Ekundayo TC, Elhadi M, Elilo LT, Emeto TI, Engelbert Bain L, Fagbamigbe AF, Fahim A, Feizkhah A, Fetensa G, Fischer F, Gaipov A, Gandhi AP, Gautam RK, Gebregergis MW, Gebrehiwot M, Gebrekidan KG, Ghaffari K, Ghassemi F, Ghazy RM, Goodridge A, Goyal A, Guan SY, Gudeta MD, Guled RA, Gultom NB, Gupta VB, Gupta VK, Gupta S, Hagins H, Hailu SG, Hailu WB, Hamidi S, Hanif A, Harapan H, Hasan RS, Hassan S, Haubold J, Hezam K, Hong SH, Horita N, Hossain MB, Hosseinzadeh M, Hostiuc M, Hostiuc S, Huynh HH, Ibitoye SE, Ikuta KS, Ilic IM, Ilic MD, Islam MR, Ismail NE, Ismail F, Jafarzadeh A, Jakovljevic M, Jalili M, Janodia MD, Jomehzadeh N, Jonas JB, Joseph N, Joshua CE, Kabir Z, Kamble BD, Kanchan T, Kandel H, Kanmodi KK, Kantar RS, Karaye IM, Karimi Behnagh A, Kassa GG, Kaur RJ, Kaur N, Khajuria H, Khamesipour F, Khan YH, Khan MN, Khan Suheb MZ, Khatab K, Khatami F, Kim MS, Kosen S, Koul PA, Koulmane Laxminarayana SL, Krishan K, Kucuk Bicer B, Kuddus MA, Kulimbet M, Kumar N, Lal DK, Landires I, Latief K, Le TDT, Le TTT, Ledda C, Lee M, Lee SW, Lerango TL, Lim SS, Liu C, Liu X, Lopukhov PD, Luo H, Lv H, Mahajan PB, Mahboobipour AA, Majeed A, Malakan Rad E, Malhotra K, Malik MSA, Malinga LA, Mallhi TH, Manilal A, Martinez-Guerra BA, Martins-Melo FR, Marzo RR, Masoumi-Asl H, Mathur V, Maude RJ, Mehrotra R, Memish ZA, Mendoza W, Menezes RG, Merza MA, Mestrovic T, Mhlanga L, Misra S, Misra AK, Mithra P, Moazen B, Mohammed H, Mokdad AH, Monasta L, Moore CE, Mousavi P, Mulita F, Musaigwa F, Muthusamy R, Nagarajan AJ, Naghavi P, Naik GR, Naik G, Nair S, Nair TS, Natto ZS, Nayak BP, Negash H, Nguyen DH, Nguyen VT, Niazi RK, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Oancea B, Obamiro KO, Odetokun IA, Odo DBO, Odukoya OO, Oh IH, Okereke CO, Okonji OC, Oren E, Ortiz-Brizuela E, Osuagwu UL, Ouyahia A, P A MP, Parija PP, Parikh RR, Park S, Parthasarathi A, Patil S, Pawar S, Peng M, Pepito VCF, Peprah P, Perdigão J, Perico N, Pham HT, Postma MJ, Prabhu ARA, Prasad M, Prashant A, Prates EJS, Rahim F, Rahman M, Rahman MA, Rahmati M, Rajaa S, Ramasamy SK, Rao IR, Rao SJ, Rapaka D, Rashid AM, Ratan ZA, Ravikumar N, Rawaf S, Reddy MMRK, Redwan EMM, Remuzzi G, Reyes LF, Rezaei N, Rezaeian M, Rezahosseini O, Rodrigues M, Roy P, Ruela GDA, Sabour S, Saddik B, Saeed U, Safi SZ, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahiledengle B, Sahoo SS, Salam N, Salami AA, Saleem S, Saleh MA, Samadi Kafil H, Samadzadeh S, Samodra YL, Sanjeev RK, Saravanan A, Sawyer SM, Selvaraj S, Senapati S, Senthilkumaran S, Shah PA, Shahid S, Shaikh MA, Sham S, Shamshirgaran MA, Shanawaz M, Sharath M, Sherchan SP, Shetty RS, Shirzad-Aski H, Shittu A, Siddig EE, Silva JP, Singh S, Singh P, Singh H, Singh JA, Siraj MS, Siswanto S, Solanki R, Solomon Y, Soriano JB, Sreeramareddy CT, Srivastava VK, Steiropoulos P, Swain CK, Tabuchi T, Tampa M, Tamuzi JJLL, Tat NY, Tavakoli Oliaee R, Teklay G, Tesfaye EG, Tessema B, Thangaraju P, Thapar R, Thum CCC, Ticoalu JHV, Tleyjeh IM, Tobe-Gai R, Toma TM, Tram KH, Udoakang AJ, Umar TP, Umeokonkwo CD, Vahabi SM, Vaithinathan AG, van Boven JFM, Varthya SB, Wang Z, Warsame MSA, Westerman R, Wonde TE, Yaghoubi S, Yi S, Yiğit V, Yon DK, Yonemoto N, Yu C, Zakham F, Zangiabadian M, Zeukeng F, Zhang H, Zhao Y, Zheng P, Zielińska M, Salomon JA, Reiner Jr RC, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Infect Dis 2024:S1473-3099(24)00007-0. [PMID: 38518787 DOI: 10.1016/s1473-3099(24)00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. METHODS We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990-2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. FINDINGS We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5-14 years, 6·29% (5·05 to 7·70) in those aged 15-49 years, 5·72% (4·02 to 7·39) in those aged 50-69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5-14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15-49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50-69 years, and a 3·29% (-5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (-713 to 2180) fewer deaths. INTERPRETATION Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. FUNDING Bill & Melinda Gates Foundation.
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Schumacher AE, Kyu HH, Aali A, Abbafati C, Abbas J, Abbasgholizadeh R, Abbasi MA, Abbasian M, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdoun M, Abdullahi A, Abdurehman AM, Abebe M, Abedi A, Abedi A, Abegaz TM, Abeldaño Zuñiga RA, Abhilash ES, Abiodun OO, Aboagye RG, Abolhassani H, Abouzid M, Abreu LG, Abrha WA, Abrigo MRM, Abtahi D, Abu Rumeileh S, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Acuna JM, Adair T, Addo IY, Adebayo OM, Adegboye OA, Adekanmbi V, Aden B, Adepoju AV, Adetunji CO, Adeyeoluwa TE, Adeyomoye OI, Adha R, Adibi A, Adikusuma W, Adnani QES, Adra S, Afework A, Afolabi AA, Afraz A, Afyouni S, Afzal S, Agasthi P, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmadzade M, Ahmed A, Ahmed H, Ahmed LA, Ahmed MB, Ahmed SA, Ajami M, Aji B, Ajumobi O, Akalu GT, Akara EM, Akinosoglou K, Akkala S, Akyirem S, Al Hamad H, Al Hasan SM, Al Homsi A, Al Qadire M, Ala M, Aladelusi TO, AL-Ahdal TMA, Alalalmeh SO, Al-Aly Z, Alam K, Alam M, Alam Z, Al-amer RM, Alanezi FM, Alanzi TM, Albashtawy M, AlBataineh MT, Aldridge RW, Alemi S, Al-Eyadhy A, Al-Gheethi AAS, Alhabib KF, Alhalaiqa FAN, Al-Hanawi MK, Ali A, Ali A, Ali BA, Ali H, Ali MU, Ali R, Ali SSS, Ali Z, Alian Samakkhah S, Alicandro G, Alif SM, Aligol M, Alimi R, Aliyi AA, Al-Jumaily A, Aljunid SM, Almahmeed W, Al-Marwani S, Al-Maweri SAA, Almazan JU, Al-Mekhlafi HM, Almidani O, Alomari MA, Alonso N, Alqahtani JS, Alqutaibi AY, Al-Sabah SK, Altaf A, Al-Tawfiq JA, Altirkawi KA, Alvi FJ, Alwafi H, Al-Worafi YM, Aly H, Alzoubi KH, Amare AT, Ameyaw EK, Amhare AF, Amin TT, Amindarolzarbi A, Aminian Dehkordi J, Amiri S, Amu H, Amugsi DA, Amzat J, Ancuceanu R, Anderlini D, Andrade PP, Andrei CL, Andrei T, Angappan D, Anil A, Anjum A, Antony CM, Antriyandarti E, Anuoluwa IA, Anwar SL, Anyasodor AE, Appiah SCY, Aqeel M, Arabloo J, Arabzadeh Bahri R, Arab-Zozani M, Arafat M, Araújo AM, Aravkin AY, Aremu A, Ariffin H, 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Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samara KA, Samargandy S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanadgol N, Sanganyado E, Sanjeev RK, Sanmarchi F, Sanna F, Santri IN, Santric-Milicevic MM, Sarasmita MA, Saravanan A, Saravi B, Sarikhani Y, Sarkar C, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Sattin D, Saulam J, Sawyer SM, Saxena S, Saya GK, Sayadi Y, Sayeed A, Sayeed MA, Saylan M, Scarmeas N, Schaarschmidt BM, Schlee W, Schmidt MI, Schuermans A, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Semreen MH, Senapati S, Sengupta P, Senthilkumaran S, Sepanlou SG, Serban D, Sertsu A, Sethi Y, SeyedAlinaghi S, Seyedi SA, Shafaat A, Shafaat O, Shafie M, Shafiee A, Shah NS, Shah PA, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahwan MJ, Shaikh MA, Shakeri A, Shakil H, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Shariff M, Sharifi-Rad J, Sharma M, Sharma R, Sharma S, Sharma V, Shastry RP, Shavandi A, Shaw DH, Shayan AM, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shenoy MM, Shetty BSK, Shetty RS, Shey RA, Shiani A, Shibuya K, Shiferaw D, Shigematsu M, Shin JI, Shin MJ, Shiri R, Shirkoohi R, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shool S, Shrestha S, Shuja KH, Shuval K, Si Y, Sibhat MM, Siddig EE, Sigfusdottir ID, Silva JP, Silva LMLR, Silva S, Simões JP, Simpson CR, Singal A, Singh A, Singh A, Singh A, Singh BB, Singh B, Singh M, Singh M, Singh NP, Singh P, Singh S, Siraj MS, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Slepak ELN, Sohrabi H, Soleimani H, Soliman SSM, Solmi M, Solomon Y, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Sreeramareddy CT, Starnes JR, Starodubov VI, Starodubova AV, Stefan SC, Stein DJ, Steinbeis F, Steiropoulos P, Stockfelt L, Stokes MA, Stortecky S, Stranges S, Stroumpoulis K, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Sunkersing D, Susanty S, Swain CK, Sykes BL, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabish M, Taborda-Barata LM, Tabuchi T, Tadesse BT, Taheri A, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Tajbakhsh A, Talaat IM, Talukder A, Tamuzi JL, Tan KK, Tang H, Tang HK, Tat NY, Tat VY, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tebeje TM, Tefera YM, Teimoori M, Temsah MH, Temsah RMH, Teramoto M, Tesfaye SH, Thangaraju P, Thankappan KR, Thapa R, Thapar R, Thomas N, Thrift AG, Thum CCC, Tian J, Tichopad A, Ticoalu JHV, Tiruye TY, Tohidast SA, Tonelli M, Touvier M, Tovani-Palone MR, Tram KH, Tran NM, Trico D, Trihandini I, Tromans SJ, Truong VT, Truyen TTTT, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Ubah CS, Udoakang AJ, Udoh A, Ulhaq I, Ullah S, Ullah S, Umair M, Umar TP, Umeokonkwo CD, Umesh A, Unim B, Unnikrishnan B, Upadhyay E, Urso D, Vacante M, Vahdani AM, Vaithinathan AG, Valadan Tahbaz S, Valizadeh R, Van den Eynde J, Varavikova E, Varga O, Varma SA, Vart P, Varthya SB, Vasankari TJ, Veerman LJ, Venketasubramanian N, Venugopal D, Verghese NA, Verma M, Verma P, Veroux M, Verras GI, Vervoort D, Vieira RJ, Villafañe JH, Villani L, Villanueva GI, Villeneuve PJ, Violante FS, Visontay R, Vlassov V, Vo B, Vollset SE, Volovat SR, Volovici V, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wado YD, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang D, Wang F, Wang S, Wang S, Wang Y, Wang YP, Ward P, Watson S, Weaver MR, Weerakoon KG, Weiss DJ, Weldemariam AH, Wells KM, Wen YF, Werdecker A, Westerman R, Wickramasinghe DP, Wickramasinghe ND, Wijeratne T, Wilson S, Wojewodzic MW, Wool EE, Woolf AD, Wu D, Wulandari RD, Xiao H, Xu B, Xu X, Yadav L, Yaghoubi S, Yang L, Yano Y, Yao Y, Ye P, Yesera GE, Yesodharan R, Yesuf SA, Yiğit A, Yiğit V, Yip P, Yon DK, Yonemoto N, You Y, Younis MZ, Yu C, Zadey S, Zadnik V, Zafari N, Zahedi M, Zahid MN, Zahir M, Zakham F, Zaki N, Zakzuk J, Zamagni G, Zaman BA, Zaman SB, Zamora N, Zand R, Zandi M, Zandieh GGZ, Zanghì A, Zare I, Zastrozhin MS, Zeariya MGM, Zeng Y, Zhai C, Zhang C, Zhang H, Zhang H, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao Y, Zhao Y, Zheng P, Zhong C, Zhou J, Zhu B, Zhu Z, Ziaeefar P, Zielińska M, Zou Z, Zumla A, Zweck E, Zyoud SH, Lim SS, Murray CJL. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00476-8. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Wu AM, Cross M, Elliott JM, Culbreth GT, Haile LM, Steinmetz JD, Hagins H, Kopec JA, Brooks PM, Woolf AD, Kopansky-Giles DR, Walton DM, Treleaven JM, Dreinhoefer KE, Betteridge N, Abbasifard M, Abbasi-Kangevari Z, Addo IY, Adesina MA, Adnani QES, Aithala JP, Alhalaiqa FAN, Alimohamadi Y, Amiri S, Amu H, Antony B, Arabloo J, Aravkin AY, Asghari-Jafarabadi M, Atomsa GH, Azadnajafabad S, Azzam AY, Baghdadi S, Balogun SA, Balta AB, Banach M, Banakar M, Barrow A, Bashiri A, Bekele A, Bensenor IM, Bhardwaj P, Bhat AN, Bilchut AH, Briggs AM, Buchbinder R, Cao C, Chaurasia A, Chirinos-Caceres JL, Christensen SWM, Coberly K, Cousin E, Dadras O, Dai X, de Luca K, Dehghan A, Dong HJ, Ekholuenetale M, Elhadi M, Eshetu HB, Eskandarieh S, Etaee F, Fagbamigbe AF, Fares J, Fatehizadeh A, Feizkhah A, Ferreira ML, Ferreira N, Fischer F, Franklin RC, Ganesan B, Gebremichael MA, Gerema U, Gholami A, Ghozy S, Gill TK, Golechha M, Goleij P, Golinelli D, Graham SM, Haj-Mirzaian A, Harlianto NI, Hartvigsen J, Hasanian M, Hassen MB, Hay SI, Hebert JJ, Heidari G, Hoveidaei AH, Hsiao AK, Ibitoye SE, Iwu CCD, Jacob L, Janodia MD, Jin Y, Jonas JB, Joshua CE, Kandel H, Khader YS, Khajuria H, Khan EA, Khan MAB, Khatatbeh MM, Khateri S, Khayat Kashani HR, Khonji MS, Khubchandani J, Kim YJ, Kisa A, Kolahi AA, Koohestani HR, Krishan K, Kuddus M, Kuttikkattu A, Lasrado S, Lee YH, Legesse SM, Lim SS, Liu X, Lo J, Malih N, Manandhar SP, Mathews E, Mesregah MK, Mestrovic T, Miller TR, Mirghaderi SP, Misganaw A, Mohammadi E, Mohammed S, Mokdad AH, Momtazmanesh S, Moni MA, Mostafavi E, Murray CJL, Nair TS, Nejadghaderi SA, Nzoputam OJ, Oh IH, Okonji OC, Owolabi MO, Pacheco-Barrios K, Pahlevan Fallahy MT, Park S, Patel J, Pawar S, Pedersini P, Peres MFP, Petcu IR, Pourahmadi M, Qattea I, Ram P, Rashidi MM, Rawaf S, Rezaei N, Rezaei N, Saeed U, Saheb Sharif-Askari F, Salahi S, Sawhney M, Schumacher AE, Shafie M, Shahabi S, Shahbandi A, Shamekh A, Sharma S, Shiri R, Shobeiri P, Sinaei E, Singh A, Singh JA, Singh P, Skryabina AA, Smith AE, Tabish M, Tan KK, Tegegne MD, Tharwat S, Vahabi SM, Valadan Tahbaz S, Vasankari TJ, Venketasubramanian N, Vollset SE, Wang YP, Wiangkham T, Yonemoto N, Zangiabadian M, Zare I, Zemedikun DT, Zheng P, Ong KL, Vos T, March LM. Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2024; 6:e142-e155. [PMID: 38383088 PMCID: PMC10897950 DOI: 10.1016/s2665-9913(23)00321-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Neck pain is a highly prevalent condition that leads to considerable pain, disability, and economic cost. We present the most current estimates of neck pain prevalence and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) by age, sex, and location, with forecasted prevalence to 2050. METHODS Systematic reviews identified population-representative surveys used to estimate the prevalence of and YLDs from neck pain in 204 countries and territories, spanning from 1990 to 2020, with additional data from opportunistic review. Medical claims data from Taiwan (province of China) were also included. Input data were pooled using DisMod-MR 2.1, a Bayesian meta-regression tool. Prevalence was forecast to 2050 using a mixed-effects model using Socio-demographic Index as a predictor and multiplying by projected population estimates. We present 95% UIs for every metric based on the 2·5th and 97·5th percentiles of 100 draws of the posterior distribution. FINDINGS Globally, in 2020, neck pain affected 203 million (95% uncertainty interval [UI] 163-253) people. The global age-standardised prevalence rate of neck pain was estimated to be 2450 (1960-3040) per 100 000 population and global age-standardised YLD rate was estimated to be 244 (165-346) per 100 000. The age-standardised prevalence rate remained stable between 1990 and 2020 (percentage change 0·2% [-1·3 to 1·7]). Globally, females had a higher age-standardised prevalence rate (2890 [2330-3620] per 100 000) than males (2000 [1600-2480] per 100 000), with the prevalence peaking between 45 years and 74 years in male and female sexes. By 2050, the estimated global number of neck pain cases is projected to be 269 million (219-322), with an increase of 32·5% (23·9-42·3) from 2020 to 2050. Decomposition analysis of the projections showed population growth was the primary contributing factor, followed by population ageing. INTERPRETATION Although age-standardised rates of neck pain have remained stable over the past three decades, by 2050 the projected case numbers are expected to rise. With the highest prevalence in older adults (higher in females than males), a larger effect expected in low-income and middle-income countries, and a rapidly ageing global population, neck pain continues to pose a challenge in terms of disability burden worldwide. For future planning, it is essential we improve our mechanistic understanding of the different causes and risk factors for neck pain and prioritise the consistent collection of global neck pain data and increase the number of countries with data on neck pain. FUNDING Bill & Melinda Gates Foundation and Global Alliance for Musculoskeletal Health.
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Sartorius B, Gray AP, Davis Weaver N, Robles Aguilar G, Swetschinski LR, Ikuta KS, Mestrovic T, Chung E, Wool EE, Han C, Gershberg Hayoon A, Araki DT, Abd-Elsalam S, Aboagye RG, Adamu LH, Adepoju AV, Ahmed A, Akalu GT, Akande-Sholabi W, Amuasi JH, Amusa GA, Argaw AM, Aruleba RT, Awoke T, Ayalew MK, Azzam AY, Babin FX, Banerjee I, Basiru A, Bayileyegn NS, Belete MA, Berkley JA, Bielicki JA, Dekker D, Demeke D, Demsie DG, Dessie AM, Dunachie SJ, Ed-Dra A, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Elsohaby I, Eyre D, Fagbamigbe AF, Feasey NA, Fekadu G, Fell F, Forrest KM, Gebrehiwot M, Gezae KE, Ghazy RM, Hailegiyorgis TT, Haines-Woodhouse G, Hasaballah AI, Haselbeck AH, Hsia Y, Iradukunda A, Iregbu KC, Iwu CCD, Iwu-Jaja CJ, Iyasu AN, Jaiteh F, Jeon H, Joshua CE, Kassa GG, Katoto PDMC, Krumkamp R, Kumaran EAP, Kyu HH, Manilal A, Marks F, May J, McLaughlin SA, McManigal B, Melese A, Misgina KH, Mohamed NS, Mohammed M, Mohammed S, Mohammed S, Mokdad AH, Moore CE, Mougin V, Mturi N, Mulugeta T, Musaigwa F, Musicha P, Musila LA, Muthupandian S, Naghavi P, Negash H, Nuckchady DC, Obiero CW, Odetokun IA, Ogundijo OA, Okidi L, Okonji OC, Olagunju AT, Olufadewa II, Pak GD, Perovic O, Pollard A, Raad M, Rafaï C, Ramadan H, Redwan EMM, Roca A, Rosenthal VD, Saleh MA, Samy AM, Sharland M, Shittu A, Siddig EE, Sisay EA, Stergachis A, Tesfamariam WB, Tigoi C, Tincho MB, Tiruye TY, Umeokonkwo CD, Walsh T, Walson JL, Yusuf H, Zeru NG, Hay SI, Dolecek C, Murray CJL, Naghavi M. The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis. Lancet Glob Health 2024; 12:e201-e216. [PMID: 38134946 PMCID: PMC10805005 DOI: 10.1016/s2214-109x(23)00539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle-income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date. METHODS We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for countries in the WHO African region in 2019. Our methodological approach consisted of five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths attributable to AMR (considering an alternative scenario where infections with resistant pathogens are replaced with susceptible ones) and deaths associated with AMR (considering an alternative scenario where drug-resistant infections would not occur at all). We obtained data from research hospitals, surveillance networks, and infection databases maintained by private laboratories and medical technology companies. We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. FINDINGS In the WHO African region in 2019, there were an estimated 1·05 million deaths (95% UI 829 000-1 316 000) associated with bacterial AMR and 250 000 deaths (192 000-325 000) attributable to bacterial AMR. The largest fatal AMR burden was attributed to lower respiratory and thorax infections (119 000 deaths [92 000-151 000], or 48% of all estimated bacterial pathogen AMR deaths), bloodstream infections (56 000 deaths [37 000-82 000], or 22%), intra-abdominal infections (26 000 deaths [17 000-39 000], or 10%), and tuberculosis (18 000 deaths [3850-39 000], or 7%). Seven leading pathogens were collectively responsible for 821 000 deaths (636 000-1 051 000) associated with resistance in this region, with four pathogens exceeding 100 000 deaths each: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Third-generation cephalosporin-resistant K pneumoniae and meticillin-resistant S aureus were shown to be the leading pathogen-drug combinations in 25 and 16 countries, respectively (53% and 34% of the whole region, comprising 47 countries) for deaths attributable to AMR. INTERPRETATION This study reveals a high level of AMR burden for several bacterial pathogens and pathogen-drug combinations in the WHO African region. The high mortality rates associated with these pathogens demonstrate an urgent need to address the burden of AMR in Africa. These estimates also show that quality and access to health care and safe water and sanitation are correlated with AMR mortality, with a higher fatal burden found in lower resource settings. Our cross-country analyses within this region can help local governments to leverage domestic and global funding to create stewardship policies that target the leading pathogen-drug combinations. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
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Xu W, Liu G, Varghese C, Wells C, Smith N, Windsor J, Gaborit L, Goh S, Basam A, Elhadi M, Soh RT, Saeed U, Abdulwahed E, Farrell M, Wright D, Martin J, Pockney P, Xu W, Basam A, Goh S, Li J, Shah J, Waraich A, Gaborit L, Pathak U, Hilder A, Elhadi M, Jabur A, Kalyanasundaram K, Ohis C, Ong CF, Park M, Siribaddana V, Raubenheimer K, Vu J, Wells C, Liu G, Ferguson L, Xu W, Varghese C, Pockney P, Atherton K, Dawson A, Martin J, Banerjee A, Dudi-Venkata N, Lightfoot N, Ludbrook I, Peters L, Sara R, Watson D, Wright D, Adeyeye A, Alvarez-Lozada LA, Atici SD, Buhavac M, Calini G, Elhadi M, Ioannidis O, Tepe MD, Nath U, Uzair A, Yang W, Zaidi F, Singh S, Abdullah B, Palacios DSG, Ragab A, Ahmed A, Raubenheimer K, Daudu D, Goh S, Benyani SV, Karthikeyan N, Mansour LT, Seow W, Tasi Z, Jabur A, Pathak U, Park M, Abdelmelek DE, Boussahel IFZ, Kaabache O, Lemdaoui N, Nebbar O, Rais M, Abdoun M, Kouicem AT, Bouaoud S, Bouchenak K, Saada H, Ouyahia A, Messai W, Choong ZS, Ting C, Larkin M, Fong PJ, Soh I, Grandi AD, Iftikhar H, Sinha A, Kapoor D, Chlebicka T, Singer D, Goddard K, Matthews L, Lin R, Chambers J, Chan J, Macnab B, Barker J, Mckenzie M, Ferguson N, Juwaheer G, Muralidharan V, Gill S, Sung N, Patel R, Walters C, Nguyen K, Liu D, Cabalag C, Lee J, Leow SHA, Ng SL, Ashraf H, Mulder F, Loo J, Proud D, Wong S, Zhou Y, Soh QR, Chye D, Stevens S, Tang P, Kritharides S, Dong J, Morice O, Huang D, Hardidge A, Amarasekara M, Kink A, Bolton D, Rawal A, Singh J, Heard M, Hassan Y, Naqeeb A, Cobden A, Prinsloo D, Quadros D, Gunn E, Kim HJ, Ekwebelam J, Shanahan J, Alkazali M, Hoosenally M, Nara N, Nguyen P, Barker S, Hilder A, Hui A, Karmakar A, Wang B, Goonawardena J, Cheung KT, Chan N, Natarajan R, Cade R, Jin R, Sengupta S, Snider R, Morisetty H, Weeda L, Sun P, Chilaka L, Cover J, Gunasekara ADSA, Senthilrajan R, Alwahaib A, Limmer A, Zamanbandhon B, Jaffry K, Shen Y, Chua A, Syed S, Saha S, Glynatsis J, Aitchison L, Lagana B, Crossman M, Watson D, Dawson A, Fong B, Harrison E, Horsburgh E, Glynatsis J, Khoo M, Mishra K, Hewton L, Mesecke A, Tu H, Tun T, Wong J, Ong E, Law TN, Landy A, Leano A, Li A, Soni A, Dowdle B, Pilgrim C, Abeysirigunawardana D, Jeyarajan DR, Patel D, Mckinnon K, Gould M, Gilmore P, Geng R, Loughnan R, Norton-Smith S, Nyame S, Tan S, Yoon SW, Wang Y, Zhang Y, Wang Z, Mare H, Withanage I, Khattar M, Toft A, Sivasuthan G, Zhao H, Addley J, O'brien L, Raza M, Bindra R, Sharma S, Cornwell C, Patil A, Cheung A, Lown A, Dawson A, Blassey A, Ochigbo B, Cheng F, Fatima A, Zhang E, Kocatekin H, Roth C, Brewster D, Kwok K, Chen P, Laura S, Tynan D, Latif E, Lun E, Honore E, Ziergiebel F, Blake J, Chandiok K, Bird K, Ngothanh L, Lee M, El-Masry M, Hamer P, Palaniappan RR, Mcgee R, Huang S, Zhang S, Hariharan S, Silva YD, Lee C, Fotheringham P, Incoll I, Cordingley T, Cheng F, Brown M, Kang L, Wijayaratne R, Moore P, Qian G, Elgindy Y, Carnuccio E, Rae H, Shehata M, Liu M, Lockwood B, Bockxmeer JV, Alsoudani A, Swan D, Hsieh J, Orchard-Hall F, 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Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries. Br J Surg 2024; 111:znad421. [PMID: 38207169 PMCID: PMC10783642 DOI: 10.1093/bjs/znad421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. METHODS This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge. RESULTS The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not. CONCLUSION Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.
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Khan FN, Bandar MA, Shamim R, Chowdhury S, Kovacevic B, Krdzic I, Zdravkovic M, Kenic M, Milentijevic M, Petkovic N, Radulovic R, Ngu J, Teo NZ, Singh PA, Ong SY, Li S, en Siew B, Chee C, Koh JJM, Lee KY, Tan KK, Wong SC, Loh W, Pujol AF, Rubio JC, Farrés LP, Vendrell LL, Del Olmo MIU, Pedregosa AB, Galmes C, Luckute D, Casanova D, Artigot M, Guedes X, Olivella Y, Sarda MS, Toscano MJ, Damieta MP, Pera M, Gonçalvez SA, Galvez ST, Ruiz SS, Espin-Basany E, Marinello F, Villarino-Villa L, Heras MVL, Martin-Sanchez R, Mata RM, Blanco-Colino R, Otero A, de Lacy AM, Sanahuja JM, Bravo R, Ferraz T, Gonzabay V, Gonzalez F, Menendez P, Del Castillo VCG, Lopez-Pelaez VM, Silva ÁS, Lillo-García C, Tauler EM, Manresa MCE, Pérez SL, Llopis SQ, Rubio AV, Castillo ER, Miramón FJJ, Rodriguez JLR, Rizo-Lamberti LA, Garrido PG, Carneros VJ, Alfonso BA, Sierra BG, Amador CG, Gomendio MDP, Palomino MVR, de La Plaza Llamas R, Cafranga EG, Ramos JLE, Estudillo MC, Pérez RE, Pernas RM, de Lebrusant Fernández S, Bautista WMS, Llamazares AL, Valbuena AL, Moran LA, Alvarez LJ, Raposo LG, Ceron SF, Calvo AC, Valcárcel CR, Peña JP, Gómez LMJ, Díez MC, Lindenbaum PD, Mata SK, Ruiz-De-La-Hermosa A, Abad-Motos A, Toribio-Combarro B, Ripollés-Melchor J, Fuenmayor-Valera ML, Ortega-Domene P, Loscos A, Del Pueblo CS, Dziakova J, Mugüerza JM, Carlin PS, Anula R, Mouvet Y, Forero-Torres A, Andrés BDS, Marcos CM, Rubio I, Pascual I, Yague J, Alcolea NG, Alonso A, Diéguez B, Ibañez I, Pérez JL, Losada M, García-Conde M, Hernández M, Blazquez-Martin A, Vera-Mansilla C, Mendoza-Moreno F, Hernandez-Salvan J, Diez-Alonso M, Hernandez-Juara P, Barrena-Blazquez S, Minaya-Bravo AM, Galván-Pérez A, Miguel-Méndez CS, Gonzalez-Gonzalez E, Alvarez-Díez M, García-Ureña MÁ, Llorente-Moreno M, Ruiz-Lozano C, Colás-Ruiz E, Pérez-Calvo J, Gomila-Sanso JA, Álvarez-Llano L, Serrano-Fuentes SC, Soto-Montesinos C, Dedeu-Bastardas I, Perez-Reche I, Labró-Ciurans M, Pardo-López S, Pérez EG, Fernández IO, Canals LO, Espino PC, Ruano PG, Ricardo V, Ros EP, Manuel EM, Buleje JAB, Prats MMC, Baños PAP, González PM, Celdrán RG, Pellicer-Franco EM, Valero-Navarro G, Vicente-Villena JP, Martinez-Mercader MM, Baeza-Murcia M, Mengual-Ballester M, Soria-Aledo V, Fernández-Martínez D, Varela-Rodríguez L, Garcia-Flórez LJ, Fernández-Hevia M, Gonzalez-Diaz MJ, Fernández-Arias S, Puertas CP, de San Pío Carvajal E, Cebolla ES, Brainsa E, Bayo JMM, Castro MC, Blanco RR, Gutierrez E, Pinto FL, Alegre JM, Flores N, ÓSullivan SN, Fernández BF, Alonso JE, Conde JGA, Ropero NM, Bayón RÁ, Dominguez SH, Ramirez S, Martin de Pablos A, Perez-Sanchez A, Cano-Matias A, Del-Rio-Lafuente FJ, Caballero-Delgado J, Valdes-Hernandez J, Gomez-Rosado JC, Martinez C, Cholewa H, Sancho-Muriel J, Alberola MJ, Navasquillo M, Primo V, Moreno V, Espí-Macías A, Moro-Valdezate D, Carrascosa-Morales I, Martín-Arévalo J, Soro-Domingo M, García-Botello S, Pla-Marti V, Abellán AM, Pérez CM, Cortés GFV, Blasco LF, Chornet MR, Martín RS, Diego ARD, Vázquez-Fernández A, Pascual A, de Andrés-Asenjo B, Beltrán de Heredia J, Ruiz-Soriano M, Rodríguez-Jiménez R, Iribarren EM, Rodríguez EVF, Del Carmen Casas García M, García-Señoráns MP, Valderrama ÓC, Rodríguez PF, Santos RS, Currás RP, Vigorita V, Roche CG, Delgado E, Lafuente F, Gascon I, Saudi S, Fraj V, Wickramasinghe D, de Zoysa I, Samarasekera N, Wickramarathne R, Dassanayake V, Balathayalan Y, de Silva D, Perera M, Pulleperuma S, Jayasekara S, Wijenayake W, Gunetilleke B, Abeysinghe N, Chandrasinghe P, Kumarage S, Abdalradiy AG, Widatalla ABH, Ahmed AY, Mohamed HA, Hamid HKS, Ali MH, Eldin SJ, Agger E, Jutesten H, Lindgren J, Lepsenyi M, Azhar N, Hansdotter P, Ekepil A, Lindén Å, Brandström G, Smedberg J, Schiffer E, Ris F, Longchamp G, Meyer J, Dupret L, Galetti K, Regusci L, Grischott M, Malugani M, Mouhandes AEF, Danial AK, Khayat M, Sbahi MHE, Marawy MK, Abdullah MA, Douba Z, Mansour A, Niazi A, Hamza A, Mohamad AH, Awead M, Mohammad S, Salloum S, Jabar AA, Zazo A, Shebli B, Ayoub K, Younes L, Bannoud MH, Zazo R, Saad A, Hamdan A, Wakkaf H, Adra L, Souliman M, Anton M, Hannouf S, Li KL, Cheng KI, Ji SJ, Hsieh YC, Parlak EA, Demir M, Kara U, Peker YS, Yiğit D, Unal N, Iflazoğlu N, Yalkin Ö, Topal S, Gulcu B, Ozturk E, Gümbelek G, Terkanlıoğlu S, Koklucan A, Ince G, Sen M, Isik O, Kural S, Akesen S, Yilmazlar T, Sungurtekin H, Sungurtekin U, Vural U, Ozgen U, Isik A, Onk D, Kurnaz E, Ozker TS, Ipek A, Ferlengez A, Erturk C, Tatar C, Sevik H, Akay O, Sensoy O, Hayirlioglu MB, Aktas S, Ozben V, Aliyeva Z, Mutlu AU, Gökay BV, Saraçoğlu C, Aytaç E, Gülmez M, Işık MÜ, Hacim A, Akbas A, Soyhan F, Turgut MA, Demirgan S, Meric S, Altinel Y, Baris B, Akova E, Kahraman E, Kucuk HF, Saracoglu KT, Kaya S, Lel S, Gurbulak EK, Caz E, Kostek M, Mihmanli M, Yazici P, Oba S, Kırkan EF, Ulgur HS, Kalın M, Dinkci MD, Duzgun O, Ozturk S, Zengin AK, Aşkar A, Şanlı AN, Erginöz E, Özçelik MF, Ergün S, Uludağ SS, Kara D, Yılmaz G, Sarıcı IŞ, Kara Y, Incesu A, Arican C, Atici SD, Kaya T, Gezer T, Kirmizi Y, Aydin G, Namdaroglu O, Adakaya S, Canda AE, Ozzeybek D, Coskun N, Sokmen S, Ozkardesler S, Bisgin T, Miftari A, Caliskan C, Akgun E, Avseren G, Deniz N, Yoldas T, Güreşin A, Zayakov G, Pösteki G, Utkan NZ, Tatar OC, Akçay Ö, Güler SA, Mantoğlu B, Demirel E, Akın E, Gonullu E, Altintoprak F, Palabıyık O, Bayhan Z, Ciftci AB, Colak E, Aybar E, Celik HK, Eraslan H, Yemez K, Ozbilgin SS, Senol S, Gultekin FA, Piskin O, Guler O, Karadere Y, Kakeeto A, Oguttu B, Sikakulya FK, Lule H, Rybachuk A, Shudrak A, Beznosenko A, Lisnyy I, Rozhkova V, Zvirych V, Alawlaqi D, El Jamali F, Balooshi IA, Ahmed M, Albers M, Ali NA, Church R, Dudas G, Wells J, Pavlova M, Sebastiani S, Paterson C, Kaushal M, Patel P, Panchal S, Handa S, Tezas S, Zaidi SN, Raj G, Wright J, Hallam S, Karandikar S, Gates Z, Marshall A, Thompson A, Tennakoon A, Rao M, Callan R, Tufail S, Rajendran G, Polisetty K, Husain N, Clarke N, Naranayanasamy S, Hallett A, Lorejo E, Ward N, Antakia R, Xanthis A, Simillis C, Tweedle E, Panagiotopoulou I, Grimes L, Mounstephen L, Bocancia R, Carden C, Lynch J, Noveros MS, Shaalan R, Khalil T, Marshall W, Hodge K, Balfour J, Mcintosh K, Buijs L, Yule M, Vaughan-Shaw PG, Smith S, Anderson T, Mcdermott FD, Daniels IR, Tapp J, Smart N, Rajaretnam N, Bethune R, Clark T, Delimpalta C, Liao C, Banham G, Induruwage L, Velchuru V, Lawrence A, Rahman A, Bennett J, Badawi M, Harshen R, Bhargava A, Gorrela K, Jumah M, Hanson M, Arya S, Atendido T, Shrestha A, Cook E, Rakhimov I, Collins J, Alamin N, Vigneswaran N, Basnyat P, Shamardal A, Chacko A, Wanshantha D, Bisheet G, Ebdewi H, Abdellatif M, Adu-Poku P, Tore A, Adams F, Allen K, Ahmed K, Kulkarni N, Chitnis A, Patel H, Magsino J, Sarodaya V, Minicozzi A, Dempsy C, Ahmed H, Jayasinghe JD, Okail MH, Thaha M, Hallworth S, Parmar C, Chua L, Pizanias M, Samin R, Young T, Sagar J, Yorkmui L, Cirocchi N, Ahmed S, Barreda SC, Kudchadkar S, Baker A, Jayasankar B, Jackson J, Abdelsaid K, Hassan M, Shetty S, Coldwell C, Davies E, Nader H, Raistrick M, Ryska O, Hawkin P, Raymond T, Witjes C, Van de Steen K, Crabtree N, Boyce S, Somera W, Woodward A, Ryan K, Kassai M, Aleem M, Ghosh A, Rixson D, Lewis E, Lynch N, Shovelton C, Zywicka E, Guest F, Barton J, Purnell R, Bamford R, Teare T, Adams B, Chmielewski G, Smith L, Connolly L, Niblett R, Singh A, Halliwell G, Paraoan M, Doree N, Asaad P, Kilbride C, Carpenter H, Wilson J, Fletcher J, Vijayagopal KA, Abbakar M, Zaimis T, Walsh A, Kubisz-Pudelko A, Nono J, Pippard L, Chowdhary M, Dalton R, Moussa T, Dominguez F, Solla G, Curbelo J, Laurini M, Viola M, Brito N, Al-Alnsi A, Al-Naggar H, Saryah L, Al-Shehari M, Alsayadi R, Al-Hutheifi R, Shream S, Saeed S, Spurring EM. Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries. Br J Surg 2024; 111:znad370. [PMID: 38029386 PMCID: PMC10771257 DOI: 10.1093/bjs/znad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. METHODS The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. RESULTS A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). CONCLUSION Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).
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Wernly B, Bruno RR, Beil M, Flaatten H, Kelm M, Sigal S, Szczeklik W, Elhadi M, Joannidis M, Koköfer A, Oeyen S, Marsh B, Moreno R, Wernly S, Leaver S, De Lange DW, Guidet B, Jung C. Frailty's influence on 30-day mortality in old critically ill ICU patients: a bayesian analysis evaluating the clinical frailty scale. Ann Intensive Care 2023; 13:126. [PMID: 38091131 PMCID: PMC10719192 DOI: 10.1186/s13613-023-01223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Frailty is widely acknowledged as influencing health outcomes among critically ill old patients. Yet, the traditional understanding of its impact has predominantly been through frequentist statistics. We endeavored to explore this association using Bayesian statistics aiming to provide a more nuanced understanding of this multifaceted relationship. METHODS Our analysis incorporated a cohort of 10,363 older (median age 82 years) patients from three international prospective studies, with 30-day all-cause mortality as the primary outcome. We defined frailty as Clinical Frailty Scale ≥ 5. A hierarchical Bayesian logistic regression model was employed, adjusting for covariables, using a range of priors. An international steering committee of registry members reached a consensus on a minimal clinically important difference (MCID). RESULTS In our study, the 30-day mortality was 43%, with rates of 38% in non-frail and 51% in frail groups. Post-adjustment, the median odds ratio (OR) for frailty was 1.60 (95% CI 1.45-1.76). Frailty was invariably linked to adverse outcomes (OR > 1) with 100% probability and had a 90% chance of exceeding the minimal clinically important difference (MCID) (OR > 1.5). For the Clinical Frailty Scale (CFS) as a continuous variable, the median OR was 1.19 (1.16-1.22), with over 99% probability of the effect being more significant than 1.5 times the MCID. Frailty remained outside the region of practical equivalence (ROPE) in all analyses, underscoring its clinical importance regardless of how it is measured. CONCLUSIONS This research demonstrates the significant impact of frailty on short-term mortality in critically ill elderly patients, particularly when the Clinical Frailty Scale (CFS) is used as a continuous measure. This approach, which views frailty as a spectrum, enables more effective, personalized care for this vulnerable group. Significantly, frailty was consistently outside the region of practical equivalence (ROPE) in our analysis, highlighting its clinical importance.
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Affiliation(s)
- Bernhard Wernly
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020, Salzburg, Austria
| | - Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, 40225, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jersualem, Israel
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, 5021, Bergen, Norway
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, 40225, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Sviri Sigal
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 91120, Jersualem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 31-008, Krakow, Poland
| | - Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, 6020, Innsbruck, Austria
| | - Andreas Koköfer
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, 9000, Ghent, Belgium
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Rui Moreno
- Centro Hospitalar de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisboa, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020, Salzburg, Austria
| | - Susannah Leaver
- General Intensive Care, St. George´S University Hospital NHS Foundation Trust, London, SW17 0QT, UK
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, 3584 CX, Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Inserm, Service de'Réanimation, Sorbonne Université, Hôpital Saint-Antoine, Institut Pierre-Louis d'épidémiologie Et de Santé Publique, AP-HP, 184, Rue du Faubourg-Saint-Antoine, 75012, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, 40225, Düsseldorf, Germany.
- Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya.
- Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Raasveld SJ, de Bruin S, Reuland MC, van den Oord C, Schenk J, Aubron C, Bakker J, Cecconi M, Feldheiser A, Meier J, Müller MCA, Scheeren TWL, McQuilten Z, Flint A, Hamid T, Piagnerelli M, Tomić Mahečić T, Benes J, Russell L, Aguirre-Bermeo H, Triantafyllopoulou K, Chantziara V, Gurjar M, Myatra SN, Pota V, Elhadi M, Gawda R, Mourisco M, Lance M, Neskovic V, Podbregar M, Llau JV, Quintana-Diaz M, Cronhjort M, Pfortmueller CA, Yapici N, Nielsen ND, Shah A, de Grooth HJ, Vlaar APJ. Red Blood Cell Transfusion in the Intensive Care Unit. JAMA 2023; 330:1852-1861. [PMID: 37824112 PMCID: PMC10570913 DOI: 10.1001/jama.2023.20737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
Importance Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice. Objective To evaluate and describe ICU RBC transfusion practices worldwide. Design, Setting, and Participants International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks. Exposure ICU stay. Main Outcomes and Measures The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused. Results Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL. Conclusions and Relevance RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.
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Affiliation(s)
- Senta Jorinde Raasveld
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Sanne de Bruin
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Merijn C. Reuland
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Claudia van den Oord
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jimmy Schenk
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Cécile Aubron
- Médecine Intensive Réanimation, CHU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Jan Bakker
- Department of Pulmonary and Critical Care, New York University and Columbia University New York
- Department of Intensive Care Adults, Erasmus MC University Medical Centers, Rotterdam, the Netherlands
- Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maurizio Cecconi
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Aarne Feldheiser
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, EvangKliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany
| | - Jens Meier
- Department of Anesthesiology and Intensive Care, Kepler University Clinic, Kepler University, Linz, Austria
| | - Marcella C. A. Müller
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Thomas W. L. Scheeren
- Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Zoe McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Flint
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tarikul Hamid
- Department of Critical Care, Asgar Ali Hospital, Dhaka, Bangladesh
| | - Michaël Piagnerelli
- Department of Intensive Care, CHU Charleroi Marie Curie, Université Libre de Brussels, Charleroi, Belgium
| | - Tina Tomić Mahečić
- Department of Anesthesiology and Intensive Care, University Clinical Hospital Center Zagreb, Croatia
| | - Jan Benes
- Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine in Plzen–Charles University, Plzen, Czech Republic
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Copenhagen, Copenhagen, Denmark
- Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital–Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Vasiliki Chantziara
- Intensive Care Unit, First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vincenzo Pota
- Department of Child, General and Specialistic Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy
| | | | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Mafalda Mourisco
- Department of Intensive Care, Centro Hospitalar de Entro o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Marcus Lance
- Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Vojislava Neskovic
- Department of Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | - Matej Podbregar
- Department for Internal Intensive Care, General Hospital Celje, Medical Faculty, University of Ljubljana, Slovenia
| | - Juan V. Llau
- Department of Anesthesiology and Post-surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain
| | | | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Carmen A. Pfortmueller
- Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nihan Yapici
- Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey
| | - Nathan D. Nielsen
- Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque
| | - Akshay Shah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Harm-Jan de Grooth
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Alexander P. J. Vlaar
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Safdarian M, Trinka E, Rahimi-Movaghar V, Thomschewski A, Aali A, Abady GG, Abate SM, Abd-Allah F, Abedi A, Adane DE, Afzal S, Ahinkorah BO, Ahmad S, Ahmed H, Amanat N, Angappan D, Arabloo J, Aryannejad A, Athari SS, Atreya A, Azadnajafabad S, Azzam AY, Babamohamadi H, Banik PC, Bardhan M, Bashiri A, Berhie AY, Bhat AN, Brown J, Champs AP, Charalampous P, Chukwu IS, Coberly K, Dadras O, Yada DY, Dai X, Dandona L, Dandona R, Dessalegn FN, Desta AA, Dhingra S, Diao N, Diaz D, Dibas M, Dongarwar D, Dsouza HL, Ekholuenetale M, El Nahas N, Elhadi M, Eskandarieh S, Fagbamigbe AF, Fares J, Fatehizadeh A, Fereshtehnejad SM, Fischer F, Franklin RC, Garg T, Getachew M, Ghaffarpasand F, Gholamrezanezhad A, Gholizadeh Mesgarha M, Ghozy S, Golechha M, Goleij P, Graham SM, Gupta VK, Haagsma JA, Hamidi S, Harlianto NI, Harorani M, Hasanian M, Hassan A, Hassen MB, Hoveidaei AH, Iravanpour F, Irilouzadian R, Iwu CCD, Jacob L, Jaja CJ, Joseph N, Joshua CE, Jozwiak JJ, Kadashetti V, Kandel A, Kantar RS, Karaye IM, Karkhah S, Khader YS, Khan EA, Khan MJ, Khayat Kashani HR, Khonji MS, Khormali M, Kim G, Krishnamoorthy V, Kumaran SD, Malekpour MR, Meretoja TJ, Mesregah MK, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Miller TR, Mirahmadi A, Mirghaderi SP, Mirza M, Misganaw A, Misra S, Mohammad Y, Mohammadi E, Mokdad AH, Möller H, Momtazmanesh S, Moni MA, Mostafavi E, Mulita F, Naghavi M, Nassereldine H, Natto ZS, Nejati K, Nguyen HLT, Nguyen VT, Nogueira de Sá AT, Olagunju AT, Olufadewa II, Omotayo AO, Owolabi MO, Patil S, Pawar S, Pedersini P, Petcu IR, Polinder S, Pourbagher-Shahri AM, Qureshi MF, Raghav PR, Rahman M, Rahnavard N, Rajabpour-Sanati A, Rashidi MM, Rawaf S, Roberts NLS, Saddik B, Saeed U, Samadzadeh S, Samy AM, Sarveazad A, Seylani A, Shafie M, Shahbandi A, Sharew MMS, Sheikhi RA, Shetty PH, Yigit A, Shobeiri P, Shool S, Shorofi SA, Sibhat MM, Sinaei E, Singh P, Singh S, Solomon Y, Sotoudeh H, Tadesse BA, Umair M, Valadan Tahbaz S, Valdez PR, Venketasubramanian N, Vu LG, Wickramasinghe ND, Zare I, Yazdanpanah F, Wu AM, Zhang ZJ. Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2023; 22:1026-1047. [PMID: 37863591 PMCID: PMC10584692 DOI: 10.1016/s1474-4422(23)00287-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) is a major cause of health loss due to premature mortality and long-term disability. We aimed to report on the global, regional, and national incidence, prevalence, and years of life lived with disability (YLDs) for SCI from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS Using GBD 2019 data pooled in DisMod-MR 2.1, a Bayesian meta-regression tool, we systematically derived numbers and age-standardised rate changes with 95% uncertainty intervals (95% UIs) for the incidence, prevalence, and YLDs for SCI from 1990 to 2019 for the whole world, 21 GBD regions, and 204 countries and territories. We report trends based on age, sex, year, cause of injury, and level of injury. FINDINGS Globally, 20·6 million (95% UI 18·9 to 23·6) individuals were living with SCI in 2019. The incidence of SCI was 0·9 million (0·7 to 1·2) cases with an estimated 6·2 million (4·5 to 8·2) YLDs. SCI rates increased substantially from 1990 to 2019 for global prevalence (81·5%, 74·2 to 87·1), incidence (52·7%, 30·3 to 69·8), and YLDs (65·4%, 56·3 to 76·0). However, global age-standardised rates per 100 000 population showed small changes in prevalence (5·8%, 2·6 to 9·5), incidence (-6·1%, -17·2 to 1·5), and YLDs (-1·5%, -5·5 to 3·2). Data for 2019 shows that the incidence of SCI increases sharply until age 15-19 years, where it remains reasonably constant until 85 years of age and older. By contrast, prevalence and YLDs showed similar patterns to each other, with one peak at around age 45-54 years. The incidence, prevalence, and YLDs of SCI have consistently been higher in men than in women globally, with a slight and steady increase for both men and women from 1990 to 2019. Between 1990 and 2019, SCI at neck level was more common than SCI below neck level in terms of incidence (492 thousand [354 to 675] vs 417 thousand [290 to 585]), prevalence (10·8 million [9·5 to 13·9] vs 9·7 million [9·2 to 10·4]), and YLDs (4·2 million [3·0 to 5·8] vs 1·9 million [1·3 to 2·5]). Falls (477 thousand [327 to 683] cases) and road injuries (230 thousand [122 to 389] cases) were the two leading causes of SCI globally in 2019. INTERPRETATION Although age-standardised rates of incidence, prevalence, and YLDs for SCI changed only slightly, absolute counts increased substantially from 1990 to 2019. Geographical heterogeneity in demographic, spatial, and temporal patterns of SCI, at both the national and regional levels, should be considered by policy makers aiming to reduce the burden of SCI. FUNDING Bill & Melinda Gates Foundation.
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Beil M, van Heerden PV, Joynt GM, Lapinsky S, Flaatten H, Guidet B, de Lange D, Leaver S, Jung C, Forte DN, Bin D, Elhadi M, Szczeklik W, Sviri S. Limiting life-sustaining treatment for very old ICU patients: cultural challenges and diverse practices. Ann Intensive Care 2023; 13:107. [PMID: 37884827 PMCID: PMC10603016 DOI: 10.1186/s13613-023-01189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Decisions about life-sustaining therapy (LST) in the intensive care unit (ICU) depend on predictions of survival as well as the expected functional capacity and self-perceived quality of life after discharge, especially in very old patients. However, prognostication for individual patients in this cohort is hampered by substantial uncertainty which can lead to a large variability of opinions and, eventually, decisions about LST. Moreover, decision-making processes are often embedded in a framework of ethical and legal recommendations which may vary between countries resulting in divergent management strategies. METHODS Based on a vignette scenario of a multi-morbid 87-year-old patient, this article illustrates the spectrum of opinions about LST among intensivsts with a special interest in very old patients, from ten countries/regions, representing diverse cultures and healthcare systems. RESULTS This survey of expert opinions and national recommendations demonstrates shared principles in the management of very old ICU patients. Some guidelines also acknowledge cultural differences between population groups. Although consensus with families should be sought, shared decision-making is not formally required or practised in all countries. CONCLUSIONS This article shows similarities and differences in the decision-making for LST in very old ICU patients and recommends strategies to deal with prognostic uncertainty. Conflicts should be anticipated in situations where stakeholders have different cultural beliefs. There is a need for more collaborative research and training in this field.
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Affiliation(s)
- Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gavin M Joynt
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Stephen Lapinsky
- Intensive Care Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Hans Flaatten
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint Antoine, Service MIR, Sorbonne Université, Paris, France
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Neves Forte
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Du Bin
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | | | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Ul. Wrocławska 1-3, 30 - 901, Kraków, Poland.
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Shoyombo I, Genetu A, Wong LY, Elhadi M, Twizeyimana E, Gwini GP, William R, Hall T, Khalil H, Sandrasagran SN, Langer M. Measurements of Surgical Volume in Low- and Middle-Income Countries, a Systematic Review. Ann Glob Health 2023; 89:70. [PMID: 37841804 PMCID: PMC10573813 DOI: 10.5334/aogh.4251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/17/2023] [Indexed: 10/17/2023] Open
Abstract
Background Surgical volume is a surgical indicator that was described in the Lancet Commission on Global Surgery (LCoGS) and the World Bank World Development Indicators as an important metric for tracking the delivery of surgical care. Objectives We aimed to characterize the reports on surgical volume (SV) in the existing literature by using a systematic review to assess studies that examine surgical procedures as a ratio of a population (procedures/100,000 population). Methods The PRISMA guideline was employed in the systematic review of articles that addressed the measurement of SV in low- and middle-income countries (LMICs), with the primary outcome of surgical procedures/100,000 population. Findings The search result consisted of 6,657 preliminary studies. Following the title and abstract screening, 6,464 articles were excluded, and the remaining 193 were included in the full text review. From the full text review of the 193, only 26 of these articles defined SV as the ratio of number of procedures per population of the catchment/geographical area. The reported SV was a mean of 765, with an SD of 1260 operations per 100,000. The median SV was 180 (min = 0.900, max = 4470). Conclusion Our findings support the LCoGS assessment of the gap in surgical care. The target for SV is 5000 per 100,000 population, compared to the average of 765 per 100,000 population as found in this review. The challenges for assessing surgical volume gaps are vast, including the nature of written records, which limits SV reports to an absolute number of procedures per year without a reference to the catchment population. For the purpose of tracking SV, we recommend using proxies that account for the capacity of facilities to deliver care regardless of the catchment population.
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Affiliation(s)
- Ifeoluwa Shoyombo
- Johns Hopkins University, Department of Surgery, 1800 Orleans St, Baltimore MD 21287, US
| | - Abraham Genetu
- Addis Ababa University, Department of Surgery, Cardiothoracic Unit, Zambia Street, Addis Ababa, ET
| | - Lye-Yeng Wong
- Stanford Hospital, Department of Cardiothoracic Surgery, 870 Quarry Ext Rd, Stanford, CA 94304, US
| | - Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, Tripoli, LY
- Furnaj, University Road, Tripoli, Libya, 13275, Tripoli, LY
| | - Eric Twizeyimana
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave, 5th Floor, PO Box 6955, Kigali, RW
| | - Grace Paidamoyo Gwini
- School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, 7925, ZA
| | | | - Timothy Hall
- Waikato Hospital, Urology Department, 183 Pembroke Street, Hamilton 3204, NZ
| | - Halimah Khalil
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Monica Langer
- Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, US
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Wu D, Jin Y, Xing Y, Abate MD, Abbasian M, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abd-Allah F, Abdelmasseh M, Abdollahifar MA, Abdulah DM, Abedi A, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abuabara K, Abyadeh M, Addo IY, Adeniji KN, Adepoju AV, Adesina MA, Sakilah Adnani QE, Afarideh M, Aghamiri S, Agodi A, Agrawal A, Aguilera Arriagada CE, Ahmad A, Ahmad D, Ahmad S, Ahmad S, Ahmadi A, Ahmed A, Ahmed A, Aithala JP, Ajadi AA, Ajami M, Akbarzadeh-Khiavi M, Alahdab F, AlBataineh MT, Alemi S, Saeed Al-Gheethi AA, Ali L, Alif SM, Almazan JU, Almustanyir S, Alqahtani JS, Alqasmi I, Khan Altaf IU, Alvis-Guzman N, Alvis-Zakzuk NJ, Al-Worafi YM, Aly H, Amani R, Amu H, Amusa GA, Andrei CL, Ansar A, Ansariniya H, Anyasodor AE, Arabloo J, Arefnezhad R, Arulappan J, Asghari-Jafarabadi M, Ashraf T, Atata JA, Athari SS, Atlaw D, Wahbi Atout MM, Aujayeb A, Awan AT, Ayatollahi H, Azadnajafabad S, Azzam AY, Badawi A, Badiye AD, Bagherieh S, Baig AA, Bantie BB, Barchitta M, Bardhan M, Barker-Collo SL, Barone-Adesi F, Batra K, Bayileyegn NS, Behnoush AH, Belgaumi UI, Bemanalizadeh M, Bensenor IM, Beyene KA, Bhagavathula AS, Bhardwaj P, Bhaskar S, Bhat AN, Bitaraf S, Bitra VR, Boloor A, Bora K, Botelho JS, Buchbinder R, Calina D, Cámera LA, Carvalho AF, Kai Chan JS, Chattu VK, Abebe EC, Chichagi F, Choi S, Chou TC, Chu DT, Coberly K, Costa VM, Couto RA, Cruz-Martins N, Dadras O, Dai X, Damiani G, Dascalu AM, Dashti M, Debela SA, Dellavalle RP, Demetriades AK, Demlash AA, Deng X, Desai HD, Desai R, Rahman Dewan SM, Dey S, Dharmaratne SD, Diaz D, Dibas M, Dinis-Oliveira RJ, Diress M, Do TC, Doan DK, Dodangeh M, Dodangeh M, Dongarwar D, Dube J, Dziedzic AM, Ed-Dra A, Edinur HA, Eissazade N, Ekholuenetale M, Ekundayo TC, Elemam NM, Elhadi M, Elmehrath AO, Abdou Elmeligy OA, Emamverdi M, Emeto TI, Esayas HL, Eshetu HB, Etaee F, Fagbamigbe AF, Faghani S, Fakhradiyev IR, Fatehizadeh A, Fathi M, Feizkhah A, Fekadu G, Fereidouni M, Fereshtehnejad SM, Fernandes JC, Ferrara P, Fetensa G, Filip I, Fischer F, Foroutan B, Foroutan M, Fukumoto T, Ganesan B, Belete Gemeda BN, Ghamari SH, Ghasemi M, Gholamalizadeh M, Gill TK, Gillum RF, Goldust M, Golechha M, Goleij P, Golinelli D, Goudarzi H, Guan SY, Guo Y, Gupta B, Gupta VB, Gupta VK, Haddadi R, Hadi NR, Halwani R, Haque S, Hasan I, Hashempour R, Hassan A, Hassan TS, Hassanzadeh S, Hassen MB, Haubold J, Hayat K, Heidari G, Heidari M, Heidari-Soureshjani R, Herteliu C, Hessami K, Hezam K, Hiraike Y, Holla R, Hosseini MS, Huynh HH, Hwang BF, Ibitoye SE, Ilic IM, Ilic MD, Iranmehr A, Iravanpour F, Ismail NE, Iwagami M, Iwu CC, Jacob L, Jafarinia M, Jafarzadeh A, Jahankhani K, Jahrami H, Jakovljevic M, Jamshidi E, Jani CT, Janodia MD, Jayapal SK, Jayaram S, Jeganathan J, Jonas JB, Joseph A, Joseph N, Joshua CE, Vaishali K, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kaliyadan F, Kalroozi F, Kamal VK, Kandel A, Kandel H, Kanungo S, Karami J, Karaye IM, Karimi H, Kasraei H, Kazemian S, Kebede SA, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khamesipour F, Khan EA, Khan IA, Khan M, Khan MJ, Khan MA, Khan MA, Khatatbeh H, Khatatbeh MM, Khateri S, Khayat Kashani HR, Kim MS, Kisa A, Kisa S, Koh HY, Kolkhir P, Korzh O, Kotnis AL, Koul PA, Koyanagi A, Krishan K, Kuddus M, Kulkarni VV, Kumar N, Kundu S, Kurmi OP, La Vecchia C, Lahariya C, Laksono T, Lám J, Latief K, Lauriola P, Lawal BK, Thu Le TT, Bich Le TT, Lee M, Lee SW, Lee WC, Lee YH, Lenzi J, Levi M, Li W, Ligade VS, Lim SS, Liu G, Liu X, Llanaj E, Lo CH, Machado VS, Maghazachi AA, Mahmoud MA, Mai TA, Majeed A, Sanaye PM, Makram OM, Rad EM, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Mansournia MA, Mantovani LG, Martorell M, Masoudi S, Masoumi SZ, Mathangasinghe Y, Mathews E, Mathioudakis AG, Maugeri A, Mayeli M, Carabeo Medina JR, Meles GG, Mendes JJ, Menezes RG, Mestrovic T, Michalek IM, Micheletti Gomide Nogueira de Sá AC, Mihretie ET, Nhat Minh LH, Mirfakhraie R, Mirrakhimov EM, Misganaw A, Mohamadkhani A, Mohamed NS, Mohammadi F, Mohammadi S, Mohammed S, Mohammed S, Mohan S, Mohseni A, Mokdad AH, Momtazmanesh S, Monasta L, Moni MA, Moniruzzaman M, Moradi Y, Morovatdar N, Mostafavi E, Mousavi P, Mukoro GD, Mulita A, Mulu GB, Murillo-Zamora E, Musaigwa F, Mustafa G, Muthu S, Nainu F, Nangia V, Swamy SN, Natto ZS, Navaraj P, Nayak BP, Nazri-Panjaki A, Negash H, Nematollahi MH, Nguyen DH, Hien Nguyen HT, Nguyen HQ, Nguyen PT, Nguyen VT, Niazi RK, Nikolouzakis TK, Nnyanzi LA, Noreen M, Nzoputam CI, Nzoputam OJ, Oancea B, Oh IH, Okati-Aliabad H, Okonji OC, Okwute PG, Olagunju AT, Olatubi MI, Olufadewa II, Ordak M, Otstavnov N, Owolabi MO, Mahesh P, Padubidri JR, Pak A, Pakzad R, Palladino R, Pana A, Pantazopoulos I, Papadopoulou P, Pardhan S, Parthasarathi A, Pashaei A, Patel J, Pathan AR, Patil S, Paudel U, Pawar S, Pedersini P, Pensato U, Pereira DM, Pereira J, Pereira MO, Pereira RB, Peres MF, Perianayagam A, Perna S, Petcu IR, Pezeshki PS, Pham HT, Philip AK, Piradov MA, Podder I, Podder V, Poddighe D, Sady Prates EJ, Qattea I, Radfar A, Raee P, Rafiei A, Raggi A, Rahim F, Rahimi M, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Ur Rahman MH, Rahman M, Rahman MA, Rahmani AM, Rahmani M, Rahmani S, Rahmanian V, Ramasubramani P, Rancic N, Rao IR, Rashedi S, Rashid AM, Ravikumar N, Rawaf S, Mohamed Redwan EM, Rezaei N, Rezaei N, Rezaei N, Rezaeian M, Ribeiro D, Rodrigues M, Buendia Rodriguez JA, Roever L, Romero-Rodríguez E, Saad AM, Saddik B, Sadeghian S, Saeed U, Safary A, Safdarian M, Safi SZ, Saghazadeh A, Sagoe D, Sharif-Askari FS, Sharif-Askari NS, Sahebkar A, Sahoo H, Sahraian MA, Sajid MR, Sakhamuri S, Sakshaug JW, Saleh MA, Salehi L, Salehi S, Farrokhi AS, Samadzadeh S, Samargandy S, Samieefar N, Samy AM, Sanadgol N, Sanjeev RK, Sawhney M, Saya GK, Schuermans A, Senthilkumaran S, Sepanlou SG, Sethi Y, Shafie M, Shah H, Shahid I, Shahid S, Shaikh MA, Sharfaei S, Sharma M, Shayan M, Shehata HS, Sheikh A, Shetty JK, Shin JI, Shirkoohi R, Shitaye NA, Shivakumar K, Shivarov V, Shobeiri P, Siabani S, Sibhat MM, Siddig EE, Simpson CR, Sinaei E, Singh H, Singh I, Singh JA, Singh P, Singh S, Siraj MS, Al Mamun Sohag A, Solanki R, Solikhah S, Solomon Y, Soltani-Zangbar MS, Sun J, Szeto MD, Tabarés-Seisdedos R, Tabatabaei SM, Tabish M, Taheri E, Tahvildari A, Talaat IM, Lukenze Tamuzi JJ, Tan KK, Tat NY, Oliaee RT, Tavasol A, Temsah MH, Thangaraju P, Tharwat S, Tibebu NS, Vera Ticoalu JH, Tillawi T, Tiruye TY, Tiyuri A, Tovani-Palone MR, Tripathi M, Tsegay GM, Tualeka AR, Ty SS, Ubah CS, Ullah S, Ullah S, Umair M, Umakanthan S, Upadhyay E, Vahabi SM, Vaithinathan AG, Tahbaz SV, Valizadeh R, Varthya SB, Vasankari TJ, Venketasubramanian N, Verras GI, Villafañe JH, Vlassov V, Vo DC, Waheed Y, Waris A, Welegebrial BG, Westerman R, Wickramasinghe DP, Wickramasinghe ND, Willekens B, Woldegeorgis BZ, Woldemariam M, Xiao H, Yada DY, Yahya G, Yang L, Yazdanpanah F, Yon DK, Yonemoto N, You Y, Zahir M, Zaidi SS, Zangiabadian M, Zare I, Zeineddine MA, Zemedikun DT, Zeru NG, Zhang C, Zhao H, Zhong C, Zielińska M, Zoladl M, Zumla A, Guo C, Tam LS. Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019. EClinicalMedicine 2023; 64:102193. [PMID: 37731935 PMCID: PMC10507198 DOI: 10.1016/j.eclinm.2023.102193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of -0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = -0.41), inflammatory bowel disease (AAPC = -0.72), multiple sclerosis (AAPC = -0.26), psoriasis (AAPC = -0.77), and atopic dermatitis (AAPC = -0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).
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Kim MS, Hwang J, Yon DK, Lee SW, Jung SY, Park S, Johnson CO, Stark BA, Razo C, Abbasian M, Abbastabar H, Abhari AP, Aboyans V, Adane DEA, Adebayo OM, Alahdab F, Almustanyir S, Aly H, Ameyaw EK, Anderson JA, Andrei CL, Aryan Z, Aujayeb A, Bagherieh S, Baltatu OC, Banach M, Bayileyegn NS, Bearne LM, Behnoush AH, Bensenor IM, Bhaskar S, Bhat AN, Bhat V, Bikbov B, Bintoro BS, Burkart K, Cámera LA, Catapano AL, Chandrasekar EK, Charan J, Chattu VK, Chi G, Chukwu IS, Chung SC, Cirillo M, Coberly K, Costa VM, Dadras O, Dai X, Do TC, Doshi R, Ekholuenetale M, Elgendy IY, Elhadi M, Fagbamigbe AF, Feizkhah A, Fekadu G, Gill PS, Goldust M, Golechha M, Guan SY, Gupta VK, Hadei M, Hadi NR, Hammoud A, Hankey GJ, Harlianto NI, Hasaballah AI, Hassan S, Hassen MB, Heidari G, Hostiuc M, Ilesanmi OS, Iwagami M, Jokar M, Jonas JB, Joshua CE, Jozwiak JJ, Kazemian S, Keykhaei M, Khalaji A, Khan MAB, Khateri S, Kibret BG, Korzh O, Koulmane Laxminarayana SL, Krishan K, Kumar A, Kumar M, Kuttikkattu A, Laksono T, Larijani B, Le TTT, Lim SS, Liu X, Lorkowski S, Magdy Abd El Razek H, Malhotra K, Manla Y, Maugeri A, Mentis AFA, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Mirica A, Mirrakhimov EM, Misganaw A, Mishra M, Mohammad Y, Mokdad AH, Moni MA, Montasir AA, Moradi Y, Moraga P, Morovatdar N, Mousavi-Aghdas SA, Murray CJL, Naghavi M, Nair TS, Nassereldine H, Natto ZS, Nguyen DH, Nguyen HQ, Nguyen VT, Noubiap JJ, Oancea B, Oliveira GMM, Owolabi MO, Padron-Monedero A, Perico N, Petcu IR, Radfar A, Rafferty Q, Rahman M, Rahman MA, Ram P, Rashedi S, Rashid AM, Rawaf S, Remuzzi G, Renzaho AMN, Rezaee M, Roever L, Saad AMA, Saadatagah S, Sadeghi M, Sahebkar A, Saleh MA, Samy AM, Santric-Milicevic MM, Sepanlou SG, Seylani A, Sharfaei S, Shorofi SA, Singh JA, Singh P, Spartalis M, Sundström J, Tan KK, Teramoto M, Tharwat S, Tyrovolas S, Valadan Tahbaz S, Van den Eynde J, Vart P, Wang C, Wang F, Westerman R, Xia J, Xu S, Yada DY, Yamagishi K, Yonemoto N, Zahir M, Zangiabadian M, Zarrintan A, Zastrozhin MS, Zastrozhina A, Zoladl M, Hay SI, Shin JI, Roth GA. Global burden of peripheral artery disease and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health 2023; 11:e1553-e1565. [PMID: 37734799 PMCID: PMC10522777 DOI: 10.1016/s2214-109x(23)00355-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Peripheral artery disease is a growing public health problem. We aimed to estimate the global disease burden of peripheral artery disease, its risk factors, and temporospatial trends to inform policy and public measures. METHODS Data on peripheral artery disease were modelled using the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 database. Prevalence, disability-adjusted life years (DALYs), and mortality estimates of peripheral artery disease were extracted from GBD 2019. Total DALYs and age-standardised DALY rate of peripheral artery disease attributed to modifiable risk factors were also assessed. FINDINGS In 2019, the number of people aged 40 years and older with peripheral artery disease was 113 million (95% uncertainty interval [UI] 99·2-128·4), with a global prevalence of 1·52% (95% UI 1·33-1·72), of which 42·6% was in countries with low to middle Socio-demographic Index (SDI). The global prevalence of peripheral artery disease was higher in older people, (14·91% [12·41-17·87] in those aged 80-84 years), and was generally higher in females than in males. Globally, the total number of DALYs attributable to modifiable risk factors in 2019 accounted for 69·4% (64·2-74·3) of total peripheral artery disease DALYs. The prevalence of peripheral artery disease was highest in countries with high SDI and lowest in countries with low SDI, whereas DALY and mortality rates showed U-shaped curves, with the highest burden in the high and low SDI quintiles. INTERPRETATION The total number of people with peripheral artery disease has increased globally from 1990 to 2019. Despite the lower prevalence of peripheral artery disease in males and low-income countries, these groups showed similar DALY rates to females and higher-income countries, highlighting disproportionate burden in these groups. Modifiable risk factors were responsible for around 70% of the global peripheral artery disease burden. Public measures could mitigate the burden of peripheral artery disease by modifying risk factors. FUNDING Bill & Melinda Gates Foundation.
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Black RJ, Cross M, Haile LM, Culbreth GT, Steinmetz JD, Hagins H, Kopec JA, Brooks PM, Woolf AD, Ong KL, Kopansky-Giles DR, Dreinhoefer KE, Betteridge N, Aali A, Abbasifard M, Abbasi-Kangevari M, Abdurehman AM, Abedi A, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Abu-Zaid A, Adamu K, Addo IY, Adesina MA, Adnani QES, Afzal MS, Ahmed A, Aithala JP, Akhlaghdoust M, Alemayehu A, Alvand S, Alvis-Zakzuk NJ, Amu H, Antony B, Arabloo J, Aravkin AY, Arulappan J, Ashraf T, Athari SS, Azadnajafabad S, Badawi A, Baghcheghi N, Baig AA, Balta AB, Banach M, Banik PC, Barrow A, Bashiri A, Bearne LM, Bekele A, Bensenor IM, Berhie AY, Bhagavathula AS, Bhardwaj P, Bhat AN, Bhojaraja VS, Bitaraf S, Bodicha BBA, Botelho JS, Briggs AM, Buchbinder R, Castañeda-Orjuela CA, Charalampous P, Chattu VK, Coberly K, Cruz-Martins N, Dadras O, Dai X, de Luca K, Dessalegn FN, Dessie G, Dhimal M, Digesa LE, Diress M, Doku PN, Edinur HA, Ekholuenetale M, Elhadi M, El-Sherbiny YM, Etaee F, Ezzeddini R, Faghani S, Filip I, Fischer F, Fukumoto T, Ganesan B, Gebremichael MA, Gerema U, Getachew ME, Ghashghaee A, Gill TK, Gupta B, Gupta S, Gupta VB, Gupta VK, Halwani R, Hannan MA, Haque S, Harlianto NI, Harorani M, Hasaballah AI, Hassen MB, Hay SI, Hayat K, Heidari G, Hezam K, Hill CL, Hiraike Y, Horita N, Hoveidaei AH, Hsiao AK, Hsieh E, Hussain S, Iavicoli I, Ilic IM, Islam SMS, Ismail NE, Iwagami M, Jakovljevic M, Jani CT, Jeganathan J, Joseph N, Kadashetti V, Kandel H, Kanko TK, Karaye IM, Khajuria H, Khan MJ, Khan MAB, Khanali J, Khatatbeh MM, Khubchandani J, Kim YJ, Kisa A, Kolahi AA, Kompani F, Koohestani HR, Koyanagi A, Krishan K, Kuddus M, Kumar N, Kuttikkattu A, Larijani B, Lim SS, Lo J, Machado VS, Mahajan PB, Majeed A, Malakan Rad E, Malik AA, Mansournia MA, Mathews E, Mendes JJ, Mentis AFA, Mesregah MK, Mestrovic T, Mirghaderi SP, Mirrakhimov EM, Misganaw A, Mohamadkhani A, Mohammed S, Mokdad AH, Moniruzzaman M, Montasir AA, Mulu GB, Murillo-Zamora E, Murray CJL, Mustafa G, Naghavi M, Nair TS, Naqvi AA, Natto ZS, Nayak BP, Neupane S, Nguyen CT, Niazi RK, Nzoputam OJ, Oh IH, Okati-Aliabad H, Okonji OC, Olufadewa II, Owolabi MO, Pacheco-Barrios K, Padubidri JR, Patel J, Pathan AR, Pawar S, Pedersini P, Perianayagam A, Petcu IR, Qattea I, Radfar A, Rafiei A, Rahman MHU, Rahmanian V, Rashedi V, Rashidi MM, Ratan ZA, Rawaf S, Razeghinia MS, Redwan EMM, Renzaho AMN, Rezaei N, Rezaei N, Riad A, Saad AMA, Saddik B, Saeed U, Safary A, Sahebazzamani M, Sahebkar A, Sahoo H, Salek Farrokhi A, Saqib MAN, Seylani A, Shahabi S, Shaikh MA, Shashamo BB, Shetty A, Shetty JK, Shigematsu M, Shivarov V, Shobeiri P, Sibhat MM, Sinaei E, Singh A, Singh JA, Singh P, Singh S, Siraj MS, Skryabina AA, Slater H, Smith AE, Solomon Y, Soltani-Zangbar MS, Tabish M, Tan KK, Tat NY, Tehrani-Banihashemi A, Tharwat S, Tovani-Palone MR, Tusa BS, Valadan Tahbaz S, Valdez PR, Valizadeh R, Vaziri S, Vollset SE, Wu AM, Yada DY, Yehualashet SS, Yonemoto N, You Y, Yunusa I, Zangiabadian M, Zare I, Zarrintan A, Zhang ZJ, Zhong C, Zoladl M, Vos T, March LM. Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023; 5:e594-e610. [PMID: 37795020 PMCID: PMC10546867 DOI: 10.1016/s2665-9913(23)00211-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with disability and premature death. Up-to-date estimates of the burden of rheumatoid arthritis are required for health-care planning, resource allocation, and prevention. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we provide updated estimates of the prevalence of rheumatoid arthritis and its associated deaths and disability-adjusted life-years (DALYs) by age, sex, year, and location, with forecasted prevalence to 2050. Methods Rheumatoid arthritis prevalence was estimated in 204 countries and territories from 1990 to 2020 using Bayesian meta-regression models and data from population-based studies and medical claims data (98 prevalence and 25 incidence studies). Mortality was estimated from vital registration data with the Cause of Death Ensemble model (CODEm). Years of life lost (YLL) were calculated with use of standard GBD lifetables, and years lived with disability (YLDs) were estimated from prevalence, a meta-analysed distribution of rheumatoid arthritis severity, and disability weights. DALYs were calculated by summing YLLs and YLDs. Smoking was the only risk factor analysed. Rheumatoid arthritis prevalence was forecast to 2050 by logistic regression with Socio-Demographic Index as a predictor, then multiplying by projected population estimates. Findings In 2020, an estimated 17·6 million (95% uncertainty interval 15·8-20·3) people had rheumatoid arthritis worldwide. The age-standardised global prevalence rate was 208·8 cases (186·8-241·1) per 100 000 population, representing a 14·1% (12·7-15·4) increase since 1990. Prevalence was higher in females (age-standardised female-to-male prevalence ratio 2·45 [2·40-2·47]). The age-standardised death rate was 0·47 (0·41-0·54) per 100 000 population (38 300 global deaths [33 500-44 000]), a 23·8% (17·5-29·3) decrease from 1990 to 2020. The 2020 DALY count was 3 060 000 (2 320 000-3 860 000), with an age-standardised DALY rate of 36·4 (27·6-45·9) per 100 000 population. YLDs accounted for 76·4% (68·3-81·0) of DALYs. Smoking risk attribution for rheumatoid arthritis DALYs was 7·1% (3·6-10·3). We forecast that 31·7 million (25·8-39·0) individuals will be living with rheumatoid arthritis worldwide by 2050. Interpretation Rheumatoid arthritis mortality has decreased globally over the past three decades. Global age-standardised prevalence rate and YLDs have increased over the same period, and the number of cases is projected to continue to increase to the year 2050. Improved access to early diagnosis and treatment of rheumatoid arthritis globally is required to reduce the future burden of the disease. Funding Bill & Melinda Gates Foundation, Institute of Bone and Joint Research, and Global Alliance for Musculoskeletal Health.
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Dhahri A, Laifi J, Gouadria S, Elhadi M, Dhahri E, Hlil EK. Correction: Influence of Ni content on structural, magnetocaloric and electrical properties in manganite La 0.6Ba 0.2Sr 0.2Mn 1-xNi xO 3 (0 ≤ x ≤ 0.1) type perovskites. RSC Adv 2023; 13:28158. [PMID: 37753404 PMCID: PMC10518663 DOI: 10.1039/d3ra90093b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
[This corrects the article DOI: 10.1039/D1RA07059B.].
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Affiliation(s)
- Ahmed Dhahri
- Department of Physics, College of Science and Humanities - Dawadmi, Shaqra University Riyadh Saudi Arabia
- Laboratoire de Physique Appliquée, Faculté des Sciences de Sfax, Université de Sfax BP 1171 Tunisia
| | - J Laifi
- Physics Department, College of Science, Jouf University P.O. Box: 2014 Sakaka Saudi Arabia
| | - Soumaya Gouadria
- Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University P.O. Box 84428 Riyadh 11671 Saudi Arabia
| | - M Elhadi
- Laboratoire de Physique Appliquée, Faculté des Sciences de Sfax, Université de Sfax BP 1171 Tunisia
| | - E Dhahri
- Department of Physics, College of Science and Humanities - Dawadmi, Shaqra University Riyadh Saudi Arabia
| | - E K Hlil
- Univ. Grenoble Alpes, CNRS, Grenoble INP, Institut Néel 38000 Grenoble France
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Steinmetz JD, Culbreth GT, Haile LM, Rafferty Q, Lo J, Fukutaki KG, Cruz JA, Smith AE, Vollset SE, Brooks PM, Cross M, Woolf AD, Hagins H, Abbasi-Kangevari M, Abedi A, Ackerman IN, Amu H, Antony B, Arabloo J, Aravkin AY, Argaw AM, Artamonov AA, Ashraf T, Barrow A, Bearne LM, Bensenor IM, Berhie AY, Bhardwaj N, Bhardwaj P, Bhojaraja VS, Bijani A, Briant PS, Briggs AM, Butt NS, Charan J, Chattu VK, Cicuttini FM, Coberly K, Dadras O, Dai X, Dandona L, Dandona R, de Luca K, Denova-Gutiérrez E, Dharmaratne SD, Dhimal M, Dianatinasab M, Dreinhoefer KE, Elhadi M, Farooque U, Farpour HR, Filip I, Fischer F, Freitas M, Ganesan B, Gemeda BNB, Getachew T, Ghamari SH, Ghashghaee A, Gill TK, Golechha M, Golinelli D, Gupta B, Gupta VB, Gupta VK, Haddadi R, Hafezi-Nejad N, Halwani R, Hamidi S, Hanif A, Harlianto NI, Haro JM, Hartvigsen J, Hay SI, Hebert JJ, Heidari G, Hosseini MS, Hosseinzadeh M, Hsiao AK, Ilic IM, Ilic MD, Jacob L, Jayawardena R, Jha RP, Jonas JB, Joseph N, Kandel H, Karaye IM, Khan MJ, Kim YJ, Kolahi AA, Korzh O, Koteeswaran R, Krishnamoorthy V, Kumar GA, Kumar N, Lee SW, Lim SS, Lobo SW, Lucchetti G, Malekpour MR, Malik AA, Mandarano-Filho LGG, Martini S, Mentis AFA, Mesregah MK, Mestrovic T, Mirrakhimov EM, Misganaw A, Mohammadpourhodki R, Mokdad AH, Momtazmanesh S, Morrison SD, Murray CJL, Nassereldine H, Netsere HB, Neupane Kandel S, Owolabi MO, Panda-Jonas S, Pandey A, Pawar S, Pedersini P, Pereira J, Radfar A, Rashidi MM, Rawaf DL, Rawaf S, Rawassizadeh R, Rayegani SM, Ribeiro D, Roever L, Saddik B, Sahebkar A, Salehi S, Sanchez Riera L, Sanmarchi F, Santric-Milicevic MM, Shahabi S, Shaikh MA, Shaker E, Shannawaz M, Sharma R, Sharma S, Shetty JK, Shiri R, Shobeiri P, Silva DAS, Singh A, Singh JA, Singh S, Skou ST, Slater H, Soltani-Zangbar MS, Starodubova AV, Tehrani-Banihashemi A, Valadan Tahbaz S, Valdez PR, Vo B, Vu LG, Wang YP, Yahyazadeh Jabbari SH, Yonemoto N, Yunusa I, March LM, Ong KL, Vos T, Kopec JA. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol 2023; 5:e508-e522. [PMID: 37675071 PMCID: PMC10477960 DOI: 10.1016/s2665-9913(23)00163-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background Osteoarthritis is the most common form of arthritis in adults, characterised by chronic pain and loss of mobility. Osteoarthritis most frequently occurs after age 40 years and prevalence increases steeply with age. WHO has designated 2021-30 the decade of healthy ageing, which highlights the need to address diseases such as osteoarthritis, which strongly affect functional ability and quality of life. Osteoarthritis can coexist with, and negatively effect, other chronic conditions. Here we estimate the burden of hand, hip, knee, and other sites of osteoarthritis across geographies, age, sex, and time, with forecasts of prevalence to 2050. Methods In this systematic analysis for the Global Burden of Disease Study, osteoarthritis prevalence in 204 countries and territories from 1990 to 2020 was estimated using data from population-based surveys from 26 countries for knee osteoarthritis, 23 countries for hip osteoarthritis, 42 countries for hand osteoarthritis, and US insurance claims for all of the osteoarthritis sites, including the other types of osteoarthritis category. The reference case definition was symptomatic, radiographically confirmed osteoarthritis. Studies using alternative definitions from the reference case definition (for example self-reported osteoarthritis) were adjusted to reference using regression models. Osteoarthritis severity distribution was obtained from a pooled meta-analysis of sources using the Western Ontario and McMaster Universities Arthritis Index. Final prevalence estimates were multiplied by disability weights to calculate years lived with disability (YLDs). Prevalence was forecast to 2050 using a mixed-effects model. Findings Globally, 595 million (95% uncertainty interval 535-656) people had osteoarthritis in 2020, equal to 7·6% (95% UI 6·8-8·4) of the global population, and an increase of 132·2% (130·3-134·1) in total cases since 1990. Compared with 2020, cases of osteoarthritis are projected to increase 74·9% (59·4-89·9) for knee, 48·6% (35·9-67·1) for hand, 78·6% (57·7-105·3) for hip, and 95·1% (68·1-135·0) for other types of osteoarthritis by 2050. The global age-standardised rate of YLDs for total osteoarthritis was 255·0 YLDs (119·7-557·2) per 100 000 in 2020, a 9·5% (8·6-10·1) increase from 1990 (233·0 YLDs per 100 000, 109·3-510·8). For adults aged 70 years and older, osteoarthritis was the seventh ranked cause of YLDs. Age-standardised prevalence in 2020 was more than 5·5% in all world regions, ranging from 5677·4 (5029·8-6318·1) per 100 000 in southeast Asia to 8632·7 (7852·0-9469·1) per 100 000 in high-income Asia Pacific. Knee was the most common site for osteoarthritis. High BMI contributed to 20·4% (95% UI -1·7 to 36·6) of osteoarthritis. Potentially modifiable risk factors for osteoarthritis such as recreational injury prevention and occupational hazards have not yet been explored in GBD modelling. Interpretation Age-standardised YLDs attributable to osteoarthritis are continuing to rise and will lead to substantial increases in case numbers because of population growth and ageing, and because there is no effective cure for osteoarthritis. The demand on health systems for care of patients with osteoarthritis, including joint replacements, which are highly effective for late stage osteoarthritis in hips and knees, will rise in all regions, but might be out of reach and lead to further health inequity for individuals and countries unable to afford them. Much more can and should be done to prevent people getting to that late stage. Funding Bill & Melinda Gates Foundation, Institute of Bone and Joint Research, and Global Alliance for Musculoskeletal Health.
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Croghan SM, Mohan HM, Breen KJ, McGovern R, Bennett KE, Boland MR, Elhadi M, Elliott JA, Fullard AC, Lonergan PE, McDermott F, Mehraj A, Pata F, Quinlan DM, Winter DC, Bolger JC, Fleming CA. Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study. JAMA Surg 2023; 158:865-873. [PMID: 37405798 PMCID: PMC10323764 DOI: 10.1001/jamasurg.2023.2137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/11/2023] [Indexed: 07/06/2023]
Abstract
Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.
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Affiliation(s)
- Stefanie M. Croghan
- Irish Surgical Research Collaborative, Royal College of Surgeons, Dublin, Ireland
| | - Helen M. Mohan
- Irish Surgical Research Collaborative, Royal College of Surgeons, Dublin, Ireland
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kieran J. Breen
- Department of Urology, St Vincent’s University Hospital, Dublin, Ireland
| | - Ruth McGovern
- Department of Anaesthesia, Cork University Hospital, Cork, Ireland
| | - Kathleen E. Bennett
- Data Science Centre, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Michael R. Boland
- Department of Breast Surgery, St Mary’s Hospital, London, United Kingdom
| | - Muhammed Elhadi
- Faculty of Medicine, University of Tripoli (Tripoli University Hospital) Furnaj, Tripoli, Libya
| | - Jessie A. Elliott
- Department of Upper Gastrointestinal and General Surgery, St James’s Hospital, Dublin, Ireland
| | - Anna C. Fullard
- Department of General and Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - Peter E. Lonergan
- Department of Urology, St James’s Hospital, Dublin, Ireland
- Department of Surgery, Trinity College, Dublin, Ireland
| | - Frank McDermott
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | | | - Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - David M. Quinlan
- Department of Urology, St Vincent’s University Hospital, Dublin, Ireland
| | - Des C. Winter
- Department of Colorectal and General Surgery, St Vincent’s Hospital, Dublin, Ireland
| | - Jarlath C. Bolger
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Christina A. Fleming
- Department of General and Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
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Wunrow HY, Bender RG, Vongpradith A, Sirota SB, Swetschinski LR, Novotney A, Gray AP, Ikuta KS, Sharara F, Wool EE, Aali A, Abd-Elsalam S, Abdollahi A, Abdul Aziz JM, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Adamu LH, Adane TD, Addo IY, Adegboye OA, Adekiya TA, Adnan M, Adnani QES, Afzal S, Aghamiri S, Aghdam ZB, Agodi A, Ahinkorah BO, Ahmad A, Ahmad S, Ahmadzade M, Ahmed A, Ahmed A, Ahmed JQ, Ahmed MS, Akinosoglou K, Aklilu A, Akonde M, Alahdab F, AL-Ahdal TMA, Alanezi FM, Albelbeisi AH, Alemayehu TBB, Alene KA, Al-Eyadhy A, Al-Gheethi AAS, Ali A, Ali BA, Ali L, Ali SS, Alimohamadi Y, Alipour V, Aljunid SM, Almustanyir S, Al-Raddadi RM, Alvis-Guzman N, Al-Worafi YM, Aly H, Ameyaw EK, Ancuceanu R, Ansar A, Ansari G, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Artamonov AA, Arulappan J, Aruleba RT, Asaduzzaman M, Atalell KA, Athari SS, Atlaw D, Atout MMW, Attia S, Awoke T, Ayalew MK, Ayana TM, Ayele AD, Azadnajafabad S, Azizian K, Badar M, Badiye AD, Baghcheghi N, Bagheri M, Bagherieh S, Bahadory S, Baig AA, Barac A, Barati S, Bardhan M, Basharat Z, Bashiri A, Basnyat B, Bassat Q, Basu S, Bayileyegn NS, Bedi N, Behnoush AH, Bekel AA, Belete MA, Bello OO, Bhagavathula AS, Bhandari D, Bhardwaj P, Bhaskar S, Bhat AN, Bijani A, Bineshfar N, Boloor A, Bouaoud S, Buonsenso D, Burkart K, Cámera LA, Castañeda-Orjuela CA, Cernigliaro A, Charan J, Chattu VK, Ching PR, Chopra H, Choudhari SG, Christopher DJ, Chu DT, Couto RAS, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Das S, Dash NR, Dashti M, De la Hoz FP, Debela SA, Dejen D, Dejene H, Demeke D, Demeke FM, Demessa BH, Demetriades AK, Demissie S, Dereje D, Dervišević E, Desai HD, Dessie AM, Desta F, Dhama K, Djalalinia S, Do TC, Dodangeh M, Dodangeh M, Dominguez RMV, Dongarwar D, Dsouza HL, Durojaiye OC, Dziedzic AM, Ekat MH, Ekholuenetale M, Ekundayo TC, El Sayed Zaki M, El-Abid H, Elhadi M, El-Hajj VG, El-Huneidi W, El-Sakka AA, Esayas HL, Fagbamigbe AF, Falahi S, Fares J, Fatehizadeh A, Fatima SAF, Feasey NA, Fekadu G, Fetensa G, Feyissa D, Fischer F, Foroutan B, Gaal PA, Gadanya MA, Gaipov A, Ganesan B, Gebrehiwot M, Gebrekidan KG, Gebremeskel TG, Gedef GM, Gela YY, Gerema U, Gessner BD, Getachew ME, Ghadiri K, Ghaffari K, Ghamari SH, Ghanbari R, Ghazy RMM, Ghozali G, Gizaw ABAB, Glushkova EV, Goldust M, Golechha M, Guadie HA, Guled RA, Gupta M, Gupta S, Gupta VB, Gupta VK, Gupta VK, Hadi NR, Haj-Mirzaian A, Haller S, Hamidi S, Haque S, Harapan H, Hasaballah AI, Hasan I, Hasani H, Hasanian M, Hassankhani H, Hassen MB, Hayat K, Heidari M, Heidari-Foroozan M, Heidari-Soureshjani R, Hezam K, Holla R, Horita N, Hossain MM, Hosseini MS, Hosseinzadeh M, Hostiuc S, Hussain S, Hussein NR, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Iregbu KC, Ismail NE, Iwu CCD, Jaja C, Jakovljevic M, Jamshidi E, Javadi Mamaghani A, Javidnia J, Jokar M, Jomehzadeh N, Joseph N, Joshua CE, Jozwiak JJ, Kabir Z, Kalankesh LR, Kalhor R, Kamal VK, Kandel H, Karaye IM, Karch A, Karimi H, Kaur H, Kaur N, Keykhaei M, Khajuria H, Khalaji A, Khan A, Khan IA, Khan M, Khan T, Khatab K, Khatatbeh MM, Khayat Kashani HR, Khubchandani J, Kim MS, Kisa A, Kisa S, Kompani F, Koohestani HR, Kothari N, Krishan K, Krishnamoorthy Y, Kulimbet M, Kumar M, Kumaran SD, Kuttikkattu A, Kwarteng A, Laksono T, Landires I, Laryea DO, Lawal BK, Le TTT, Ledda C, Lee SW, Lee S, Lema GK, Levi M, Lim SS, Liu X, Lopes G, Lutzky Saute R, Machado Teixeira PH, Mahmoodpoor A, Mahmoud MA, Malakan Rad E, Malhotra K, Malik AA, Martinez-Guerra BA, Martorell M, Mathur V, Mayeli M, Medina JRC, Melese A, Memish ZA, Mentis AFA, Merza MA, Mestrovic T, Michalek IM, Minh LHN, Mirahmadi A, Mirmosayyeb O, Misganaw A, Misra AK, Moghadasi J, Mohamed NS, Mohammad Y, Mohammadi E, Mohammed S, Mojarrad Sani M, Mojiri-forushani H, Mokdad AH, Momtazmanesh S, Monasta L, Moni MA, Mossialos E, Mostafavi E, Motaghinejad M, Mousavi Khaneghah A, Mubarik S, Muccioli L, Muhammad JS, Mulita F, Mulugeta T, Murillo-Zamora E, Mustafa G, Muthupandian S, Nagarajan AJ, Nainu F, Nair TS, Nargus S, Nassereldine H, Natto ZS, Nayak BP, Negoi I, Negoi RI, Nejadghaderi SA, Nguyen HQ, Nguyen PT, Nguyen VT, Niazi RK, Noroozi N, Nouraei H, Nuñez-Samudio V, Nuruzzaman KM, Nwatah VE, Nzoputam CI, Nzoputam OJ, Oancea B, Obaidur RM, Odetokun IA, Ogunsakin RE, Okonji OC, Olagunju AT, Olana LT, Olufadewa II, Oluwafemi YD, Oumer KS, Ouyahia A, P A M, Pakshir K, Palange PN, Pardhan S, Parikh RR, Patel J, Patel UK, Patil S, Paudel U, Pawar S, Pensato U, Perdigão J, Pereira M, Peres MFP, Petcu IR, Pinheiro M, Piracha ZZ, Pokhrel N, Postma MJ, Prates EJS, Qattea I, Raghav PR, Rahbarnia L, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahmanian V, Rahnavard N, Ramadan H, Ramasubramani P, Rani U, Rao IR, Rapaka D, Ratan ZA, Rawaf S, Redwan EMM, Reiner Jr RC, Rezaei N, Riad A, Ribeiro da Silva TM, Roberts T, Robles Aguilar G, Rodriguez JAB, Rosenthal VD, Saddik B, Sadeghian S, Saeed U, Safary A, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahu M, Sajedi SA, Saki M, Salahi S, Salahi S, Saleh MA, Sallam M, Samadzadeh S, Samy AM, Sanjeev RK, Satpathy M, Seylani A, Sha'aban A, Shafie M, Shah PA, Shahrokhi S, Shahzamani K, Shaikh MA, Sham S, Shannawaz M, Sheikh A, Shenoy SM, Shetty PH, Shin JI, Shokri F, Shorofi SA, Shrestha S, Sibhat MM, Siddig EE, Silva LMLR, Singh H, Singh JA, Singh P, Singh S, Sinto R, Skryabina AA, Socea B, Sokhan A, Solanki R, Solomon Y, Sood P, Soshnikov S, Stergachis A, Sufiyan MB, Suliankatchi Abdulkader R, Sultana A, T Y SS, Taheri E, Taki E, Tamuzi JJLL, Tan KK, Tat NY, Temsah MH, Terefa DR, Thangaraju P, Tibebu NS, Ticoalu JHV, Tillawi T, Tincho MB, Tleyjeh II, Toghroli R, Tovani-Palone MR, Tufa DG, Turner P, Ullah I, Umeokonkwo CD, Unnikrishnan B, Vahabi SM, Vaithinathan AG, Valizadeh R, Varthya SB, Vos T, Waheed Y, Walde MT, Wang C, Weerakoon KG, Wickramasinghe ND, Winkler AS, Woldemariam M, Worku NA, Wright C, Yada DY, Yaghoubi S, Yahya GATY, Yenew CYY, Yesiltepe M, Yi S, Yiğit V, You Y, Yusuf H, Zakham F, Zaman M, Zaman SB, Zare I, Zareshahrabadi Z, Zarrintan A, Zastrozhin MS, Zhang H, Zhang J, Zhang ZJ, Zheng P, Zoladl M, Zumla A, Hay SI, Murray CJL, Naghavi M, Kyu HH. Global, regional, and national burden of meningitis and its aetiologies, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2023; 22:685-711. [PMID: 37479374 PMCID: PMC10356620 DOI: 10.1016/s1474-4422(23)00195-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories. METHODS We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category. FINDINGS In 2019, there were an estimated 236 000 deaths (95% uncertainty interval [UI] 204 000-277 000) and 2·51 million (2·11-2·99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400-145 000) and 1·28 million incident cases (0·947-1·71) in 2019. Age-standardised mortality rates decreased from 7·5 (6·6-8·4) per 100 000 population in 1990 to 3·3 (2·8-3·9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18·1% [17·1-19·2]), followed by N meningitidis (13·6% [12·7-14·4]) and K pneumoniae (12·2% [10·2-14·3]). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76·5% [69·5-81·8]), followed by N meningitidis (72·3% [64·4-78·5]) and viruses (58·2% [47·1-67·3]). INTERPRETATION Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatment. FUNDING Bill & Melinda Gates Foundation.
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Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, Dalton BE, Duprey J, Cruz JA, Hagins H, Lindstedt PA, Aali A, Abate YH, Abate MD, Abbasian M, Abbasi-Kangevari Z, Abbasi-Kangevari M, Abd ElHafeez S, Abd-Rabu R, Abdulah DM, Abdullah AYM, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Abu-Zaid A, Adane TD, Adane DE, Addo IY, Adegboye OA, Adekanmbi V, Adepoju AV, Adnani QES, Afolabi RF, Agarwal G, Aghdam ZB, Agudelo-Botero M, Aguilera Arriagada CE, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad R, Ahmad S, Ahmad A, Ahmadi A, Ahmadi K, Ahmed A, Ahmed A, Ahmed LA, Ahmed SA, Ajami M, Akinyemi RO, Al Hamad H, Al Hasan SM, AL-Ahdal TMA, Alalwan TA, Al-Aly Z, AlBataineh MT, Alcalde-Rabanal JE, Alemi S, Ali H, Alinia T, Aljunid SM, Almustanyir S, Al-Raddadi RM, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Amusa GA, Andrei CL, Anjana RM, Ansar A, Ansari G, Ansari-Moghaddam A, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Arifin H, Arkew M, Armocida B, Ärnlöv J, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Aryan Z, Asemu MT, Asghari-Jafarabadi M, Askari E, Asmelash D, Astell-Burt T, Athar M, Athari SS, Atout MMW, Avila-Burgos L, Awaisu A, Azadnajafabad S, B DB, Babamohamadi H, Badar M, Badawi A, Badiye AD, Baghcheghi N, Bagheri N, Bagherieh S, Bah S, Bahadory S, Bai R, Baig AA, Baltatu OC, Baradaran HR, Barchitta M, Bardhan M, Barengo NC, Bärnighausen TW, Barone MTU, Barone-Adesi F, Barrow A, Bashiri H, Basiru A, Basu S, Basu S, Batiha AMM, Batra K, Bayih MT, Bayileyegn NS, Behnoush AH, Bekele AB, Belete MA, Belgaumi UI, Belo L, Bennett DA, Bensenor IM, Berhe K, Berhie AY, Bhaskar S, Bhat AN, Bhatti JS, Bikbov B, Bilal F, Bintoro BS, Bitaraf S, Bitra VR, Bjegovic-Mikanovic V, Bodolica V, Boloor A, Brauer M, Brazo-Sayavera J, Brenner H, Butt ZA, Calina D, Campos LA, Campos-Nonato IR, Cao Y, Cao C, Car J, Carvalho M, Castañeda-Orjuela CA, Catalá-López F, Cerin E, Chadwick J, Chandrasekar EK, Chanie GS, Charan J, Chattu VK, Chauhan K, Cheema HA, Chekol Abebe E, Chen S, Cherbuin N, Chichagi F, Chidambaram SB, Cho WCS, Choudhari SG, Chowdhury R, Chowdhury EK, Chu DT, Chukwu IS, Chung SC, Coberly K, Columbus A, Contreras D, Cousin E, Criqui MH, Cruz-Martins N, Cuschieri S, Dabo B, Dadras O, Dai X, Damasceno AAM, Dandona R, Dandona L, Das S, Dascalu AM, Dash NR, Dashti M, Dávila-Cervantes CA, De la Cruz-Góngora V, Debele GR, Delpasand K, Demisse FW, Demissie GD, Deng X, Denova-Gutiérrez E, Deo SV, Dervišević E, Desai HD, Desale AT, Dessie AM, Desta F, Dewan SMR, Dey S, Dhama K, Dhimal M, Diao N, Diaz D, Dinu M, Diress M, Djalalinia S, Doan LP, Dongarwar D, dos Santos Figueiredo FW, Duncan BB, Dutta S, Dziedzic AM, Edinur HA, Ekholuenetale M, Ekundayo TC, Elgendy IY, Elhadi M, El-Huneidi W, Elmeligy OAA, Elmonem MA, Endeshaw D, Esayas HL, Eshetu HB, Etaee F, Fadhil I, Fagbamigbe AF, Fahim A, Falahi S, Faris MEM, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fazli G, Feng X, Ferede TY, Fischer F, Flood D, Forouhari A, Foroumadi R, Foroutan Koudehi M, Gaidhane AM, Gaihre S, Gaipov A, Galali Y, Ganesan B, Garcia-Gordillo MA, Gautam RK, Gebrehiwot M, Gebrekidan KG, Gebremeskel TG, Getacher L, Ghadirian F, Ghamari SH, Ghasemi Nour M, Ghassemi F, Golechha M, Goleij P, Golinelli D, Gopalani SV, Guadie HA, Guan SY, Gudayu TW, Guimarães RA, Guled RA, Gupta R, Gupta K, Gupta VB, Gupta VK, Gyawali B, Haddadi R, Hadi NR, Haile TG, Hajibeygi R, Haj-Mirzaian A, Halwani R, Hamidi S, Hankey GJ, Hannan MA, Haque S, Harandi H, Harlianto NI, Hasan SMM, Hasan SS, Hasani H, Hassanipour S, Hassen MB, Haubold J, Hayat K, Heidari G, Heidari M, Hessami K, Hiraike Y, Holla R, Hossain S, Hossain MS, Hosseini MS, Hosseinzadeh M, Hosseinzadeh H, Huang J, Huda MN, Hussain S, Huynh HH, Hwang BF, Ibitoye SE, Ikeda N, Ilic IM, Ilic MD, Inbaraj LR, Iqbal A, Islam SMS, Islam RM, Ismail NE, Iso H, Isola G, Itumalla R, Iwagami M, Iwu CCD, Iyamu IO, Iyasu AN, Jacob L, Jafarzadeh A, Jahrami H, Jain R, Jaja C, Jamalpoor Z, Jamshidi E, Janakiraman B, Jayanna K, Jayapal SK, Jayaram S, Jayawardena R, Jebai R, Jeong W, Jin Y, Jokar M, Jonas JB, Joseph N, Joseph A, Joshua CE, Joukar F, Jozwiak JJ, Kaambwa B, Kabir A, Kabthymer RH, Kadashetti V, Kahe F, Kalhor R, Kandel H, Karanth SD, Karaye IM, Karkhah S, Katoto PDMC, Kaur N, Kazemian S, Kebede SA, Khader YS, Khajuria H, Khalaji A, Khan MAB, Khan M, Khan A, Khanal S, Khatatbeh MM, Khater AM, Khateri S, khorashadizadeh F, Khubchandani J, Kibret BG, Kim MS, Kimokoti RW, Kisa A, Kivimäki M, Kolahi AA, Komaki S, Kompani F, Koohestani HR, Korzh O, Kostev K, Kothari N, Koyanagi A, Krishan K, Krishnamoorthy Y, Kuate Defo B, Kuddus M, Kuddus MA, Kumar R, Kumar H, Kundu S, Kurniasari MD, Kuttikkattu A, La Vecchia C, Lallukka T, Larijani B, Larsson AO, Latief K, Lawal BK, Le TTT, Le TTB, Lee SWH, Lee M, Lee WC, Lee PH, Lee SW, Lee SW, Legesse SM, Lenzi J, Li Y, Li MC, Lim SS, Lim LL, Liu X, Liu C, Lo CH, Lopes G, Lorkowski S, Lozano R, Lucchetti G, Maghazachi AA, Mahasha PW, Mahjoub S, Mahmoud MA, Mahmoudi R, Mahmoudimanesh M, Mai AT, Majeed A, Majma Sanaye P, Makris KC, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Mamun AA, Mansouri B, Marateb HR, Mardi P, Martini S, Martorell M, Marzo RR, Masoudi R, Masoudi S, Mathews E, Maugeri A, Mazzaglia G, Mekonnen T, Meshkat M, Mestrovic T, Miao Jonasson J, Miazgowski T, Michalek IM, Minh LHN, Mini GK, Miranda JJ, Mirfakhraie R, Mirrakhimov EM, Mirza-Aghazadeh-Attari M, Misganaw A, Misgina KH, Mishra M, Moazen B, Mohamed NS, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammadshahi M, Mohseni A, Mojiri-forushani H, Mokdad AH, Momtazmanesh S, Monasta L, Moniruzzaman M, Mons U, Montazeri F, Moodi Ghalibaf A, Moradi Y, Moradi M, Moradi Sarabi M, Morovatdar N, Morrison SD, Morze J, Mossialos E, Mostafavi E, Mueller UO, Mulita F, Mulita A, Murillo-Zamora E, Musa KI, Mwita JC, Nagaraju SP, Naghavi M, Nainu F, Nair TS, Najmuldeen HHR, Nangia V, Nargus S, Naser AY, Nassereldine H, Natto ZS, Nauman J, Nayak BP, Ndejjo R, Negash H, Negoi RI, Nguyen HTH, Nguyen DH, Nguyen PT, Nguyen VT, Nguyen HQ, Niazi RK, Nigatu YT, Ningrum DNA, Nizam MA, Nnyanzi LA, Noreen M, Noubiap JJ, Nzoputam OJ, Nzoputam CI, Oancea B, Odogwu NM, Odukoya OO, Ojha VA, Okati-Aliabad H, Okekunle AP, Okonji OC, Okwute PG, Olufadewa II, Onwujekwe OE, Ordak M, Ortiz A, Osuagwu UL, Oulhaj A, Owolabi MO, Padron-Monedero A, Padubidri JR, Palladino R, Panagiotakos D, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pantea Stoian AM, Pardhan S, Parekh T, Parekh U, Pasovic M, Patel J, Patel JR, Paudel U, Pepito VCF, Pereira M, Perico N, Perna S, Petcu IR, Petermann-Rocha FE, Podder V, Postma MJ, Pourali G, Pourtaheri N, Prates EJS, Qadir MMF, Qattea I, Raee P, Rafique I, Rahimi M, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Rahman MA, Rahman MHU, Rahman M, Rahman MM, Rahmani M, Rahmani S, Rahmanian V, Rahmawaty S, Rahnavard N, Rajbhandari B, Ram P, Ramazanu S, Rana J, Rancic N, Ranjha MMAN, Rao CR, Rapaka D, Rasali DP, Rashedi S, Rashedi V, Rashid AM, Rashidi MM, Ratan ZA, Rawaf S, Rawal L, Redwan EMM, Remuzzi G, Rengasamy KRR, Renzaho AMN, Reyes LF, Rezaei N, Rezaei N, Rezaeian M, Rezazadeh H, Riahi SM, Rias YA, Riaz M, Ribeiro D, Rodrigues M, Rodriguez JAB, Roever L, Rohloff P, Roshandel G, Roustazadeh A, Rwegerera GM, Saad AMA, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Sadeghi E, Saeed U, Saeedi Moghaddam S, Safi S, Safi SZ, Saghazadeh A, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahoo SS, Sahoo H, Saif-Ur-Rahman KM, Sajid MR, Salahi S, Salahi S, Saleh MA, Salehi MA, Salomon JA, Sanabria J, Sanjeev RK, Sanmarchi F, Santric-Milicevic MM, Sarasmita MA, Sargazi S, Sathian B, Sathish T, Sawhney M, Schlaich MP, Schmidt MI, Schuermans A, Seidu AA, Senthil Kumar N, Sepanlou SG, Sethi Y, Seylani A, Shabany M, Shafaghat T, Shafeghat M, Shafie M, Shah NS, Shahid S, Shaikh MA, Shanawaz M, Shannawaz M, Sharfaei S, Shashamo BB, Shiri R, Shittu A, Shivakumar KM, Shivalli S, Shobeiri P, Shokri F, Shuval K, Sibhat MM, Silva LMLR, Simpson CR, Singh JA, Singh P, Singh S, Siraj MS, Skryabina AA, Sohag AAM, Soleimani H, Solikhah S, Soltani-Zangbar MS, Somayaji R, Sorensen RJD, Starodubova AV, Sujata S, Suleman M, Sun J, Sundström J, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaeizadeh SA, Tabish M, Taheri M, Taheri E, Taki E, Tamuzi JJLL, Tan KK, Tat NY, Taye BT, Temesgen WA, Temsah MH, Tesler R, Thangaraju P, Thankappan KR, Thapa R, Tharwat S, Thomas N, Ticoalu JHV, Tiyuri A, Tonelli M, Tovani-Palone MR, Trico D, Trihandini I, Tripathy JP, Tromans SJ, Tsegay GM, Tualeka AR, Tufa DG, Tyrovolas S, Ullah S, Upadhyay E, Vahabi SM, Vaithinathan AG, Valizadeh R, van Daalen KR, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Verma MV, Verras GI, Vo DC, Wagaye B, Waheed Y, Wang Z, Wang Y, Wang C, Wang F, Wassie GT, Wei MYW, Weldemariam AH, Westerman R, Wickramasinghe ND, Wu Y, Wulandari RDWI, Xia J, Xiao H, Xu S, Xu X, Yada DY, Yang L, Yatsuya H, Yesiltepe M, Yi S, Yohannis HK, Yonemoto N, You Y, Zaman SB, Zamora N, Zare I, Zarea K, Zarrintan A, Zastrozhin MS, Zeru NG, Zhang ZJ, Zhong C, Zhou J, Zielińska M, Zikarg YT, Zodpey S, Zoladl M, Zou Z, Zumla A, Zuniga YMH, Magliano DJ, Murray CJL, Hay SI, Vos T. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402:203-234. [PMID: 37356446 PMCID: PMC10364581 DOI: 10.1016/s0140-6736(23)01301-6] [Citation(s) in RCA: 250] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. FUNDING Bill & Melinda Gates Foundation.
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Williams PG, Tabah A, Cotta MO, Sandaradura I, Kanji S, Scheetz MH, Imani S, Elhadi M, Luque-Pardos S, Schellack N, Sanches C, Timsit JF, Xie J, Farkas A, Wilks K, Roberts JA. International survey of antibiotic dosing and monitoring in adult intensive care units. Crit Care 2023; 27:241. [PMID: 37331935 DOI: 10.1186/s13054-023-04527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time. METHODS A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides. RESULTS A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25 mg/kg and 20 mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%). CONCLUSIONS We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence.
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Affiliation(s)
- Paul G Williams
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia.
- Pharmacy Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
| | - Alexis Tabah
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia
- Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
| | - Menino Osbert Cotta
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia
| | - Indy Sandaradura
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW, Australia
| | - Salmaan Kanji
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marc H Scheetz
- Pharmacometric Center of Excellence, Departments of Pharmacy Practice and Pharmacology, College of Pharmacy, Midwestern University, Downers Grove, IL, USA
| | - Sahand Imani
- Nepean Blue Mountains Local Health District, Nepean Hospital, Sydney, NSW, Australia
| | | | - Sònia Luque-Pardos
- Pharmacy Department, Parc de Salut Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBER of Pharmacy, Saint Clare's Infectious Diseases (CIBERINFEC CB21/13/0002) Institute of Health Carlos III, Madrid, Spain
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Cristina Sanches
- Campus Centro Oeste Dona Lindu, Federal University of Sao João del Rei, Divinópolis, Minas Gerais, Brasil
| | - Jean-Francois Timsit
- Assistance Publique Hôpitaux de Paris - Bichat hospital Medical and infectious diseases ICU (MI2), 75018, Paris, France
- IAME U 1137 Université Paris-Cité Site Bichat, 75018, Paris, France
| | - Jiao Xie
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Andras Farkas
- Optimum Dosing Strategies, Bloomingdale, NJ, USA
- Department of Pharmacy, Saint Clare's Health, Denville, NJ, USA
| | - Kathryn Wilks
- Infectious Diseases Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Thomson AM, McHugh TA, Oron AP, Teply C, Lonberg N, Vilchis Tella V, Wilner LB, Fuller K, Hagins H, Aboagye RG, Aboye MB, Abu-Gharbieh E, Abu-Zaid A, Addo IY, Ahinkorah BO, Ahmad A, AlRyalat SAS, Amu H, Aravkin AY, Arulappan J, Atout MMW, Badiye AD, Bagherieh S, Banach M, Banakar M, Bardhan M, Barrow A, Bedane DA, Bensenor IM, Bhagavathula AS, Bhardwaj P, Bhardwaj PV, Bhat AN, Bhutta ZA, Bilalaga MM, Bishai JD, Bitaraf S, Boloor A, Butt MH, Chattu VK, Chu DT, Dadras O, Dai X, Danaei B, Dang AK, Demisse FW, Dhimal M, Diaz D, Djalalinia S, Dongarwar D, Elhadi M, Elmonem MA, Esezobor CI, Etaee F, Eyawo O, Fagbamigbe AF, Fatehizadeh A, Force LM, Gardner WM, Ghaffari K, Gill PS, Golechha M, Goleij P, Gupta VK, Hasani H, Hassan TS, Hassen MB, Ibitoye SE, Ikiroma AI, Iwu CCD, James PB, Jayaram S, Jebai R, Jha RP, Joseph N, Kalantar F, Kandel H, Karaye IM, Kassahun WD, Khan IA, Khanmohammadi S, Kisa A, Kompani F, Krishan K, Landires I, Lim SS, Mahajan PB, Mahjoub S, Majeed A, Marasini BP, Meresa HA, Mestrovic T, Minhas S, Misganaw A, Mokdad AH, Monasta L, Mustafa G, Nair TS, Narasimha Swamy S, Nassereldine H, Natto ZS, Naveed M, Nayak BP, Noubiap JJ, Noyes T, Nri-ezedi CA, Nwatah VE, Nzoputam CI, Nzoputam OJ, Okonji OC, Onikan AO, Owolabi MO, Patel J, Pati S, Pawar S, Petcu IR, Piel FB, Qattea I, Rahimi M, Rahman M, Rawaf S, Redwan EMM, Rezaei N, Saddik B, Saeed U, Saheb Sharif-Askari F, Samy AM, Schumacher AE, Shaker E, Shetty A, Sibhat MM, Singh JA, Suleman M, Sunuwar DR, Szeto MD, Tamuzi JJLL, Tat NY, Taye BT, Temsah MH, Umair M, Valadan Tahbaz S, Wang C, Wickramasinghe ND, Yigit A, Yiğit V, Yunusa I, Zaman BA, Zangiabadian M, Zheng P, Hay SI, Naghavi M, Murray CJL, Kassebaum NJ. Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000-2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Haematol 2023:S2352-3026(23)00118-7. [PMID: 37331373 PMCID: PMC10390339 DOI: 10.1016/s2352-3026(23)00118-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. METHODS We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures-borrowing strength from predictive covariates and across age, time, and geography-and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). FINDINGS Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13·7% (95% uncertainty interval 11·1-16·5), to 515 000 (425 000-614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41·4% (38·3-44·9), from 5·46 million (4·62-6·45) in 2000 to 7·74 million (6·51-9·2) in 2021. We estimated 34 400 (25 000-45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000-467 000). In children younger than 5 years, there were 81 100 (58 800-108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. INTERPRETATION Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease. FUNDING Bill & Melinda Gates Foundation.
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Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, Mclean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili A, Elkazaz A, Kedwany A, Nuhu AM, Sakr A, Shehta A, Shirazi A, Mohamed AMI, Sherif AE, Awad AK, Abbas AM, Abdelrahman AS, Ammar AS, Azzam AY, Ciftci AB, Dural AC, Sanli AN, Rahy-Martín AC, Tantri AR, Khan A, Al-Touny A, Tariq A, Gmati A, Costas-Chavarri A, Auerkari A, Landaluce-Olavarria A, Puri A, Radhakrishnan A, Ubom AE, Pradhan A, Turna A, Adepiti A, Kuriyama A, Kassam AF, Hassouneh A, El-Hussuna A, Habeebullah A, Ads AM, Mousli A, Biloslavo A, Hoang A, Kirk A, Santini A, Melero AV, Calvache AJN, Baduell A, Chan A, Abrate A, Balduzzi A, Sánchez AC, Navarrete-Peón A, Porcu A, Brolese A, Barranquero AG, Saibene AM, Adam AA, Vagge A, Maquilón AJ, Leon-Andrino A, Sekulić A, Trifunovski A, Mako A, Bedada AG, Broglia A, Coppola A, Giani A, Grandi A, Iacomino A, Moro A, D’amico A, Malagnino A, Tang A, Doyle A, Alfieri A, Haynes A, Wilkins A, Baldwin A, Heriot A, Laird A, Lazarides A, O'connor A, Trulson A, Rokohl AC, Caziuc A, Triantafyllou A, Anesi A, Nikova A, Andrianakis A, Charalabopoulos A, Tsolakidis A, Chirca A, Arnaud AP, Narvaez-Rojas AR, Kavalakat A, Spina A, Recordare A, Annicchiarico A, Conti A, Mohammed AD, Kocataş A, Almhimid A, Arnaout A, Fahmy A, Mangi A, Modabber A, Ulas AB, Mohamedahmed AYY, Frontali A, Moynihan A, Yunus A, Ahmad A, Kent AJ, Khamees A, Ugwu AO, Turan A, Mohammed AAK, Navarro-Barrios A, Yebes A, De Sousa ÁFL, Moreno A, Sethi A, Dawson AC, Othman AAA, Kaur A, Wolde A, Antonelli A, Scifo A, Alhamad A, Davis A, Alderazi A, Harky A, Mohammed-Durosinlorun A, Seguya A, Okhakhu A, Chamakhi A, Sebai A, Souadka A, Asla A, Agrawal A, Persad A, Gupta A, Elgazar A, Kulkarni A, Coates A, Bellés AC, Hadzibegovic AD, Jotic A, Kowark A, Martins A, Pineda AM, Peral A, Gollarte AS, Senent-Boza A, Camarena AIA, Castaño-Leon AM, Bravo AMM, Moro AMG, Musina AM, Tapia-Herrero AM, Kothari A, Gupta A, Raja A, Aljaiuossi A, Taha A, Majbar AM, Prodromidou A, Kanatas A, Gupte A, Zakaria AD, Balla A, Barberis A, Bondurri A, Bottari A, Costantino A, Figus A, Lauretta A, Mingoli A, Romanzi A, Sagnotta A, Scacchi A, Picchetto A, Valadez AEC, Luzzi AP, Älgå A, Fontalis A, Hecker A, Demetriades AK, Serban AM, Văcărașu AB, Cokan A, Isaza-Restrepo A, Beamish A, Schache A, Stevenson A, Yiu A, Cockbain AJ, Litvin A, Abad-Motos A, Becerra A, Ramos ÁC, Chiaradia A, Dell A, Romano A, Pascale A, Marra AA, Dimas A, Kolias A, Cerovac A, Koneru A, Tidjane A, Agbeko AE, Bajaj A, Gosain A, Allan A, Carreras-Castañer A, D'amore A, Dare A, Maffioli A, Palepa A, Paspala A, Konney A, Gatta AND, Ezanno AC, Yiallourou A, Kinnair A, Rayner A, Scafa AK, Bowan AB, Veglia A, Russo A, Maniaci A, Castaldi A, Gil-Moreno A, Maffuz-Aziz A, Meola A, Nenna A, Ferrer AP, Bonilla AR, Ramos-De La Medina A, Infante AR, Santoro A, Laganà AS, Bateman A, Michael ALR, Abozid A, Seidu AS, Lowery A, Tantraworasin A, Rasheed A, Picciariello A, Isik A, Saif A, Anjum A, Ioannidis A, Abeldaño A, Hussain A, Nathan A, Bedzhanyan A, Perfecto A, De Virgilio A, Galvan A, Sablotzki A, Böttcher A, Pellacani A, Gatti A, Ibrahimli A, Menon A, Sahni A, Mwenda AS, Choudhry A, Jayawardane A, Gupta A, Ramasamy A, Mitul AR, Bawa A, Nugur A, Rammohan A, Sachdeva A, Mehraj A, Yildirim A, Alqaseer A, Radwan A, Sallam A, Syllaios A, Tampakis A, Alwael A, Samara A, Eroglu A, Rahman A, Ulkucu A, Zaránd A, Dulskas A, Tawiah A, Zani A, Vas A, Lukosiute-Urboniene A, Adamu A, Aujayeb A, Malik AA, İplikçi A, Mahmud A, Cil AP, Makanjuola A, Akwaisah A, Galandarova A, Saracoglu A, Regan A, Barlas AM, Alhassan BAB, Mostafa B, Hamida BB, Torun BC, Abdullah B, Balagobi B, Banky B, Singh B, Alegbeleye B, Yigit B, Hajjaj BN, Burgos-Blasco B, Seeliger B, Alayande B, Alhazmi B, Enodien B, Torre B, Pérez BG, Tamayo BV, De Andrés-Asenjo B, Quintana-Villamandos B, Girgin B, Barmayehvar B, Beisenov B, Creavin B, Dunne B, Marson B, Waterson B, Martin B, Zucker B, Wong BNX, Ozmen BB, Hammond B, Mbwele B, Núñez B, Dhondt B, Gafsi B, Mcleish B, Lieske B, Tailor B, La Pira B, Picardi B, Zampogna B, Casagranda B, Festa BM, Panda B, Kirmani B, Sulaiman B, Gurung B, Zacharia B, Bette B, Ayana B, Nikolovska B, Vilaró BC, De Vega Sánchez B, Hameed BZ, Diaconescu B, Kovacevic B, Bumber B, Sakakushev B, Tadic B, Malek B, Alrayes B, Thomas B, Gális B, Gallagher B, Knowles B, Cunningham B, Daley B, Mishra B, Ashford B, Pirozzi BM, Berselli B, Martinez-Leo B, Sensi B, Nardo B, Celik B, Giray B, Abud B, Almiqlash B, Pramesh CS, Taskiran C, De Campos Prado CA, Cipolla C, Kumar C, English C, Riccetti C, Vanni C, Brasset C, Downey C, Duffy C, Chwat C, Cutmore C, Sars C, Ratto C, Pacilio CA, De La Infiesta García C, Moreno CG, Magalhães C, Prada C, Zapata CS, Senni C, Flumignan CDQ, Martinez-Perez C, Duarte CL, Garcia CSR, Anderson C, Hing C, Cullinane C, Cina C, Zabkiewicz C, Sohrabi C, Guldogan CE, Ciubotaru C, Desai C, Raut C, Demetriou C, Handford C, Okpani C, Paranjape C, Koh C, Khatri C, Parmar C, Mok CW, Caricato C, Marafante C, Echieh CP, Tan CY, Ong CS, Conso C, Jardinez C, Konrads C, Warner C, Makwe CC, Henein C, Fleming C, Roland CL, Maurus C, Nitschke C, Mittermair C, Mallmann C, Andro C, Harmston C, Kuppler C, Lotz C, Nahm C, Rowe C, Ryalino C, Wallis C, Millward CP, Anthoulakis C, Apostolou C, Chouliaras C, Kalfountzos C, Kaselas C, Vosinakis C, Okereke C, Chean CS, Barlow C, Tatar C, Clancy C, Forde C, Sharpin C, Mccarthy C, Nestor C, Warden C, Ávila CC, Massaguer C, Fang CEH, Martins CP, Guerci C, Mauriello C, Holzmeister C, Miller C, Weber C, Wiesinger CG, Kenington C, Noel C, Sue-Chue-Lam C, Adumah C, Neary C, Sen C, Fitzgerald C, Ezeme C, Nastos C, Mesina C, Bombardini C, Torregrosa C, Valdespino CP, Don CP, Wickramasinghe D, Milanesi D, Armijos D, Asiimwe D, Beswick D, Clerc D, Cox D, Doherty D, Martínez DF, Lechuga DG, Gero D, Gil-Sala D, Lindegger D, Reim D, Shaerf D, Shmukler D, Branzan D, Filipescu D, Rega D, Bernardi D, Bissacco D, Fusario D, Morezzi D, Sabella D, Zimak DM, Vinci D, Sale D, Khan DZ, Thereska D, Andreotti D, Tartaglia D, Abdulai DR, Mukherjee D, Verdi D, Idowu D, John D, Johnson D, Moro-Valdezate D, Naumann D, Omar D, Proud D, Roberts D, Guzmán DS, Watson D, Bergkvist DJ, Lumenta DB, Ferrari D, Rizzo D, Degarege D, Castillo DFC, Douglas D, Wright D, Nanjiani D, Bratus D, Altun D, Sievers D, Vaysburg D, Katechia D, Ghosh D, Azize DA, Rodrigues D, Pachajoa DAP, Hayne D, Mutter D, Raimondo D, Eskinazi D, Sasia D, Corallino D, Muduly D, Grewal D, Hadzhiev D, Peristeri D, Pournaras D, Raptis DA, Angelou D, Haidopoulos D, Magouliotis D, Moris D, Schizas D, Symeonidis D, Tsironis D, Korkolis D, Tatsis D, Thekkinkattil D, Bulian DR, Pandey D, Vatansever D, Parker D, Wiedemann D, Borselle D, Pedini D, Schweitzer D, Venskutonis D, Otokwala J, Adamu KM, Pk P, Garod M, Ellafi AAD, Zivkovic D, Jelovac D, Wijeysundera D, Mcpherson D, Ryan É, Ugwu E, Baidoo EI, Shaddad E, Memişoğlu E, Naranjo EPL, Brodkin E, Segalini E, Viglietta E, Hendriks E, Bonci EA, Sá-Marta E, Ortega EN, Gomez EGL, Joviliano EE, Clune E, Horwell E, Mains E, Vasarhelyi E, Caruana EJ, Nevins EJ, Yenli EMTA, Baili E, Lostoridis E, Morgan E, Shiban E, Latif E, Tampaki EC, Ezenwa E, Irune E, Borg E, Eisa E, Gialamas E, Parvez E, Theophilidou E, Toma EA, Arnaoutoglou E, Samadov E, Kantor E, Ulman EA, Colak E, Cassinotti E, Bannone E, Sarjanoja E, Yates E, Vincent E, Lun EWY, Cerovac E, Dif ES, Alkhalifa E, Daketsey E, Fayad EA, Sheikh E, Pontecorvi E, Cammarata E, La Corte E, Rausa E, Odai ED, Guasch E, Cano-Trigueros E, Uldry E, Ros EP, Matthews E, Donmez EE, Giorgakis E, Kapetanakis E, Stamatakis E, Bua E, Schneck E, Nachelleh EA, Ofori EO, Akin E, Gönüllü E, Kirkan EF, Çelik E, Wong E, Capozzi E, Pinotti E, Colás-Ruiz E, González E, Fekaj E, Ohazurike E, Kebede E, Erginöz E, Duran EES, Scott E, Aytac E, Albanese E, Castro EJ, Albayadi E, Kriem E, Siddig E, Otify E, El Tayeb EEABH, Hong EH, Saguil E, Belzile E, Tuyishime E, Panieri 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Gyamfi FE, Messner F, Koh F, Cáceres F, Smolle-Juettner FM, Herman F, Ayeni F, Djedovic G, De Oliveira GP, Rodrigues G, Wagner G, Bellio G, Giarratano G, Capolupo GT, Budd G, Marom G, Poillucci G, Thiruchandran G, Nicholson G, Groot G, Hoey G, Bass GA, Sachdev G, Agarwal G, Aggarwal G, Cormio G, Mazzarella G, Perrone G, Osterhoff G, Singer G, Dejeu G, Fowler G, Garas G, Gradinariu G, Theodoropoulos G, Tzimas G, Babis G, Wong GKC, Cross GWV, Micha G, Chrysovitsiotis G, Koukoulis G, Peros G, Tsoulfas G, Kapetanios G, Karagiannidis G, Verras GI, Ekwen G, Perrotta G, Petruzzi G, Bertelli G, Calini G, Fiacchini G, Pirola GM, Dolci G, Mendiola G, Baiocchi GL, Palini GM, Prucher GM, D'andrea G, Maggiore G, Cassese G, Franceschini G, Pellino G, Saponaro G, Pattacini GC, Pantuso G, Iannella G, Bonsaana GB, Lever G, Brachini G, Giraudo G, Lisi G, Russo GI, Aprea G, Pascale G, Tomasicchio G, Sandri GBL, Armatura G, Turri G, Zaccaria G, Barugola G, Lantone G, Gasparini G, Iacob G, Sozzi G, Zancana G, Mercante G, Bianco G, Brisinda G, Consorti G, Currò G, Giannaccare G, Palomba G, Pascarella G, Rotunno G, Spriano G, Vizzielli G, Cucinella G, Sica G, Campisi G, Baiocchi G, Guerra GR, Pacheco GMF, Atis G, Augustin G, Šantak G, Chauhan GS, Branagan G, Harris G, Stewart GD, Padmore G, Kocher GJ, Di Franco G, De Jesus Labrador Hernandez G, Christodoulidis G, Neal-Smith G, Yim G, Piozzi GN, Claret G, Yanowsky-Reyes G, Dhaity GD, Cakmak GK, Mohamed G, Kucuk GO, Ancans G, Banipal GS, De Bacco Marangon G, Laporte G, Martinez-Mier G, Recinos G, V GMM, Benshetrit G, Vijgen G, Pickett G, Rodriguez HA, Shiwani H, Derilo H, Awad H, El Assaad H, Raji HO, Hardgrave H, Karakullukcu HK, Abdussalam HO, Mustafa H, Parwaiz H, Khan H, Arbab H, Naga H, Salem H, Ulgur HS, Perez-Chrzanowska H, Greenlee H, Javanmard-Emamghissi H, Lederhuber H, Osman H, Adamou H, Majid HJ, Van Goor H, Spiers HVM, Manesh HF, Mushtaq H, Aljaaly H, Hasan HB, Ahmed HTA, Martinez-Said H, Aguado HJ, Consani H, Chaplin H, Mohan H, Van Vliet H, Lohse HAS, Shah H, Claireaux H, Lule H, Juara H, Abozied H, Bayo HL, Alibrahim H, Kroon HM, Ulman H, Khan H, Yonekura H, Abou-Taleb H, Wong HYF, Carpenter H, Majd HS, Zenha H, Mayer HF, Elghadban H, Abdou H, Elfeki H, Yusefi H, Gomez-Fernandez H, Horsfall HL, Meleiro H, Sungurtekin H, Junior HFL, Moloo H, Bayhan H, Şevi̇k H, Embarek H, Hamid HKS, Pradeep IHDS, Donkin I, Ateca IV, Jafarov I, Salisu I, Abdalaal I, Garzali IU, Sall I, Adebara I, Aghadi I, Ugwu I, Zapardiel I, Reis I, Nwafor I, Fakhradiyev I, Surya IU, Robo I, Njokanma I, Iannone I, Khan I, Correia I, Königsrainer I, Seiwerth I, Linero IB, Kadiri I, Florian IA, Tzima I, Akrida I, Baloyiannis I, Gerogiannis I, Katsaros I, Tsakiridis I, Valioulis I, Negoi I, Yadev I, De Haro Jorge I, Vázquez IO, Dajti I, Russo IS, Afzal I, Wasserman I, Chukwu I, Gracia I, Oliver IM, Hughes I, Mondi I, Ncogoza I, Bsisu I, Rashid I, Balasubramanian I, Omar I, Dominguez-Rosado I, Smati I, Vokshi I, Al-Badawi IA, Saleh IA, Pilkington I, Kirac I, Trostchansky I, Gawron IM, Trebol J, Martellucci J, Andreuccetti J, Abou-Khalil J, Shah J, Manickavasagam J, De Alarcón JR, Mihanovic J, O'riordan J, Archer J, Ashcroft J, Blair J, Hamill J, Munthali J, Park J, Parry J, Ryan J, Tomlinson J, Wheeler J, Wilkins J, Balogun JA, Hodgetts JM, Vatish J, Žatecký J, Dziakova J, Martin J, Beatty JW, Stijns J, Faiz J, Ripollés-Melchor J, Mata J, Vásquez JAG, Mitra JK, Tuech JJ, Mvukiyehe JP, Fallah JM, Díaz JT, Vishnoi JR, Van Den Eynde J, Rickard J, Rolinger J, Kaplowitz J, Meyer J, Reid J, Rossaak J, Smelt J, Thomas JJ, Reyes JAS, Davies J, Luc J, Alonso JAM, Hajiioannou J, Querney J, Van Acker J, Pu JJ, Cama J, Simoes J, Cozens J, Barbosa-Breda J, Ribeiro J, De Haro J, Nigh J, Bowen J, Pollok JM, Strotmann JJ, Doerner J, Edwards J, Green J, Massoud J, Mcgrath J, Squiers J, Street J, Windsor J, Santoshi JA, Meara JG, Abebrese JT, Reilly JJ, Zabaleta J, Phillips J, Herron J, Horsnell J, Dawson J, Sheen J, Kauppila JH, Konsten J, Raurich-Leandro J, Romera JS, Nuñez J, Gass JM, Blanco J, Calvache JA, Iturralde JLF, D’addino JL, Hermosa JMG, Guillen JRO, Beristain-Hernandez JL, Sole-Sedeno JM, Vives JMM, Attwood J, Furey J, Hadaya J, Mckay J, Meilak J, Natale J, Shalhoub J, Jung J, Arthur J, Kealey J, Wright J, Moreau J, Miskovic J, Juloski J, Bauset JCC, Segura-Sampedro JJ, Cisneros JRT, Gomez-Rosado JC, Arneja J, Heider J, Fernández JD, Plata-Bello J, Villanueva J, Olaogun J, Hing JX, Košir JA, Daruwalla J, Yeung J, Wormald J, Seyi-Olajide J, Rani J, Wong KY, Hristova K, Kajal K, Algarni K, Theivendran K, Futaba K, Elsayem K, Kapur K, Bailey K, El-Boghdadly K, Ataya K, Lacorbiniere K, Shah K, Tellez KSM, Szyluk K, Rangasamy K, Iyengar K, Szabómihályová K, Atkinson K, Camargo-Parra K, Galliard K, Dickson K, Singh K, Qader K, Hasan K, Spellar K, Feeney K, Ajenifuja K, Oh KE, Okunade K, Adanu K, Bateman K, Saracoglu K, Ho KW, Enwerem K, Mishra K, Verhoeff K, Bensoltane K, Larabi K, Hamdan KH, Nadi K, 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Calabrò M, Martino MD, Reicher M, Baia M, Caricato M, Clementi M, De Zuanni M, Fiore M, Giacometti M, Inama M, Maestri M, Materazzo M, Sparavigna M, Pascale MM, Nemeth M, Serra M, Fahim MMF, Soucheiron MC, Papadoliopoulou M, Wittmann M, Sotiropoulou M, García-Conde M, Ranucci MC, Amo MDAD, Boedo MJM, Velázquez MJM, Pissaridou MK, Petersen ML, Sacras ML, Modolo MM, Caubet MM, Di Nuzzo MM, Ntalouka MP, Menna MP, Aguilera-Arevalo ML, Rela M, Capuano M, Hollyman M, Olivos M, Sacdalan MD, Raphael MC, Takkenberg M, Bortul M, Cabrera M, Castaño M, D'oria M, Giuffrida M, Laborde MM, Rodriguez-Lopez M, Trejo-Avila M, Papa MV, Ghobrial M, Kryzauskas M, Anwer M, Cheetham M, Davies M, Higgins M, Siboe M, Tarle M, Velten M, Wurm M, Süleyman M, Bauer M, O’dwyer M, Caretto M, De La Rosa-Estadella M, Fragoso M, Serra ML, Merayo M, Golet MR, Martínez-Sánchez MI, Domingo MMA, Gosselink M, Batstone M, Reichert M, Salö M, Soljic M, Zambon M, Angeles MA, Abdulkhaleq M, Abdelkarim M, Alsefri M, Iwasaki M, 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Othman R, Saad R, Amores RR, Colombari RC, Radivojević RC, Patrone R, Novysedlák R, Palacios Huatuco RM, Baertschiger R, Liang R, Luckwell R, Escrevente R, Rezende RF, Cruz RP, Lenzi R, Rosati R, Donovan R, Egan R, Morris R, Page R, Seglenieks R, Unsworth R, Wilkin R, Skipworth RJ, Davies RJ, Bezirci R, Talwar R, Azami R, Bohmer R, Crichton R, Fruscio R, Hooker R, Jach R, Parker R, Pillerstorff R, Sinnerton R, Stabler R, O'connell RM, Ragozzino R, Tutino R, Angelico R, Cammarata R, Colasanti R, Macchiavello R, Peltrini R, Pirrello R, Vaschetti R, Pires RE, Papalia R, Arrangoiz R, Hompes R, Mittal R, Salah R, Pinto R, Flumignan R, Callan R, Cuthbert R, Dennis R, Scaramuzzo R, Macías RM, Sánchez R, Ogu R, Ramely R, Sgarzani R, Ramli R, Hillier R, Thumbadoo R, Ooi R, Abdus-Salam R, Masri R, Hodgson R, Mathew R, Wade R, D'archi S, Khan S, Ngaserin S, Kale S, Hassan S, Merghani S, Benamar S, Muhammad S, Badran S, Elsahli S, Heta S, Hammouche S, Baeesa S, Paiella S, Eldeen STEHT, Arkani S, Mittal S, Hirji S, Tebha S, Emile S, Dbouk S, Bandyopadhyay SK, Muhammad S, Olori S, Asirifi SA, Hailu S, Ling S, Newman S, Ross S, Wanjara S, Kumar S, Seneviratne S, Tamburello S, Suarez SB, Ingallinella S, Irshaidat S, Konswa S, Mambrilla S, Nasser S, Parini S, Pitoni S, Ornaghi S, Rodrigues SC, Abdelmohsen S, Aitken S, Tian S, Badiani S, Ahmad S, Swed S, Muthu S, Lakpriya S, Alzahrani S, Mikalauskas S, Lasrado S, Satoskar S, Bawa S, Altiner S, Garcia S, Stevens S, Demir S, Ken-Amoah S, Tranca S, Ziemann S, Awad S, Atici SD, Subramaniam S, Erel S, Jiang S, Efetov S, Efremov S, Katorkin S, Valladares SC, Contreras SM, Meriç S, Zenger S, Safi S, Leventoğlu S, Elsalhawy S, Shaikh S, Sheik S, Islam S, Shamim S, Waqar SH, Ahmad S, Farid S, Seraj SS, Sundarraju S, Karandikar S, Sambhwani S, Chopra S, Chowdhury S, Laura S, Ahmed S, Wason S, Tan SJH, Fraser S, Williams S, Ghozy S, Abdelmawgoud S, Shehata S, Sharma S, Ahmed S, Al-Touny SA, Ramzanali S, Nah SA, Jansen S, Rajan S, Dindyal S, Amin S, Ahmad S, Shoukrie SIM, Karar S, Patkar S, Abdulsalam S, Lin S, Hegde S, Fiorelli S, Quaresima S, Redondo SV, Palmisano S, Ruggiero S, Balogun S, Cais S, Cole S, Federer S, Le Roux S, Ippoliti S, Meneghini S, Viola S, Manfredelli S, Novello S, Gananadha S, Mesli SN, Kale S, Tani SI, Malik S, Anastasiadou S, Boligo S, Esposito S, Valanci S, Xenaki S, Pejkova S, Bandyopadhyay S, Trungu S, Basu S, Alkhatib S, Pérez-Bertólez S, Flores SL, Donoghue S, Lunca S, Orsoo S, Potamianos S, Devarakonda S, Suresh S, Croghan SM, Turi S, Capella S, Lucchini S, Magnone S, Salizzoni S, Scabini S, Scaringi S, Cioffi SPB, Seyfried S, Degener S, Potten S, Taha-Mehlitz S, Ali S, Angamuthu S, Mcaleer S, Knight SR, White S, Mantziari S, Kykalos S, Goh SK, Chowdhury SP, Ibrahim S, Elzwai S, Bansal S, Tripathy S, Amrayev S, Anwar SL, Banerjee S, Thakar S, Saeed S, Venkatappa SK, Das S, Techapongsatorn S, Dube SK, Lee S, González-Suárez S, Henriques S, Konjevoda S, Gisbertz S, Bravo SL, Mannan S, Bukhari SI, Zafar SN, Batista S, Chin SL, Arif T, Lawal TA, Aktokmakyan TV, Osborn T, Szakmany T, Sztipits T, Triantafyllou T, Valadez TAC, Singh T, Khaliq T, Patel T, Fadalla T, Jichi T, Sammour T, Al-Shaiji T, Naggs T, Barišić T, Nikolouzakis T, Bisgin T, Perra T, Uprak TK, Dagklis T, Liakakos T, Sidiropoulos T, Adjeso TJK, Dölker T, Oung T, Aherne T, Diehl T, Pinkney T, Raymond T, Rhomberg T, Schmitz-Rixen T, Madhuri TK, Lohmann TK, Yeoh T, Zaimis T, Bright T, Vilz TO, Glowka TR, Board T, Hardcastle T, Cohnert T, Mahečić TT, William TG, Klatte T, Abbott T, Watcyn-Jones T, Mendes T, Kulis T, Sečan T, Campagnaro T, Frisoni T, Simoncini T, Violante T, Safranovs TJ, Risteski T, Pang T, Akinyemi T, Yotsov T, Laeke T, Kochiyama T, Sholadoye TT, Alekberli T, Ezomike U, Giustizieri U, Grossi U, Köksoy ÜC, Bork U, Kisser U, Ronellenfitsch U, Saeed U, Bracale U, Jayarajah U, Rauf UHA, Bumbasirevic U, Ferrer UMJ, Ahmed U, Bello UM, Jogiat U, Sadia U, Galandarov V, Narayanan V, Calu V, Bianchi V, Ciniero V, Tonini V, Silvestri V, Vijay V, Dewan V, Lohsiriwat V, Thuduvage V, Mousafeiris V, Dragisic V, Sasireka V, Santric V, Kusuma VRM, Kolli VS, Alonso V, De Simone V, Picotti V, Martínez VM, Panduro-Correa V, Kakotkin V, Angulo VP, Turrado-Rodriguez V, Krishnamoorthy V, Ban VS, Shah V, Maiola V, Giordano V, La Vaccara V, Lizzi V, Papagni V, Schiavone V, Satchithanantham V, Garcia-Virto V, Jimenez V, Kumar V, Shelat V, Bhat V, Sodhai V, Graziadei V, Kutuzov V, Stoyanov V, Oktseloglou V, Flis V, Elhassan WAF, Yang W, Soon WC, Tashkandi W, Al-Khyatt W, Mabood W, Bijou W, Wijenayake W, D W, Krawczyk W, Atkins W, Bolton W, White W, Ceelen W, Vagena X, Gozal Y, Baba YI, Subramani Y, Jansen Y, Mittal Y, Kara Y, Zwain Y, Noureldin Y, Alawneh Y, Aydin Y, Lam YH, Tang Y, Lim Y, Dean Y, Tanas Y, Su YX, Fujimoto Y, Altinel Y, Frolova Y, Oshodi Y, Fadel ZT, Zahid Z, Elahi Z, Djama Z, Zaheen Z, Jawad Z, Demetrashvili Z, Gebremeskel Z, Gudisa Z, Alyami Z, Garoufalia Z, Li Z, Zimak Z, Radin Z, Balogh ZJ. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg 2023; 110:804-817. [PMID: 37079880 PMCID: PMC10364528 DOI: 10.1093/bjs/znad092] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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Wolff G, Wernly B, Flaatten H, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Binneboessel S, Baldia P, Beil M, Sivri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Flamm M, Marsh B, Andersen FH, Moreno R, Boumendil A, De Lange DW, Guidet B, Leaver S, Jung C. In reply: Sex-specific outcomes in COVID-19: missing pieces of the puzzle. Can J Anaesth 2023; 70:1110-1112. [PMID: 37165131 PMCID: PMC10171910 DOI: 10.1007/s12630-023-02470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Philipp Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sivri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Unidade de Cuidados Intensivos Neurocríticos e Trauma, Lisbon, Portugal
| | - Ariane Boumendil
- UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, Paris, France
- Assistance Publique - Hôpitaux de Paris, service de réanimation médicale, Hôpital Saint-Antoine, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, Paris, France
- Assistance Publique - Hôpitaux de Paris, service de réanimation médicale, Hôpital Saint-Antoine, Paris, France
| | - Susannah Leaver
- General Intensive Care, St George´s University Hospitals NHS Foundation Trust, London, UK
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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Ubels S, Matthée E, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen MI, Daams F, Dekker JWT, van Det MJ, van Esser S, Griffiths EA, Haveman JW, Nieuwenhuijzen G, Siersema PD, Wijnhoven B, Hannink G, van Workum F, Rosman C, Heisterkamp J, Polat F, Schouten J, Singh P, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, Van Etten B, Poelmann F, Vuurberg N, Willem van den Berg J, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TC, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JW, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CM, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RP, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJ, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MA, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Koshy R, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Constantinoiu S, Birla R, Achim F, Rosianu CG, Hoara P, Castro RG, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Koshy R, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Ahmed HA, Elhadi A, Elnagar FA, Msherghi AA, Wills V, Campbell C, Cerdeira MP, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Barbosa JA, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZ, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler M, Schofield W, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Fernández SL, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Ben Taher FA, Ekheel M, Msherghi AA. Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue. Eur J Surg Oncol 2023; 49:974-982. [PMID: 36732207 DOI: 10.1016/j.ejso.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences. METHODS TENTACLE - Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20-60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment. RESULTS FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2-0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5-1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4-1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5-1.4). CONCLUSION Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Eric Matthée
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Marc J van Det
- Department of Surgery, ZGT Hospital Group, Almelo, the Netherlands
| | - Stijn van Esser
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Jan Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Fatih Polat
- Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Jeroen Schouten
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pritam Singh
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Cobianchi L, Dal Mas F, Agnoletti V, Ansaloni L, Biffl W, Butturini G, Campostrini S, Catena F, Denicolai S, Fugazzola P, Martellucci J, Massaro M, Previtali P, Ruta F, Venturi A, Woltz S, Kaafarani HM, Loftus TJ, Aapoäÿlu R, Abbott KL, Abdelmalik A, Abebe NS, Abu-Zidan F, Adam YAY, Adamou H, Adamovich DM, Agresta F, Agrusa A, Akin E, Alessiani M, Alexandrino H, Bidoli C, Ali SM, Mihai VA, Almeida PM, Al-Shehari MM, Altomare M, Amico F, Ammendola M, Andreuccetti J, Anestiadou E, Annicchiarico A, Antonelli A, Aparicio-Sanchez D, Ardito A, Argenio G, Arvieux CC, Arvieux C, Askevold IH, Atanasov BT, Augustin G, Awad SS, Bacchiocchi G, Bagnoli C, Bahouth H, Baili E, Bains L, Baiocchi GL, Bala M, Balaguà© C, Balalis D, Baldini E, Baraket O, Baral S, Barone M, Gonzãlez Barranquero A, Barreras JA, Bass GA, Bayhan Z, Bellanova G, Ben-Ishay O, Bert F, Bianchi V, Biancuzzi H, Radulescu RB, Bignell MB, Biloslavo A, Bini R, Bissacco D, Boati P, Boddaert G, Bogdanic B, Bombardini C, Bonavina L, Bonomo L, Bottari A, Bouliaris K, Brachini G, Brillantino A, Brisinda G, Bulanauca MM, Buonomo LA, Burcharth J, Buscemi S, Calabretto F, Calini G, Calu V, Campanile FC, Campo Dall’Orto R, Campos-Serra A, Carvas JM, Cascella M, Pattacini GC, Celentano V, Centonze DC, Ceresoli M, Chatzipetris D, Chessa A, Chiarello MM, Chirica M, Chooklin S, Chouliaras C, Chowdhury S, Cianci P, Cillara N, Cimbanassi S, Cioffi SPB, Colãis-Ruiz E, Colak E, Conti L, Coppola A, de Sa TC, Costa SD, Cozza V, Curro’ G, Dabekaussen KFASA, D’acapito F, Damaskos D, D’Ambrosio G, Das K, Davies RJ, de Beaux AC, De Lebrusant Fernandez SP, De Luca A, De Simone B, De Stefano F, Degrate L, Demetrashvili Z, Demetriades AK, Detanac DS, Dezi A, Di Buono G, Carlo IDI, Di Lascio P, Di Martino M, Di Saverio S, Diaconescu B, Diaz JJ, Dibra R, Dimitrov EN, Dinuzzi VP, Dios-Barbeito S, Diyani JFA, Dogjani A, Domanin M, D’Oria M, Munoz-Cruzado VD, East B, Ekelund M, Ekwen GT, Elbaih AH, Elhadi M, Enninghorst N, Ernisova M, Escalera-Antezana JP, Esposito S, Esposito G, Estaire-Gãmez M, Farã CN, Farre R, Favi F, Ferrario L, Ferrario di Tor Vajana A, Filisetti C, Fleres F, Fonseca VC, Forero-Torres A, Forfori F, Fortuna L, Fradelos E, Fraga GP, Fransvea P, Frassini S, Frazzetta G, Frigerio I, Frountzas M, Gachabayov M, Galeiras R, Garcãa BM, Garcia Vazquez A, Gargarella S, Garzali IU, Ghannam WM, Ghazi FN, Gillman LM, Gioco R, Giordano A, Giordano L, Giove C, Giraudo G, Giuffrida M, Capponi MG, Gois E, Gomes CA, Gomes FC, Gonsaga RAT, Gonullu E, Goosen J, Goranovic T, Gracia-Roman R, Graziano GMP, Griffiths EA, Guagni T, Hadzhiev DB, Haidar MG, Hamid HKS, Hardcastle TC, Hayati F, Healey AJ, Hecker A, Hecker M, Garcia EFH, hodonou AM, huaman EC, Huerta M, Ibrahim AF, Ibrahim BMS, Ietto G, Inama M, Ioannidis O, Isik A, Ismail N, Ismail AMH, Jailani RUHIF, Jang JY, Kalfountzos C, Kalipershad SNR, Kaouras E, Kaplan LJ, Kara Y, Karamagioli E, Karamarkovia A, Katsaros I, Kavalakat AJ, Kechagias A, Kenig J, Kessel BJ, Khan JS, Khokha V, Kim JI, Kirkpatrick AW, Klappenbach R, Kobe Y, Lymperis EK, Kok KYY, Kong V, Korkolis DP, Koukoulis G, Kovacevic B, Kruger VF, Kryvoruchko IA, Kurihara H, Kuriyama A, Landaluce-Olavarria A, Lapolla P, Licari L, Lisi G, Litvin A, Lizarazu A, Bayo HL, Lohsiriwat V, Moreira CCL, Lostoridis E, Luna AT, Luppi D, V. GMM, Maegele M, Maggiore D, Magnone S, Maier RV, Maier RV, Major P, Manangi M, manetti A, Mantoglu B, Marafante C, Mariani F, Marinis A, Mariot ES, Marseglia GR, Martãnez-Pãrez A, Martines G, Perez AM, Martino C, Mascagni P, Massalou D, Matãas-Garcãa B, Mazzarella G, Mazzarolo G, Melo RB, Mendoza-Moreno F, Meric S, Meyer J, Miceli L, Michalopoulos NV, Milana F, Mingoli A, Mishra TS, Mohamed M, Mohamed MIEA, Mohamedahmed AY, Mohammed MJS, Mohan R, Moore EE, Morales-Garcia D, Muhrbeck M, Mulita F, Mustafa SMS, Muttillo EM, Naimzada MD, Navsaria PH, Negoi I, Nespoli L, Nguyen C, Nidaw MK, Nigri G, Nikolopoulos I, O’Connor DB, Ogundipe HD, Oliveri C, Olmi S, Ong ECW, Orecchia L, Osipov AV, Othman MF, Pace M, Pacilli M, Pagani L, Palomba G, Pantalone D, Panyko A, Paolillo C, Papa MV, Papaconstantinou D, Papadoliopoulou M, Papadopoulos A, Papis D, Pararas N, Parreira JG, Parry NG, Pata F, Patel T, Paterson-Brown S, Pavone G, Pecchini F, Pellino G, Pelloni M, Peloso A, del Pozo EP, Pereira RG, Pereira BM, perez AL, Perra T, Perrone G, Pesce A, Petagna L, Petracca G, Phupong V, Picardi B, Picciariello A, Piccoli M, Piccolo D, Picetti E, Pikoulis Pikoulis E, Pintar T, Pirozzolo G, Piscioneri F, Podda M, Porcu A, Privitera F, Punzo C, Quaresima S, Quiodettis MA, Qvist N, Rahim R, de Almeida FR, Ramely RB, Rasa HK, Reichert M, Reinisch-Liese A, Renne A, Riccetti C, Rodriguez-Luna MR, Roizblatt D, Romanzi A, Romeo L, Roscio FPM, Rosnelifaizur RB, Rossi S, Rubiano AM, Ruiz-Úcar E, Sakakushev BE, Salamea JC, Sall I, Samarakoon LB, Sammartano F, Arteaga AS, Sanchez-Cordero S, Santoanastaso DPM, Sasia D, Sato N, Savchuk A, Sawyer RG, Scaioli G, Schizas D, Sebastiani S, Seeliger B, Lohse HAS, Seretis C, Sermonesi G, Serradilla-Martin M, Shelat VG, Shlyapnikov S, Sidiropoulos T, Simoes RL, Siragusa L, Siribumrungwong B, Slavchev M, Solaini L, soldini G, Sopuev A, Soreide K, Sovatzidis A, Stahel PF, Strickland M, Sultan MAH, Sydorchuk R, Sydorchuk L, Syed SMAM, Syed AM, Tallon-Aguilar L, Tamburini AM, Tamini N, Tan ECTH, Tan JH, Tarasconi A, Tartaglia N, Tartaglia G, Tartaglia D, Taylor JV, Tebala GD, Gonsaga RAT, Teuben M, Theodorou A, Tolonen M, Tomasicchio G, Toro A, Torre B, Triantafyllou T, Trigiante Trigiante G, Tripepi M, Trostchansky J, Tsekouras K, Turrado-Rodriguez V, Tutino R, Uccelli M, Uchikov PA, Ugarte-Sierra B, Ukkonen MT, Vailas M, Vassiliu PG, Vazquez AG, Vazquez RG, Verde JE, Verde JM, Veroux M, Viganò J, Vilallonga R, Visconti D, Vittori A, Waledziak M, Wannatoop T, Widmer LW, Wilson MSJ, Wong TH, Xenaki S, Yu B, Yule S, Zachariah SK, Zacharis G, Zaghi C, Zakaria AD, Zambrano DA, Zampitis N, Zampogna B, Zanghã S, Zapsalis K, Zattoni F, Zese M, Farre SP, Atanasov BT, Pegoraro V, Zantedeschi M, Reitano E, Pizzocaro E. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey. World J Emerg Surg 2023; 18:14. [PMID: 36803568 PMCID: PMC9936681 DOI: 10.1186/s13017-022-00464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. METHODS Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. RESULTS A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. DISCUSSION Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.
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Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy. .,IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy.
| | - Francesca Dal Mas
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Luca Ansaloni
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, PV Italy ,grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Walter Biffl
- grid.415402.60000 0004 0449 3295Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Giovanni Butturini
- grid.513352.3Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Stefano Campostrini
- grid.7240.10000 0004 1763 0578Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Stefano Denicolai
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Jacopo Martellucci
- grid.24704.350000 0004 1759 9494Department of Surgery, Careggi University Hospital, Florence, Italy
| | - Maurizio Massaro
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Pietro Previtali
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Federico Ruta
- General Direction, ASL BAT (Health Agency), Andria, Italy
| | - Alessandro Venturi
- grid.8982.b0000 0004 1762 5736Department of Political and Social Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Bureau of the Presidency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sarah Woltz
- grid.416219.90000 0004 0568 6419Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Haytham M. Kaafarani
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - Tyler J. Loftus
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, Gainesville, FL USA
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Cotoia A, Rizzo AC, Mikstacki A, Tamowicz B, Komorowska IK, Szczesniak A, Bojko J, Kotkowska A, Walczak-Wieteska P, Wasowska D, Nowakowski T, Broda H, Peichota M, Pietraszek-Grzywaczewska I, Martin-Loeches I, Bisanti A, Cartoze N, Pereira T, Guimarães N, Alves M, Marques AJP, Pinto AR, Krystopchuk A, Teresa A, de Figueiredo AMP, Botelho I, Duarte T, Costa V, Cunha RP, Molinos E, da Costa T, Ledo S, Queiró J, Pascoalinho D, Nunes C, Moura JP, Pereira É, Mendes AC, Valeanu L, Bubenek-Turconi S, Grintescu IM, Cobilinschi C, Filipescu DC, Predoi CE, Tomescu D, Popescu M, Marcu A, Grigoras I, Lungu O, Gritsan A, Anderzhanova A, Meleshkina Y, Magomedov M, Zubareva N, Tribulev M, Gaigolnik D, Eremenko A, Vistovskaya N, Chukina M, Belskiy V, Furman M, Rocca RF, Martinez M, Casares V, Vera P, Flores M, Amerigo JA, Arnillas MPG, Bermudez RM, Armestar F, Catalan B, Roig R, Raguer L, Quesada MD, Santos ED, Gomà G, Ubeda A, Salgado DM, Espina LF, Prieto EG, Asensio DM, Rodriguez DM, Maseda E, De La Rica AS, Ayestaran JI, Novo M, Blasco-Navalpotro MA, Gallego AO, Sjövall F, Spahic D, Svensson CJ, Haney M, Edin A, Åkerlund J, De Geer L, Prazak J, Jakob S, Pagani J, Abed-Maillard S, Akova M, Aslan AT, Timuroglu A, Kocagoz S, Kusoglu H, Mehtap S, Ceyhun S, Altintas ND, Talan L, Kayaaslan B, Kalem AK, Kurt I, Telli M, Ozturk B, Erol Ç, Demiray EKD, Çolak S, Akbas T, Gundogan K, Sari A, Agalar C, Çolak O, Baykam NN, Akdogan OO, Yilmaz M, Tunay B, Cakmak R, Saltoglu N, Karaali R, Koksal I, Aksoy F, Eroglu A, Saracoglu KT, Bilir Y, Guzeldag S, Ersoz G, Evik G, Sungurtekin H, Ozgen C, Erdoğan C, Gürbüz Y, Altin N, Bayindir Y, Ersoy Y, Goksu S, Akyol A, Batirel A, Aktas SC, Morris AC, Routledge M, Morris AC, Ercole A, Antcliffe D, Rojo R, Tizard K, Faulkner M, Cowton A, Kent M, Raj A, Zormpa A, Tinaslanidis G, Khade R, Torlinski T, Mulhi R, Goyal S, Bajaj M, Soltan M, Yonan A, Dolan R, Johnson A, Macfie C, Lennard J, Templeton M, Arias SS, Franke U, Hugill K, Angell H, Parcell BJ, Cobb K, Cole S, Smith T, Graham C, Cerman J, Keegan A, Ritzema J, Sanderson A, Roshdy A, Szakmany T, Baumer T, Longbottom R, Hall D, Tatham K, Loftus S, Husain A, Black E, Jhanji S, Baikady RR, Mcguigan P, Mckee R, Kannan S, Antrolikar S, Marsden N, Torre VD, Banach D, Zaki A, Jackson M, Chikungwa M, Attwood B, Patel J, Tilley RE, Humphreys MSK, Renaud PJ, Sokhan A, Burma Y, Sligl W, Baig N, McCoshen L, Kutsogiannis DJ, Sligl W, Thompson P, Hewer T, Rabbani R, Huq SMR, Hasan R, Islam MM, Gurjar M, Baronia A, Kothari N, Sharma A, Karmakar S, Sharma P, Nimbolkar J, Samdani P, Vaidyanathan R, Rubina NA, Jain N, Pahuja M, Singh R, Shekhar S, Muzaffar SN, Ozair A, Siddiqui SS, Bose P, Datta A, Rathod D, Patel M, Renuka MK, Baby SK, Dsilva C, Chandran J, Ghosh P, Mukherjee S, Sheshala K, Misra KC, Yakubu SY, Ugwu EM, Olatosi JO, Desalu I, Asiyanbi G, Oladimeji M, Idowu O, Adeola F, Mc Cree M, Karar AAA, Saidahmed E, Hamid HKS. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med 2023; 49:178-190. [PMID: 36764959 PMCID: PMC9916499 DOI: 10.1007/s00134-022-06944-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/23/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. METHODS We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. RESULTS 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. CONCLUSIONS HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.
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Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia. .,Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France
| | | | - Stéphane Ruckly
- Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France.,ICUREsearch, Biometry, 38600, Fontaine, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.,Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK.,JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Jeffrey Lipman
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Nimes University Hospital, University of Montpellier, Nimes, France.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal.,Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Infection and Sepsis ID Group, Porto, Portugal
| | - Pedro Povoa
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.,Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Liesbet De Bus
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Farid Zand
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Adel Alsisi
- ICU Department, Prime Hospital, Dubai, United Arab Emirates.,Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khalid Abidi
- Medical ICU, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hendrik Bracht
- Central Interdisciplinary Emergency Medicine, University Hospital Ulm, Ulm, Germany
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine, Kameda General Hospital, Kamogawa, Japan
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, avenue de L'Hôpital, 45100, Orléans, France
| | - Jean-François Timsit
- Université Paris-Cité, INSERM, IAME UMR 1137, 75018, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Omdurman maternity hospitalrue Henri Huchard, 75877, Paris Cedex, France
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Erkens R, Duse D, Wernly B, Flaatten H, Fjølner J, Bruno RR, Wolff G, Artigas A, Kelm M, Beil M, Sviri S, Schaller SJ, Fuest K, Szczeklik W, Piayda K, Elhadi M, Joannidis M, Nedergaard HK, Oeyen S, Moreno R, Leaver S, de Lange DW, Guidet B, Jung C. Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients - Results from the prospective COVIP Study. Clin Hemorheol Microcirc 2023; 84:309-320. [PMID: 37248892 DOI: 10.3233/ch-231790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIMS Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients. METHODS In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded. RESULTS In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality. CONCLUSION The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.
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Affiliation(s)
- Ralf Erkens
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Dragos Duse
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, Parc Tauli Hospital Universitari, Institut d'Investigació I Innovacio Par tauli (I3PT-CERCA), CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Barcelona, Spain
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Stefan J Schaller
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charitè-Universitätsmedizin Berlin, Freie Universiätt Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kristina Fuest
- Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, School of Medicine, Technical University Munich, Munich, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kerstin Piayda
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Helene Korvenius Nedergaard
- Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Kolding, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitério de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale,, Paris, France
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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36
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Baldia PH, Wernly B, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Bruno RR, Binnebößel S, Wolff G, Erkens R, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Leaver S, De Lange DW, Guidet B, Jung C, Joannidis M, Mesotten D, Reper P, Swinnen W, Serck N, DEWAELE ELISABETH, Brix H, Brushoej J, Kumar P, Nedergaard HK, Balleby IR, Bundesen C, Hansen MA, Uhrenholt S, Bundgaard H, Innes R, Gooch J, Cagova L, Potter E, Reay M, Davey M, Abusayed MA, Humphreys S, Galbois A, Charron C, Berlemont CH, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, PLANTEFEVE G, Vanderlinden T, Jurcisin I, Megarbane B, Chousterman BG, Dépret F, Garnier M, Besset S, Oziel J, Ferre A, Dauger S, Dumas G, Goncalves B, Vettoretti L, Thevenin D, Schaller S, Schaller S, Kurt M, Faltlhauser A, Schaller S, Milovanovic M, Lutz M, Shala G, Haake H, Randerath W, Kunstein A, Meybohm P, Schaller S, Steiner S, Barth E, Poerner T, Simon P, Lorenz M, Dindane Z, Kuhn KF, Welte M, Voigt I, Kabitz HJ, Wollborn J, Goebel U, Stoll SE, Kindgen-Milles D, Dubler S, Jung C, Fuest K, Schuster M, Papadogoulas A, Mulita F, Rovina N, Aidoni Z, CHRISANTHOPOULOU EVANGELIA, KONDILI EUMORFIA, Andrianopoulos I, Groenendijk M, Evers M, Evers M, van Lelyveld-Haas L, Meynaar I, Cornet AD, Zegers M, Dieperink W, de Lange D, Dormans T, Hahn M, Sjøbøe B, Strietzel HF, Olasveengen T, Romundstad L, Kluzik A, Zatorski P, Drygalski T, Klimkiewicz J, Solek-pastuszka J, Onichimowski D, Czuczwar M, Gawda R, Stefaniak J, Stefanska-Wronka K, Zabul E, Oliveira AIP, Assis R, de Lurdes Campos Santos M, Santos H, Cardoso FS, Gordinho A, Banzo MJA, Zalba-Etayo B, CUBERO PATRICIAJIMENO, Priego J, Gomà G, Tomasa-Irriguible TM, Sancho S, Ferreira AF, Vázquez EM, Mira ÁP, Ibarz M, Iglesias D, Arias-Rivera S, Frutos-Vivar F, Lopez-Cuenca S, Aldecoa C, Perez-Torres D, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, de Gopegui PR, Ben-Hamouda N, Roberti A, Fleury Y, Abidi N, Dullenkopf A, Pugh R, Smuts S. The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial. BMC Geriatr 2022; 22:1000. [PMID: 36575394 PMCID: PMC9794407 DOI: 10.1186/s12877-022-03709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients. METHODS This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression. RESULTS 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2-5 versus IQR 2-4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis. CONCLUSION Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19. TRIAL REGISTRATION This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020.
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Affiliation(s)
- Philipp Heinrich Baldia
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Department of Anaestesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- grid.154185.c0000 0004 0512 597XDepartment of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Critical Care Centre, Sabadell Hospital University Institute Parc Tauli, Sabadell Barcelona, Spain
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- grid.411656.10000 0004 0479 0855Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Beil
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan Binnebößel
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Georg Wolff
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ralf Erkens
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sviri Sigal
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- grid.9619.70000 0004 1937 0538General & Medical Intensive Care Units, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Muhammed Elhadi
- grid.411306.10000 0000 8728 1538Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- grid.5947.f0000 0001 1516 2393Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway. Dep. of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- grid.414551.00000 0000 9715 2430Multipurpose and Neurocritical Intensive Care Unit, Hospital of São José, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Susannah Leaver
- grid.451349.eGeneral Intensive Care, St George´S University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W. De Lange
- grid.7692.a0000000090126352Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, Netherlands
| | - Bertrand Guidet
- Institute Pierre Louis Epidemiology and Public Health, Medical Intensive Care Unit, Sorbonne University, UPMC, INSERM, Hôpital Saint-Antoine, Paris, France
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Haakenstad A, Yearwood JA, Fullman N, Bintz C, Bienhoff K, Weaver MR, Nandakumar V, LeGrand KE, Knight M, Abbafati C, Abbasi-Kangevari M, Abdoli A, Abeldaño Zuñiga RA, Adedeji IA, Adekanmbi V, Adetokunboh OO, Afzal MS, Afzal S, Agudelo-Botero M, Ahinkorah BO, Ahmad S, Ahmadi A, Ahmadi S, Ahmed A, Ahmed Rashid T, Aji B, Akande-Sholabi W, Alam K, Al Hamad H, Alhassan RK, Ali L, Alipour V, Aljunid SM, Ameyaw EK, Amin TT, Amu H, Amugsi DA, Ancuceanu R, Andrade PP, Anjum A, Arabloo J, Arab-Zozani M, Ariffin H, Arulappan J, Aryan Z, Ashraf T, Atnafu DD, Atreya A, Ausloos M, Avila-Burgos L, Ayano G, Ayanore MA, Azari S, Badiye AD, Baig AA, Bairwa M, Bakkannavar SM, Baliga S, Banik PC, Bärnighausen TW, Barra F, Barrow A, Basu S, Bayati M, Belete R, Bell AW, Bhagat DS, Bhagavathula AS, Bhardwaj P, Bhardwaj N, Bhaskar S, Bhattacharyya K, Bhurtyal A, Bhutta ZA, Bibi S, Bijani A, Bikbov B, Biondi A, Bolarinwa OA, Bonny A, Brenner H, Buonsenso D, Burkart K, Busse R, Butt ZA, Butt NS, Caetano dos Santos FL, Cahuana-Hurtado L, Cámera LA, Cárdenas R, Carneiro VLA, Catalá-López F, Chandan JS, Charan J, Chavan PP, Chen S, Chen S, Choudhari SG, Chowdhury EK, Chowdhury MAK, Cirillo M, Corso B, Dadras O, Dahlawi SMA, Dai X, Dandona L, Dandona R, Dangel WJ, Dávila-Cervantes CA, Davletov K, Deuba K, Dhimal M, Dhimal ML, Djalalinia S, Do HP, Doshmangir L, Duncan BB, Effiong A, Ehsani-Chimeh E, Elgendy IY, Elhadi M, El Sayed I, El Tantawi M, Erku DA, Eskandarieh S, Fares J, Farzadfar F, Ferrero S, Ferro Desideri L, Fischer F, Foigt NA, Foroutan M, Fukumoto T, Gaal PA, Gaihre S, Gardner WM, Garg T, Getachew Obsa A, Ghafourifard M, Ghashghaee A, Ghith N, Gilani SA, Gill PS, Goharinezhad S, Golechha M, Guadamuz JS, Guo Y, Gupta RD, Gupta R, Gupta VK, Gupta VB, Hamiduzzaman M, Hanif A, Haro JM, Hasaballah AI, Hasan MM, Hasan MT, Hashi A, Hay SI, Hayat K, Heidari M, Heidari G, Henry NJ, Herteliu C, Holla R, Hossain S, Hossain SJ, Hossain MBH, Hosseinzadeh M, Hostiuc S, Hoveidamanesh S, Hsieh VCR, Hu G, Huang J, Huda MM, Ifeagwu SC, Ikuta KS, Ilesanmi OS, Irvani SSN, Islam RM, Islam SMS, Ismail NE, Iso H, Isola G, Itumalla R, Iwagami M, Jahani MA, Jahanmehr N, Jain R, Jakovljevic M, Janodia MD, Jayapal SK, Jayaram S, Jha RP, Jonas JB, Joo T, Joseph N, Jürisson M, Kabir A, Kalankesh LR, Kalhor R, Kamath AM, Kamenov K, Kandel H, Kantar RS, Kapoor N, Karanikolos M, Katikireddi SV, Kavetskyy T, Kawakami N, Kayode GA, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khalilov R, Khammarnia M, Khan MN, Khan MAB, Khan M, Khezeli M, Kim MS, Kim YJ, Kisa S, Kisa A, Klymchuk V, Koly KN, Korzh O, Kosen S, Koul PA, Kuate Defo B, Kumar GA, Kusuma D, Kyu HH, Larsson AO, Lasrado S, Lee WC, Lee YH, Lee CB, Li S, Lucchetti G, Mahajan PB, Majeed A, Makki A, Malekzadeh R, Malik AA, Malta DC, Mansournia MA, Mantovani LG, Martinez-Valle A, Martins-Melo FR, Masoumi SZ, Mathur MR, Maude RJ, Maulik PK, McKee M, Mendoza W, Menezes RG, Mensah GA, Meretoja A, Meretoja TJ, Mestrovic T, Michalek IM, Mirrakhimov EM, Misganaw A, Misra S, Moazen B, Mohammadi M, Mohammed S, Moitra M, Mokdad AH, Molokhia M, Monasta L, Moni MA, Moradi G, Moreira RS, Mosser JF, Mostafavi E, Mouodi S, Nagarajan AJ, Nagata C, Naghavi M, Nangia V, Narasimha Swamy S, Narayana AI, Nascimento BR, Nassereldine H, Nayak BP, Nazari J, Negoi I, Nepal S, Neupane Kandel S, Ngunjiri JW, Nguyen HLT, Nguyen CT, Ningrum DNA, Noubiap JJ, Oancea B, Oghenetega OB, Oh IH, Olagunju AT, Olakunde BO, Omar Bali A, Omer E, Onwujekwe OE, Otoiu A, Padubidri JR, Palladino R, Pana A, Panda-Jonas S, Pandi-Perumal SR, Pardhan S, Pasupula DK, Pathak PK, Patton GC, Pawar S, Pereira J, Pilania M, Piroozi B, Podder V, Pokhrel KN, Postma MJ, Prada SI, Quazi Syed Z, Rabiee N, Radhakrishnan RA, Rahman MM, Rahman M, Rahman M, Rahman MHU, Rahmani AM, Ranabhat CL, Rao CR, Rao SJ, Rasella D, Rawaf S, Rawaf DL, Rawal L, Renzaho AM, Reshmi B, Resnikoff S, Rezapour A, Riahi SM, Ripon RK, Sacco S, Sadeghi M, Saeed U, Sahebkar A, Sahiledengle B, Sahoo H, Sahu M, Salama JS, Salamati P, Samy AM, Sanabria J, Santric-Milicevic MM, Sathian B, Sawhney M, Schmidt MI, Seidu AA, Sepanlou SG, Seylani A, Shaikh MA, Sheikh A, Shetty A, Shigematsu M, Shiri R, Shivakumar KM, Shokri A, Singh JA, Sinha DN, Skryabin VY, Skryabina AA, Sofi-Mahmudi A, Sousa RARC, Stephens JH, Sun J, Szócska M, Tabarés-Seisdedos R, Tadbiri H, Tamiru AT, Thankappan KR, Topor-Madry R, Tovani-Palone MR, Tran MTN, Tran BX, Tripathi N, Tripathy JP, Troeger CE, Uezono DR, Ullah S, Ullah A, Unnikrishnan B, Vacante M, Valadan Tahbaz S, Valdez PR, Vasic M, Veroux M, Vervoort D, Violante FS, Vladimirov SK, Vlassov V, Vo B, Waheed Y, Wamai RG, Wang YP, Wang Y, Ward P, Wiangkham T, Yadav L, Yahyazadeh Jabbari SH, Yamagishi K, Yaya S, Yazdi-Feyzabadi V, Yi S, Yiğit V, Yonemoto N, Younis MZ, Yu C, Yunusa I, Zaman SB, Zastrozhin MS, Zhang ZJ, Zhong C, Zuniga YMH, Lim SS, Murray CJL, Lozano R. Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Glob Health 2022; 10:e1715-e1743. [PMID: 36209761 PMCID: PMC9666426 DOI: 10.1016/s2214-109x(22)00429-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/13/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. METHODS We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. FINDINGS Between 1990 and 2019, the HAQ Index increased overall (by 19·6 points, 95% uncertainty interval 17·9-21·3), as well as among the young (22·5, 19·9-24·7), working (17·2, 15·2-19·1), and post-working (15·1, 13·2-17·0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30·7 (28·6-33·0) on average in low-SDI countries to 83·4 (82·4-84·3) on average in high-SDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40·4-89·0), working (33·8-82·8), and post-working (30·4-79·1) groups. Absolute convergence in HAQ Index was estimated in the young group only. In contrast, divergence was estimated among the working and post-working groups, driven by slow progress in low-SDI countries. INTERPRETATION Although major gaps remain across levels of social and economic development, convergence in the young group is an encouraging sign of reduced disparities in health-care access and quality. However, divergence in the working and post-working groups indicates that health-care access and quality is lagging at lower levels of social and economic development. To meet the needs of ageing populations, health systems need to improve health-care access and quality for working-age adults and older populations while continuing to realise gains among the young. FUNDING Bill & Melinda Gates Foundation.
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Wendel-Garcia PD, Moser A, Jeitziner MM, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Roche-Campo F, Franch-Llasat D, Kleger GR, Schrag C, Pietsch U, Filipovic M, David S, Stahl K, Bouaoud S, Ouyahia A, Fodor P, Locher P, Siegemund M, Zellweger N, Cereghetti S, Schott P, Gangitano G, Wu MA, Alfaro-Farias M, Vizmanos-Lamotte G, Ksouri H, Gehring N, Rezoagli E, Turrini F, Lozano-Gómez H, Carsetti A, Rodríguez-García R, Yuen B, Weber AB, Castro P, Escos-Orta JO, Dullenkopf A, Martín-Delgado MC, Aslanidis T, Perez MH, Hillgaertner F, Ceruti S, Franchitti Laurent M, Marrel J, Colombo R, Laube M, Fogagnolo A, Studhalter M, Wengenmayer T, Gamberini E, Buerkle C, Buehler PK, Keiser S, Elhadi M, Montomoli J, Guerci P, Fumeaux T, Schuepbach RA, Jakob SM, Que YA, Hilty MP, Hilty MP, Wendel-Garcia P, Schuepbach RA, Montomoli J, Guerci P, Fumeaux T, Bouaoud S, Ouyahia A, Abdoun M, Rais M, Alfaro-Farias M, Vizmanos-Lamotte G, Caballero A, Tschoellitsch T, Meier J, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Martinez LA, Tirapé-Castro H, Galal I, Tharwat S, Abdehaleem I, Jurkolow G, Guerci P, Novy E, Losser MR, Wengenmayer T, Zotzmann V, David S, Stahl K, Seeliger B, Welte T, Aslanidis T, Korsos A, Ahmed LA, Hashim HT, Nikandish R, Carsetti A, Casarotta E, Giaccaglia P, Rezoagli E, Giacomini M, Magliocca A, Bolondi G, Potalivo A, Fogagnolo A, Salvi L, Wu MA, Cogliati C, Colombo R, Catena E, Turrini F, Simonini MS, Fabbri S, Montomoli J, Gamberini E, Gangitano G, Bitondo MM, Maciopinto F, de Camillis E, Venturi M, Bocci MG, Antonelli M, Alansari A, Abusalama A, Omar O, Binnawara M, Alameen H, Elhadi M, Alhadi A, Arhaym A, Gommers D, Ince C, Jayyab M, Alsharif M, Rodríguez-García R, Gámez-Zapata J, Taboada-Fraga X, Castro P, Fernandez J, Reverter E, Lander-Azcona A, Escós-Orta J, Martín-Delgado MC, Algaba-Calderon A, Roche-Campo F, Franch-Llasat D, Concha P, Sauras-Colón E, Lozano-Gómez H, Zalba-Etayo B, Montes MP, Michot MP, Klarer A, Ensner R, Schott P, Urech S, Siegemund M, Zellweger N, Gebhard CE, Hollinger A, Merki L, Lambert A, Laube M, Jeitziner MM, Moser A, Que YA, Jakob SM, Wiegand J, Yuen B, Lienhardt-Nobbe B, Westphalen A, Salomon P, Hillgaertner F, Sieber M, Dullenkopf A, Barana G, Ksouri H, Sridharan GO, Cereghetti S, Boroli F, Pugin J, Grazioli S, Bürkle C, Marrel J, Brenni M, Fleisch I, Perez MH, Ramelet AS, Weber AB, Gerecke P, Christ A, Ceruti S, Glotta A, Biggiogero M, Marquardt K, Hübner T, Neff T, Redecker H, Fumeaux T, Moret-Bochatay M, Betello M, zu Bentrup FM, Studhalter M, Stephan M, Gehring N, Selz D, Kleger GR, Schrag C, Pietsch U, Filipovic M, Ristic A, Heise A, Franchitti Laurent M, Laurent JC, Gaspert T, Haberthuer C, Fodor P, Locher P, Garcia PDW, Hilty MP, Schuepbach R, Keiser S, Heuberger D, Bartussek J, Bühler P, Brugger S, Kleinert EM, Fehlbier KJ, Danial A, Almousa M, Abdulbaki Y, Sannah K, Colak E, Marczin N, Al-Ameri S. Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry. Crit Care 2022; 26:199. [PMID: 35787726 PMCID: PMC9254551 DOI: 10.1186/s13054-022-04065-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/10/2022] [Indexed: 12/22/2022] Open
Abstract
Background It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. Methods Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. Results Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60–63] years vs 64 [62–66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6–9.0] vs 5.8 [5.3–6.4], p < 0.001) and increased, while more female patients (26 [23–29]% vs 41 [35–48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2–7.2| days vs 9.7 [8.9–10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123–141] mmHg vs 101 [91–113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20–48] mmHg vs 70 [41–100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4–7]% vs 20 [14–29], p < 0.001) and non-invasive mechanical ventilation (14 [11–18]% vs 24 [17–33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76–86]% vs 74 [64–82]%, p < 0.001). The ICU mortality (23 [19–26]% vs 17 [12–25]%, p < 0.001) and length of stay (14 [13–16] days vs 11 [10–13] days, p < 0.001) decreased over 19 months of the pandemic. Conclusion Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04065-2.
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Cinotti R, Mijangos JC, Pelosi P, Haenggi M, Gurjar M, Schultz MJ, Kaye C, Godoy DA, Alvarez P, Ioakeimidou A, Ueno Y, Badenes R, Suei Elbuzidi AA, Piagnerelli M, Elhadi M, Reza ST, Azab MA, McCredie V, Stevens RD, Digitale JC, Fong N, Asehnoune K. Extubation in neurocritical care patients: the ENIO international prospective study. Intensive Care Med 2022; 48:1539-1550. [PMID: 36038713 DOI: 10.1007/s00134-022-06825-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. METHODS ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24 h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. RESULTS 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71-0.87] and 0.71 CI95 [0.61-0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7-21] vs 6 [3-11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). CONCLUSIONS In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort.
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Affiliation(s)
- Raphaël Cinotti
- Department of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France.,UMR 1246 SPHERE "MethodS in Patients-Centered Outcomes and HEalth Research", University of Nantes, University of Tours, INSERM, IRS2 22 Boulevard Benoni Goulin, 44200, Nantes, France
| | - Julio Cesar Mijangos
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Hospital No. 278, Col. El Retiro 44280, Guadalajara, Mexico.,División de Disciplinas Clínicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Paolo Pelosi
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Largo Rosanna Benzi 10, 16100, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Matthias Haenggi
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', 1105 AZ, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, OX3 7LG, UK
| | - Callum Kaye
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
| | | | - Pablo Alvarez
- Hospital Maciel, ASSE, Street 25 de Mayo 174, 11000, Montevideo, Uruguay
| | - Aikaterini Ioakeimidou
- Department of Critical Care Medicine of Asklepieio G.H.A, V.Paulou 1, 16673, Athens, Greece
| | - Yoshitoyo Ueno
- Tokushima University Hospital, 2-50-1, Kuramotocho, Tokushima, 7700042, Japan
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Department of Surgery, Hospital Clínico Universitario Valencia, University of Valencia, Valencia, Spain
| | | | - Michaël Piagnerelli
- CHU Charleroi-Hôpital Civil Marie-Curie, Université libre de Bruxelles, 140 Chaussée de Bruxelles, Lodelinsart, 6042, Charleroi, Belgium
| | - Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, Furnaj, University Road, 13275, Tripoli, Libya
| | - Syed Tariq Reza
- Department of Anaesthesia, Analgesia, Palliative and Intensive Care, Dhaka Medical College Hospital, Dhaka, 1000, Bangladesh
| | | | - Victoria McCredie
- Toronto Western Hospital-University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Robert D Stevens
- Department of Anesthesiology and Critical Care, John Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Jean Catherine Digitale
- Department of Epidemiology and Biostatistics, University of California, UCSF, 550 16th St, San Francisco, CA, 94158, USA
| | - Nicholas Fong
- Department of Anesthesia and Perioperative Care, University of California, UCSF, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Karim Asehnoune
- Department of Anaesthesia and Critical Care, CHU Nantes, Nantes Université, Hôtel Dieu, 44000, Nantes, France.
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Kyu HH, Vongpradith A, Sirota SB, Novotney A, Troeger CE, Doxey MC, Bender RG, Ledesma JR, Biehl MH, Albertson SB, Frostad JJ, Burkart K, Bennitt FB, Zhao JT, Gardner WM, Hagins H, Bryazka D, Dominguez RMV, Abate SM, Abdelmasseh M, Abdoli A, Abdoli G, Abedi A, Abedi V, Abegaz TM, Abidi H, Aboagye RG, Abolhassani H, Abtew YD, Abubaker Ali H, Abu-Gharbieh E, Abu-Zaid A, Adamu K, Addo IY, Adegboye OA, Adnan M, Adnani QES, Afzal MS, Afzal S, Ahinkorah BO, Ahmad A, Ahmad AR, Ahmad S, Ahmadi A, Ahmadi S, Ahmed H, Ahmed JQ, Ahmed Rashid T, Akbarzadeh-Khiavi M, Al Hamad H, Albano L, Aldeyab MA, Alemu BM, Alene KA, Algammal AM, Alhalaiqa FAN, Alhassan RK, Ali BA, Ali L, Ali MM, Ali SS, Alimohamadi Y, Alipour V, Al-Jumaily A, Aljunid SM, Almustanyir S, Al-Raddadi RM, Al-Rifai RHH, AlRyalat SAS, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Aminian Dehkordi JJ, Amuasi JH, Amugsi DA, Anbesu EW, Ansar A, Anyasodor AE, Arabloo J, Areda D, Argaw AM, Argaw ZG, Arulappan J, Aruleba RT, Asemahagn MA, Athari SS, Atlaw D, Attia EF, Attia S, Aujayeb A, Awoke T, Ayana TM, Ayanore MA, Azadnajafabad S, Azangou-Khyavy M, Azari S, Azari Jafari A, Badar M, Badiye AD, Baghcheghi N, Bagherieh S, Baig AA, Banach M, Banerjee I, Bardhan M, Barone-Adesi F, Barqawi HJ, Barrow A, Bashiri A, Bassat Q, Batiha AMM, Belachew AB, Belete MA, Belgaumi UI, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhatt P, Bhojaraja VS, Bhutta ZA, Bhuyan SS, Bijani A, Bitaraf S, Bodicha BBA, Briko NI, Buonsenso D, Butt MH, Cai J, Camargos P, Cámera LA, Chakraborty PA, Chanie MG, Charan J, Chattu VK, Ching PR, Choi S, Chong YY, Choudhari SG, Chowdhury EK, Christopher DJ, Chu DT, Cobb NL, Cohen AJ, Cruz-Martins N, Dadras O, Dagnaw FT, Dai X, Dandona L, Dandona R, Dao ATM, Debela SA, Demisse B, Demisse FW, Demissie S, Dereje D, Desai HD, Desta AA, Desye B, Dhingra S, Diao N, Diaz D, Digesa LE, Doan LP, Dodangeh M, Dongarwar D, Dorostkar F, dos Santos WM, Dsouza HL, Dubljanin E, Durojaiye OC, Edinur HA, Ehsani-Chimeh E, Eini E, Ekholuenetale M, Ekundayo TC, El Desouky ED, El Sayed I, El Sayed Zaki M, Elhadi M, Elkhapery AMR, Emami A, Engelbert Bain L, Erkhembayar R, Etaee F, Ezati Asar M, Fagbamigbe AF, Falahi S, Fallahzadeh A, Faraj A, Faraon EJA, Fatehizadeh A, Ferrara P, Ferrari AA, Fetensa G, Fischer F, Flavel J, Foroutan M, Gaal PA, Gaidhane AM, Gaihre S, Galehdar N, Garcia-Basteiro AL, Garg T, Gebrehiwot MD, Gebremichael MA, Gela YY, Gemeda BNB, Gessner BD, Getachew M, Getie A, Ghamari SH, Ghasemi Nour M, Ghashghaee A, Gholamrezanezhad A, Gholizadeh A, Ghosh R, Ghozy S, Goleij P, Golitaleb M, Gorini G, Goulart AC, Goyomsa GG, Guadie HA, Gudisa Z, Guled RA, Gupta S, Gupta VB, Gupta VK, Guta A, Habibzadeh P, Haj-Mirzaian A, Halwani R, Hamidi S, Hannan MA, Harorani M, Hasaballah AI, Hasani H, Hassan AM, Hassani S, Hassanian-Moghaddam H, Hassankhani H, Hayat K, Heibati B, Heidari M, Heyi DZ, Hezam K, Holla R, Hong SH, Horita N, Hosseini MS, Hosseinzadeh M, Hostiuc M, Househ M, Hoveidamanesh S, Huang J, Hussein NR, Iavicoli I, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Ismail NE, Iwagami M, Jaafari J, Jamshidi E, Jang SI, Javadi Mamaghani A, Javaheri T, Javanmardi F, Javidnia J, Jayapal SK, Jayarajah U, Jayaram S, Jema AT, Jeong W, Jonas JB, Joseph N, Joukar F, Jozwiak JJ, K V, Kabir Z, Kacimi SEO, Kadashetti V, Kalankesh LR, Kalhor R, Kamath A, Kamble BD, Kandel H, Kanko TK, Karaye IM, Karch A, Karkhah S, Kassa BG, Katoto PDMC, Kaur H, Kaur RJ, Keikavoosi-Arani L, Keykhaei M, Khader YS, Khajuria H, Khan EA, Khan G, Khan IA, Khan M, Khan MN, Khan MAB, Khan YH, Khatatbeh MM, Khosravifar M, Khubchandani J, Kim MS, Kimokoti RW, Kisa A, Kisa S, Kissoon N, Knibbs LD, Kochhar S, Kompani F, Koohestani HR, Korshunov VA, Kosen S, Koul PA, Koyanagi A, Krishan K, Kuate Defo B, Kumar GA, Kurmi OP, Kuttikkattu A, Lal DK, Lám J, Landires I, Ledda C, Lee SW, Levi M, Lewycka S, Liu G, Liu W, Lodha R, Lorenzovici L, Lotfi M, Loureiro JA, Madadizadeh F, Mahmoodpoor A, Mahmoudi R, Mahmoudimanesh M, Majidpoor J, Makki A, Malakan Rad E, Malik AA, Mallhi TH, Manla Y, Matei CN, Mathioudakis AG, Maude RJ, Mehrabi Nasab E, Melese A, Memish ZA, Mendoza-Cano O, Mentis AFA, Meretoja TJ, Merid MW, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Mijena GFW, Minh LHN, Mir SA, Mirfakhraie R, Mirmoeeni S, Mirza AZ, Mirza M, Mirza-Aghazadeh-Attari M, Misganaw AS, Misganaw AT, Mohammadi E, Mohammadi M, Mohammed A, Mohammed S, Mohan S, Mohseni M, Moka N, Mokdad AH, Momtazmanesh S, Monasta L, Moniruzzaman M, Montazeri F, Moore CE, Moradi A, Morawska L, Mosser JF, Mostafavi E, Motaghinejad M, Mousavi Isfahani H, Mousavi-Aghdas SA, Mubarik S, Murillo-Zamora E, Mustafa G, Nair S, Nair TS, Najafi H, Naqvi AA, Narasimha Swamy S, Natto ZS, Nayak BP, Nejadghaderi SA, Nguyen HVN, Niazi RK, Nogueira de Sá AT, Nouraei H, Nowroozi A, Nuñez-Samudio V, Nzoputam CI, Nzoputam OJ, Oancea B, Ochir C, Odukoya OO, Okati-Aliabad H, Okekunle AP, Okonji OC, Olagunju AT, Olufadewa II, Omar Bali A, Omer E, Oren E, Ota E, Otstavnov N, Oulhaj A, P A M, Padubidri JR, Pakshir K, Pakzad R, Palicz T, Pandey A, Pant S, Pardhan S, Park EC, Park EK, Pashazadeh Kan F, Paudel R, Pawar S, Peng M, Pereira G, Perna S, Perumalsamy N, Petcu IR, Pigott DM, Piracha ZZ, Podder V, Polibin RV, Postma MJ, Pourasghari H, Pourtaheri N, Qadir MMF, Raad M, Rabiee M, Rabiee N, Raeghi S, Rafiei A, Rahim F, Rahimi M, Rahimi-Movaghar V, Rahman A, Rahman MO, Rahman M, Rahman MA, Rahmani AM, Rahmanian V, Ram P, Ramezanzadeh K, Rana J, Ranasinghe P, Rani U, Rao SJ, Rashedi S, Rashidi MM, Rasul A, Ratan ZA, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Redwan EMM, Reitsma MB, Renzaho AMN, Rezaeian M, Riad A, Rikhtegar R, Rodriguez JAB, Rogowski ELB, Ronfani L, Rudd KE, Saddik B, Sadeghi E, Saeed U, Safary A, Safi SZ, Sahebazzamani M, Sahebkar A, Sakhamuri S, Salehi S, Salman M, Samadi Kafil H, Samy AM, Santric-Milicevic MM, Sao Jose BP, Sarkhosh M, Sathian B, Sawhney M, Saya GK, Seidu AA, Seylani A, Shaheen AA, Shaikh MA, Shaker E, Shamshad H, Sharew MM, Sharhani A, Sharifi A, Sharma P, Sheidaei A, Shenoy SM, Shetty JK, Shiferaw DS, Shigematsu M, Shin JI, Shirzad-Aski H, Shivakumar KM, Shivalli S, Shobeiri P, Simegn W, Simpson CR, Singh H, Singh JA, Singh P, Siwal SS, Skryabin VY, Skryabina AA, Soltani-Zangbar MS, Song S, Song Y, Sood P, Sreeramareddy CT, Steiropoulos P, Suleman M, Tabatabaeizadeh SA, Tahamtan A, Taheri M, Taheri Soodejani M, Taki E, Talaat IM, Tampa M, Tandukar S, Tat NY, Tat VY, Tefera YM, Temesgen G, Temsah MH, Tesfaye A, Tesfaye DG, Tessema B, Thapar R, Ticoalu JHV, Tiyuri A, Tleyjeh II, Togtmol M, Tovani-Palone MR, Tufa DG, Ullah I, Upadhyay E, Valadan Tahbaz S, Valdez PR, Valizadeh R, Vardavas C, Vasankari TJ, Vo B, Vu LG, Wagaye B, Waheed Y, Wang Y, Waris A, West TE, Wickramasinghe ND, Xu X, Yaghoubi S, Yahya GAT, Yahyazadeh Jabbari SH, Yon DK, Yonemoto N, Zaman BA, Zandifar A, Zangiabadian M, Zar HJ, Zare I, Zareshahrabadi Z, Zarrintan A, Zastrozhin MS, Zeng W, Zhang M, Zhang ZJ, Zhong C, Zoladl M, Zumla A, Lim SS, Vos T, Naghavi M, Brauer M, Hay SI, Murray CJL. Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis 2022; 22:1626-1647. [PMID: 35964613 PMCID: PMC9605880 DOI: 10.1016/s1473-3099(22)00510-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/18/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. METHODS In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466-469, 470.0, 480-482.8, 483.0-483.9, 484.1-484.2, 484.6-484.7, and 487-489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4-B97.6, J09-J15.8, J16-J16.9, J20-J21.9, J91.0, P23.0-P23.4, and U04-U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age-sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age-sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. FINDINGS Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240-275) LRI incident episodes in males and 232 million (217-248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18-1·42) male deaths and 1·20 million (1·07-1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16-1·18) and 1·31 times (95% UI 1·23-1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4-131·1]) and deaths (100·0% [83·4-115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (-70·7% [-77·2 to -61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7-61·8] in males and 56·4% [40·7-65·1] in females), and more than a quarter of LRI deaths among those aged 5-14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6-35·5] for males and PAF 25·8% [16·3-35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4-25·2) in those aged 15-49 years, 30·5% (24·1-36·9) in those aged 50-69 years, and 21·9% (16·8-27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5-27·9) in those aged 15-49 years and 18·2% (12·5-24·5) in those aged 50-69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2-15·8) of LRI deaths. INTERPRETATION The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. FUNDING Bill & Melinda Gates Foundation.
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Wolff G, Wernly B, Flaatten H, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Binneboessel S, Baldia P, Beil M, Sivri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Flamm M, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Boumendil A, De Lange DW, Guidet B, Leaver S, Jung C. Sex-specific treatment characteristics and 30-day mortality outcomes of critically ill COVID-19 patients over 70 years of age-results from the prospective COVIP study. Can J Anaesth 2022; 69:1390-1398. [PMID: 35945477 PMCID: PMC9363137 DOI: 10.1007/s12630-022-02304-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Older critically ill patients with COVID-19 have been the most vulnerable during the ongoing pandemic, with men being more prone to hospitalization and severe disease than women. We aimed to explore sex-specific differences in treatment and outcome after intensive care unit (ICU) admission in this cohort. METHODS We performed a sex-specific analysis in critically ill patients ≥ 70 yr of age with COVID-19 who were included in the international prospective multicenter COVIP study. All patients were analyzed for ICU admission and treatment characteristics. We performed a multilevel adjusted regression analysis to elucidate associations of sex with 30-day mortality. RESULTS A total of 3,159 patients (69.8% male, 30.2% female; median age, 75 yr) were included. Male patients were significantly fitter than female patients as determined by the Clinical Frailty Scale (fit, 67% vs 54%; vulnerable, 14% vs 19%; frail, 19% vs 27%; P < 0.001). Male patients more often underwent tracheostomy (20% vs 14%; odds ratio [OR], 1.57; P < 0.001), vasopressor therapy (69% vs 62%; OR, 1.25; P = 0.02), and renal replacement therapy (17% vs 11%; OR, 1.96; P < 0.001). There was no difference in mechanical ventilation, life-sustaining treatment limitations, and crude 30-day mortality (50% male vs 49% female; OR, 1.11; P = 0.19), which remained true after adjustment for disease severity, frailty, age and treatment limitations (OR, 1.17; 95% confidence interval, 0.94 to 1.45; P = 0.16). CONCLUSION In this analysis of sex-specific treatment characteristics and 30-day mortality outcomes of critically ill patients with COVID-19 ≥ 70 yr of age, we found more tracheostomy and renal replacement therapy in male vs female patients, but no significant association of patient sex with 30-day mortality. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT04321265); registered 25 March 2020).
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Affiliation(s)
- Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Philipp Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sivri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Paris, France, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
| | - Susannah Leaver
- General Intensive care, St George´s University Hospitals NHS Foundation Trust, London, UK
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany.
- Division of Cardiology, Department of Internal Medicine, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Flaatten H, Guidet B, Jung C, Boumendil A, Leaver S, Szczeklik W, Artigas A, Andersen F, Moreno R, Walther S, Oeyen S, Schefold JC, Marsh B, Joannidis M, Elhadi M, Nalapko Y, Fjølner J, de Lange DW. Consent is a confounding factor in a prospective observational study of critically ill elderly patients. PLoS One 2022; 17:e0276386. [PMID: 36301954 PMCID: PMC9612504 DOI: 10.1371/journal.pone.0276386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
During analysis of a prospective multinational observation study of critically ill patients ≥80 years of age, the VIP2 study, we also studied the effects of differences in country consent for study inclusion. This is a post hoc analysis where the ICUs were analyzed according to requirement for study consent. Group A: ICUs in countries with no requirement for consent at admission but with deferred consent in survivors. Group B: ICUs where some form of active consent at admission was necessary either from the patient or surrogates. Patients’ characteristics, the severity of disease and outcome variables were compared. Totally 3098 patients were included from 21 countries. The median age was 84 years (IQR 81–87). England was not included because of changing criteria for consent during the study period. Group A (7 countries, 1200 patients), and group B (15 countries, 1898 patients) were comparable with age and gender distribution. Cognition was better preserved prior to admission in group B. Group A suffered from more organ dysfunction at admission compared to group B with Sequential Organ Failure Assessment score median 8 and 6 respectively. ICU survival was lower in group A, 66.2% compared to 78.4% in group B (p<0.001). We hence found profound effects on outcomes according to differences in obtaining consent for this study. It seems that the most severely ill elderly patients were less often recruited to the study in group B. Hence the outcome measured as survival was higher in this group. We therefore conclude that consent likely is an important confounding factor for outcome evaluation in international studies focusing on old patients.
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Affiliation(s)
- Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Saint Antoine Hospital, AP-HP, Hôpital Saint-Antoine, Service de Animation, F75012, Paris, France
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ariane Boumendil
- AP-HP, Hôpital Saint-Antoine, service de réanimation, F75012, Paris, France
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George’s Hospital, London, United Kingdom
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Antonio Artigas
- Intensive care Department, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Finn Andersen
- Department of Anaesthesia and Intensive Care, NTNU, Dep of Circulation and Medical Imaging, Ålesund Hospital, Trondheim, Ålesund, Norway
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sten Walther
- Linkoping University Hospital, Linkoping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC Ghent University Hospital, Ghent, Belgium
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Dylan W. de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
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Wernly B, Flaatten H, Beil M, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Rezar R, Oeyen S, Wolff G, Marsh B, Andersen FH, Moreno R, Wernly S, Leaver S, Boumendil A, De Lange DW, Guidet B, Perings S, Jung C. A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems. Sci Rep 2022; 12:17460. [PMID: 36261587 PMCID: PMC9580441 DOI: 10.1038/s41598-022-21580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023] Open
Abstract
In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40-0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe.
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Affiliation(s)
- Bernhard Wernly
- grid.21604.310000 0004 0523 5263Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria ,grid.21604.310000 0004 0523 5263Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Hans Flaatten
- grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Anaestesia and Intensive Care, Haukeland University Hospital, 5021 Bergen, Norway
| | - Michael Beil
- grid.9619.70000 0004 1937 0538Deptartment of Medical Intensive Care, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120 Jersualem, Israel
| | - Jesper Fjølner
- grid.416838.00000 0004 0646 9184Department of Anesthesia and Intensive Care, Viborg Regional Hospital, 8800 Viborg, Denmark
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Antonio Artigas
- grid.7080.f0000 0001 2296 0625Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, 08208 Sabadell, Spain
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Joerg C. Schefold
- grid.411656.10000 0004 0479 0855Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, 3010 Bern, Switzerland
| | - Malte Kelm
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Sviri Sigal
- grid.9619.70000 0004 1937 0538Deptartment of Medical Intensive Care, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120 Jersualem, Israel
| | - Peter Vernon van Heerden
- grid.17788.310000 0001 2221 2926Deptartment of Anesthesia, Intensive Care and Pain Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, 91120 Jerusalem, Israel
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Muhammed Elhadi
- grid.411306.10000 0000 8728 1538Faculty of Medicine, University of Tripoli, R6XF+46G, Tripoli, Libya
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Richard Rezar
- grid.21604.310000 0004 0523 5263Clinic of Internal Medicine II, Department of Cardiology and Intensive Care, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, 9000 Ghent, Belgium
| | - Georg Wolff
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, D07 R2WY Ireland
| | - Finn H. Andersen
- grid.459807.7Department of Anaesthesia and Intensive Care, Ålesund Hospital, 6017 Ålesund, Norway ,grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Rui Moreno
- grid.418334.90000 0004 0625 3076Centro Hospitalar de Lisboa Central, Lisbon, Portugal ,grid.10772.330000000121511713Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisbon, Portugal ,grid.7427.60000 0001 2220 7094Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal
| | - Sarah Wernly
- grid.21604.310000 0004 0523 5263Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Susannah Leaver
- grid.264200.20000 0000 8546 682XGeneral Intensive Care, St. George´s University Hospital NHS Foundation Trust, London, SW17 0QT UK
| | - Ariane Boumendil
- grid.412370.30000 0004 1937 1100Inserm, Service de réanimation, Institut Pierre-Louis d’épidémiologie et de Santé Publique, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 184, Rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Dylan W. De Lange
- grid.5477.10000000120346234Department of Intensive Care Medicine, University Medical Center, University Utrecht, 3584 CX Utrecht, The Netherlands
| | - Bertrand Guidet
- grid.412370.30000 0004 1937 1100Inserm, Service de réanimation, Institut Pierre-Louis d’épidémiologie et de Santé Publique, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 184, Rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Stefan Perings
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
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Tabah A, Elhadi M, Ballard E, Cortegiani A, Cecconi M, Unoki T, Galarza L, Rosa RG, Barbier F, Azoulay E, Laupland KB, Kai NSY, Ostermann M, Francois G, De Waele JJ, Fiest K, Spronk P, Benbenishty J, Pellegrini M, Rose L. Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic: The COVISIT international survey. J Crit Care 2022; 71:154050. [PMID: 35525226 PMCID: PMC9067300 DOI: 10.1016/j.jcrc.2022.154050] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. METHODS We conducted a web-based survey (March-July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting policies and communication modes including use of virtual visiting (videoconferencing). RESULTS We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/525) had unrestricted visiting hours; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey. CONCLUSIONS Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits.
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Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health services, Queensland, Australia,Queensland University of Technology, Brisbane, Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia,Corresponding author at: Intensive Care, Redcliffe Hospital, Anzac Av, Redcliffe, 4020, Queensland, Australia
| | | | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Maurizio Cecconi
- Anaesthesia and Intensive Care Units, Humanitas Research Hospital, Milan, Italy,Humanitas University, Milan, Italy
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Laurą Galarza
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Francois Barbier
- Médecine Intensive – Réanimation Hôpital de la Source - CHR Orléans, Orléans, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Groupe FAMIREA, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Kevin B. Laupland
- Queensland University of Technology, Brisbane, Queensland, Australia,Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Marlies Ostermann
- Department of Critical Care & Nephrology, King's College London, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Guy Francois
- Division of Scientific Affairs, Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Jan J. De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium,Division of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kirsten Fiest
- Departments of Critical Care Medicine, Community Health Sciences, Psychiatry, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Peter Spronk
- Departments of Intensive Care Medicine, Gelre Hospitals, Albert Schweitzerlaan, Apeldoorn, the Netherlands
| | | | - Mariangela Pellegrini
- Intensive Care Unit, AnOpIVA, Akademiska sjukhuset, Uppsala, Sweden,Hedenstierna Laboratory, Department of Surgical Science, Uppsala University, Uppsala, Sweden
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK,Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - the COVISIT contributorsRamananMahesh1234BaileyRachel5KronbergerIrmgard E.32CerovacAnis3334SliglWendy6PeršecJasminka78Lincango-NaranjoEddy35OsmanNermin91011TanasYousef12DeanYomna13AbbasAhmed Mohamed3652ElbahnasawyMohamed Gamal14ElshennawyEslam Mohamed37ElmandouhOmar38AhmedFatima Hamed39KoulentiDespoina15TsakiridisIoannis40GurjarMohan16CindryaniMarilaeta41MahmoodpoorAta424356AldawoodyHogir Imad Rasheed44ZuccaroFrancesco17IozzoPasquale57IppolitoMariachiara5859KatayamaYukiko60KuribaraTomoki61MiyazakiSatoko62NakayamaAsami63OuchiAkira64SakuramotoHideaki65TamotoMitsuhiro66YamadaToru67SerhanHashem Abdulaziz Abu45AlsakarnehSaqr Ghaleb Ghassab46KaligozhinZhannur18VidermanDmitriy19KaroutLina47HasanMohd Shahnaz20ZakariaAndee Dzulkarnaen55Ñamendys-SilvaSilvio A.21RaiLajpat48AbelloAntonio Thaddeus R.22PovoaPedro23TomescuDana2425DrozdovEvgeniy49GallegoAlberto Orejas26Jariod-FerrerUrsula M.53Nuñez-GarçiaBernardo54MohamedAhmed Mohamed Ibrahim50GeorgeAbram Raymon Moneer51JeitzinerMarie-Madlen27SaracogluKemal Tolga28IsikArda29AslanAbdullah Tarik30TorlinskiTomasz31Intensive Care Units, Caboolture and Prince Charles Hospitals, Queensland, AustraliaSchool of Medicine, University of Queensland, AustraliaThe George Institute for Global Health, Sydney, AustraliaUniversity of New South Wales, Sydney, AustraliaIntensive Care Outreach, Caboolture Hospital, Caboolture, QLD, AustraliaCritical Care Medicine and Infectious Diseases, Adjunct Appointment, School of Public Health, University of Alberta, CanadaClinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, CroatiaCroatian Society of Intensive Care Medicine, CroatiaMedical Statistics, Medical Research Institute, Alexandria University, EgyptUnited Nations System Staff College Intern-UNITAR, EgyptMember of the Royal Statistical Association, EgyptAlexandria University Main Hospital, EgyptAlexandria University Main Hospital, EgyptTanta University Faculty of Medicine, Egypt2nd Critical Care Department, Attikon University Hospital, Athens, GreeceDepartment of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow, UP 226014, IndiaMedico Chirurgo - Anestesia e Rianimazione, Responsabile U.O.S. Coordinamento Aziendale Trapianti d'Organo E Tessuti, ItalyNational Research Center for Oncology and Transplantation, Astana, KazakhstanNazarbayev University School of Medicine, National Research Oncology Center, Department of Anesthesiology and Intensive Care, Nur-Sultan, KazakhstanUMMC, Kuala Lumpur, MalaysiaDivision of Pulmonary, Anesthesia and Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoThe Medical City Clark, Mabalacat, Pampanga, PhilippinesNOVA Medical School, New University of Lisbon, PortugalAnesthesia and Intensive Care, "Carol Davila "University of Medicine and Pharmacy, RomaniaAnesthesiology & Intensive Care Dept 3, Fundeni Clinical Institute, Sos Fundeni 258 sect 2 zip, 22328, Bucharest, ROMANIAHospital Universitario Severo Ochoa, Leganés, Madrid, SpainDepartment of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 4, 3010 Bern, SwitzerlandDepartment of Anesthesiology and Intensive Care, Health Sciences University, Kartal Dr Lutfi Kirdar City Hospital, Istanbul, TurkeyGeneral Surgery, Division of General Surgery,School of Medicine, Istanbul Medeniyet University, Kadıkoy/Istanbul, TurkeyDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, TurkeyAnaesthetics - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, UKMedical University Innsbruck, Department of Visceral, Transplant and Thoracic Surgery, Anichstrasse 35, A-6020 Innsbruck, AustriaGeneral Hospital Tešanj, Department for Gynecology and Obstetrics, Bosnia and HerzegovinaSchool of Medicine, Department for Anatomy, University of Tuzla, Bosnia and HerzegovinaHospital Vozandes Quito, Quito, EcuadorAssiut University, EgyptKafr Elshikh University Hospital, EgyptAlexandria University Hospital, EgyptFaculty of Medicine Alkasr Alainy, Cairo University, Cairo, EgyptThird Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceICU IRD Sanglah, IndonesiaAnesthesiology, IranResearch Deputy of Faculty of Medicine, Tabriz University of Medical Sciences, IranKhanaqin General Hospital, IraqJordan Hospitals, JordanAl-Balqa’ Applied University, JordanAmerican University of Beirut Medical Center, LebanonDow University of Health Sciences Karachi, PakistanSiberian State Medical University, Tomsk, RussiaGadarif Teaching Hospital, SudanSoba University Hospital, SudanFaculty of Medicine, Assiut University, Assiut, EgyptMiguel Servet University Hospital, Zaragoza, SpainUniversity Hospital Parc Taulí de Sabadell, SpainSchool of Medical Sciences & Hospital, Universiti Sains, MalaysiaDirector of ICU Program, IranDepartment of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, ItalyDepartment of Surgical Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, ItalyDepartment of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, ItalyNursing Department, Sakakibara Memorial Hospital, Fuchu, JapanSchool of Nursing, Sapporo City University, Sapporo, JapanNursing Department, Tokai University Hospital, Isehara, JapanNursing Department, Dokkyo Medical University Hospital, Mibu, JapanCollege of Nursing, Ibaraki Christian University, Omika, JapanSchool of Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, JapanNursing Department, University of Kyoto Hospital, Kyoto, JapanNursing Department, Toho University Omori Hospital, Tokyo, Japan
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Kamarajah S, Evans R, Nepogodiev D, Hodson J, Bundred J, Gockel I, Gossage J, Isik A, Kidane B, Mahendran H, Negoi I, Okonta K, Sayyed R, van Hillegersberg R, Vohra R, Wijnhoven B, Singh P, Griffiths E, Kamarajah S, Hodson J, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, MA N, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández Díaz M, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez L, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel Gijs, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit. J Thorac Cardiovasc Surg 2022; 164:674-684.e5. [PMID: 35249756 DOI: 10.1016/j.jtcvs.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. METHODS This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. RESULTS Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. CONCLUSIONS Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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Wernly B, Rezar R, Flaatten H, Beil M, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Wolff G, Marsh B, Andersen FH, Moreno R, Leaver S, Wernly S, Boumendil A, De Lange DW, Guidet B, Jung C. Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe. J Intern Med 2022; 292:438-449. [PMID: 35398948 PMCID: PMC9115222 DOI: 10.1111/joim.13492] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe. OBJECTIVES The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic. METHODS A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome. RESULTS The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78). CONCLUSION This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.
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Affiliation(s)
- Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jesper Fjølner
- Department of Anesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Raphael R Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Bernardo B Pinto
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Sviri Sigal
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter V van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Brian Marsh
- Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, FCSaude-Universidade da Beira Interior, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St. George's University Hospital NHS Foundation Trust, London, UK
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ariane Boumendil
- Inserm, Service de réanimation, Institut Pierre-Louis d'épidémiologie et de santé publique, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Inserm, Service de réanimation, Institut Pierre-Louis d'épidémiologie et de santé publique, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | -
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
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MA, Geda YF, Gela YY, Gemeda BNB, Getachew M, Getachew ME, Ghaffari K, Ghafourifard M, Ghamari SH, Ghasemi Nour M, Ghassemi F, Ghimire A, Ghith N, Gholamalizadeh M, Gholizadeh Navashenaq J, Ghozy S, Gilani SA, Gill PS, Ginindza TG, Gizaw ATT, Glasbey JC, Godos J, Goel A, Golechha M, Goleij P, Golinelli D, Golitaleb M, Gorini G, Goulart BNG, Grosso G, Guadie HA, Gubari MIM, Gudayu TW, Guerra MR, Gunawardane DA, Gupta B, Gupta S, Gupta VB, Gupta VK, Gurara MK, Guta A, Habibzadeh P, Haddadi Avval A, Hafezi-Nejad N, Hajj Ali A, Haj-Mirzaian A, Halboub ES, Halimi A, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hanif A, Hariri S, Harlianto NI, Haro JM, Hartono RK, Hasaballah AI, Hasan SMM, Hasani H, Hashemi SM, Hassan AM, Hassanipour S, Hayat K, Heidari G, Heidari M, Heidarymeybodi Z, Herrera-Serna BY, Herteliu C, Hezam K, Hiraike Y, Hlongwa MM, Holla R, Holm M, Horita N, Hoseini M, Hossain MM, Hossain MBH, Hosseini MS, Hosseinzadeh A, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Huang J, 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AI, Nassereldine H, Natto ZS, Nayak BP, Ndejjo R, Nduaguba SO, Negash WW, Nejadghaderi SA, Nejati K, Neupane Kandel S, Nguyen HVN, Niazi RK, Noor NM, Noori M, Noroozi N, Nouraei H, Nowroozi A, Nuñez-Samudio V, Nzoputam CI, Nzoputam OJ, Oancea B, Odukoya OO, Oghenetega OB, Ogunsakin RE, Oguntade AS, Oh IH, Okati-Aliabad H, Okekunle AP, Olagunju AT, Olagunju TO, Olakunde BO, Olufadewa II, Omer E, Omonisi AEE, Ong S, Onwujekwe OE, Orru H, Otstavnov SS, Oulhaj A, Oumer B, Owopetu OF, Oyinloye BE, P A M, Padron-Monedero A, Padubidri JR, Pakbin B, Pakshir K, Pakzad R, Palicz T, Pana A, Pandey A, Pandey A, Pant S, Pardhan S, Park EC, Park EK, Park S, Patel J, Pati S, Paudel R, Paudel U, Paun M, Pazoki Toroudi H, Peng M, Pereira J, Pereira RB, Perna S, Perumalsamy N, Pestell RG, Pezzani R, Piccinelli C, Pillay JD, Piracha ZZ, Pischon T, Postma MJ, Pourabhari Langroudi A, Pourshams A, Pourtaheri N, Prashant A, Qadir MMF, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Radhakrishnan RA, Radhakrishnan V, Raeisi M, Rafiee A, Rafiei A, Raheem N, Rahim F, Rahman MO, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmanian V, Rajai N, Rajesh A, Ram P, Ramezanzadeh K, Rana J, Ranabhat K, Ranasinghe P, Rao CR, Rao SJ, Rashedi S, Rashidi A, Rashidi M, Rashidi MM, Ratan ZA, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Razeghinia MS, Rehman AU, Rehman IU, Reitsma MB, Renzaho AMN, Rezaei M, Rezaei N, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Rezapour A, Riad A, Rikhtegar R, Rios-Blancas M, Roberts TJ, Rohloff P, Romero-Rodríguez E, Roshandel G, Rwegerera GM, S M, Saber-Ayad MM, Saberzadeh-Ardestani B, Sabour S, Saddik B, Sadeghi E, Saeb MR, Saeed U, Safaei M, Safary A, Sahebazzamani M, Sahebkar A, Sahoo H, Sajid MR, Salari H, Salehi S, Salem MR, Salimzadeh H, Samodra YL, Samy AM, Sanabria J, Sankararaman S, Sanmarchi F, Santric-Milicevic MM, Saqib MAN, Sarveazad A, Sarvi F, Sathian B, Satpathy M, Sayegh N, Schneider IJC, Schwarzinger M, Šekerija M, Senthilkumaran S, Sepanlou SG, Seylani A, Seyoum K, Sha F, Shafaat O, Shah PA, Shahabi S, Shahid I, Shahrbaf MA, Shahsavari HR, Shaikh MA, Shaka MF, Shaker E, Shannawaz M, Sharew MMS, Sharifi A, Sharifi-Rad J, Sharma P, Shashamo BB, Sheikh A, Sheikh M, Sheikhbahaei S, Sheikhi RA, Sheikhy A, Shepherd PR, Shetty A, Shetty JK, Shetty RS, Shibuya K, Shirkoohi R, Shirzad-Aski H, Shivakumar KM, Shivalli S, Shivarov V, Shobeiri P, Shokri Varniab Z, Shorofi SA, Shrestha S, Sibhat MM, Siddappa Malleshappa SK, Sidemo NB, Silva DAS, Silva LMLR, Silva Julian G, Silvestris N, Simegn W, Singh AD, Singh A, Singh G, Singh H, Singh JA, Singh JK, Singh P, Singh S, Sinha DN, Sinke AH, Siraj MS, Sitas F, Siwal SS, Skryabin VY, Skryabina AA, Socea B, Soeberg MJ, Sofi-Mahmudi A, Solomon Y, Soltani-Zangbar MS, Song S, Song Y, Sorensen RJD, Soshnikov S, Sotoudeh H, Sowe A, Sufiyan MB, Suk R, Suleman M, Suliankatchi Abdulkader R, Sultana S, Sur D, Szócska M, Tabaeian SP, Tabarés-Seisdedos R, Tabatabaei SM, Tabuchi T, Tadbiri H, Taheri E, Taheri M, Taheri Soodejani M, Takahashi K, Talaat IM, Tampa M, Tan KK, Tat NY, Tat VY, Tavakoli A, Tavakoli A, Tehrani-Banihashemi A, Tekalegn Y, Tesfay FH, Thapar R, Thavamani A, Thoguluva Chandrasekar V, Thomas N, Thomas NK, Ticoalu JHV, Tiyuri A, Tollosa DN, Topor-Madry R, Touvier M, Tovani-Palone MR, Traini E, Tran MTN, Tripathy JP, Ukke GG, Ullah I, Ullah S, Ullah S, Unnikrishnan B, Vacante M, Vaezi M, Valadan Tahbaz S, Valdez PR, Vardavas C, Varthya SB, Vaziri S, Velazquez DZ, Veroux M, Villeneuve PJ, Violante FS, Vladimirov SK, Vlassov V, Vo B, Vu LG, Wadood AW, Waheed Y, Walde MT, Wamai RG, Wang C, Wang F, Wang N, Wang Y, Ward P, Waris A, Westerman R, Wickramasinghe ND, Woldemariam M, Woldu B, Xiao H, Xu S, Xu X, Yadav L, Yahyazadeh Jabbari SH, Yang L, Yazdanpanah F, Yeshaw Y, Yismaw Y, Yonemoto N, Younis MZ, Yousefi Z, Yousefian F, Yu C, Yu Y, Yunusa I, Zahir M, Zaki N, Zaman BA, Zangiabadian M, Zare F, Zare I, Zareshahrabadi Z, Zarrintan A, Zastrozhin MS, Zeineddine MA, Zhang D, Zhang J, Zhang Y, Zhang ZJ, Zhou L, Zodpey S, Zoladl M, Vos T, Hay SI, Force LM, Murray CJL. The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400:563-591. [PMID: 35988567 PMCID: PMC9395583 DOI: 10.1016/s0140-6736(22)01438-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/13/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). INTERPRETATION The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. FUNDING Bill & Melinda Gates Foundation.
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Bryazka D, Reitsma MB, Griswold MG, Abate KH, Abbafati C, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abdoli A, Abdollahi M, Abdullah AYM, Abhilash ES, Abu-Gharbieh E, Acuna JM, Addolorato G, Adebayo OM, Adekanmbi V, Adhikari K, Adhikari S, Adnani QES, Afzal S, Agegnehu WY, Aggarwal M, Ahinkorah BO, Ahmad AR, Ahmad S, Ahmad T, Ahmadi A, Ahmadi S, Ahmed H, Ahmed Rashid T, Akunna CJ, Al Hamad H, Alam MZ, Alem DT, Alene KA, Alimohamadi Y, Alizadeh A, Allel K, Alonso J, Alvand S, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Ancuceanu R, Anderson JA, Andrei CL, Andrei T, Arabloo J, Arshad M, Artamonov AA, Aryan Z, Asaad M, Asemahagn MA, Astell-Burt T, Athari SS, Atnafu DD, Atorkey P, Atreya A, Ausloos F, Ausloos M, Ayano G, Ayanore MAA, Ayinde OO, Ayuso-Mateos JL, Azadnajafabad S, Azanaw MM, Azangou-Khyavy M, Azari Jafari A, Azzam AY, Badiye AD, Bagheri N, Bagherieh S, Bairwa M, Bakkannavar SM, Bakshi RK, Balchut/Bilchut AH, Bärnighausen TW, Barra F, Barrow A, Baskaran P, Belo L, Bennett DA, Benseñor IM, Bhagavathula AS, Bhala N, Bhalla A, Bhardwaj N, Bhardwaj P, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bintoro BS, Blokhina EAE, Bodicha BBA, Boloor A, Bosetti C, Braithwaite D, Brenner H, Briko NI, Brunoni AR, Butt ZA, Cao C, Cao Y, Cárdenas R, Carvalho AF, Carvalho M, Castaldelli-Maia JM, Castelpietra G, Castro-de-Araujo LFS, Cattaruzza MS, Chakraborty PA, Charan J, Chattu VK, Chaurasia A, Cherbuin N, Chu DT, Chudal N, Chung SC, Churko C, Ciobanu LG, Cirillo M, Claro RM, Costanzo S, Cowden RG, Criqui MH, Cruz-Martins N, Culbreth GT, Dachew BA, Dadras O, Dai X, Damiani G, Dandona L, Dandona R, Daniel BD, Danielewicz A, Darega Gela J, Davletov K, de Araujo JAP, de Sá-Junior AR, Debela SA, Dehghan A, Demetriades AK, Derbew Molla M, Desai R, Desta AA, Dias da Silva D, Diaz D, Digesa LE, Diress M, Dodangeh M, Dongarwar D, Dorostkar F, Dsouza HL, Duko B, Duncan BB, Edvardsson K, Ekholuenetale M, Elgar FJ, Elhadi M, Elmonem MA, Endries AY, Eskandarieh S, Etemadimanesh A, Fagbamigbe AF, Fakhradiyev IR, Farahmand F, Farinha CSES, Faro A, Farzadfar F, Fatehizadeh A, Fauk NK, Feigin VL, Feldman R, Feng X, Fentaw Z, Ferrero S, Ferro Desideri L, Filip I, Fischer F, Francis JM, Franklin RC, Gaal PA, Gad MM, Gallus S, Galvano F, Ganesan B, Garg T, Gebrehiwot MGD, Gebremeskel TG, Gebremichael MA, Gemechu TR, Getacher L, Getachew ME, Getachew Obsa A, Getie A, Ghaderi A, Ghafourifard M, Ghajar A, Ghamari SH, Ghandour LA, Ghasemi Nour M, Ghashghaee A, Ghozy S, Glozah FN, Glushkova EV, Godos J, Goel A, Goharinezhad S, Golechha M, Goleij P, Golitaleb M, Greaves F, Grivna M, Grosso G, Gudayu TW, Gupta B, Gupta R, Gupta S, Gupta VB, Gupta VK, Hafezi-Nejad N, Haj-Mirzaian A, Hall BJ, Halwani R, Handiso TB, Hankey GJ, Hariri S, Haro JM, Hasaballah AI, Hassanian-Moghaddam H, Hay SI, Hayat K, Heidari G, Heidari M, Hendrie D, Herteliu C, Heyi DZ, Hezam K, Hlongwa MM, Holla R, Hossain MM, Hossain S, Hosseini SK, hosseinzadeh M, Hostiuc M, Hostiuc S, Hu G, Huang J, Hussain S, Ibitoye SE, Ilic IM, Ilic MD, Immurana M, Irham LM, Islam MM, Islam RM, Islam SMS, Iso H, Itumalla R, Iwagami M, Jabbarinejad R, Jacob L, Jakovljevic M, Jamalpoor Z, Jamshidi E, Jayapal SK, Jayarajah UU, Jayawardena R, Jebai R, Jeddi SA, Jema AT, Jha RP, Jindal HA, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabthymer RH, Kamble BD, Kandel H, Kanno GG, Kapoor N, Karaye IM, Karimi SE, Kassa BG, Kaur RJ, Kayode GA, Keykhaei M, Khajuria H, Khalilov R, Khan IA, Khan MAB, Kim H, Kim J, Kim MS, Kimokoti RW, Kivimäki M, Klymchuk V, Knudsen AKS, Kolahi AA, Korshunov VA, Koyanagi A, Krishan K, Krishnamoorthy Y, Kumar GA, Kumar N, Kumar N, Lacey B, Lallukka T, Lasrado S, Lau J, Lee SW, Lee WC, Lee YH, Lim LL, Lim SS, Lobo SW, Lopukhov PD, Lorkowski S, Lozano R, Lucchetti G, Madadizadeh F, Madureira-Carvalho ÁM, Mahjoub S, Mahmoodpoor A, Mahumud RA, Makki A, Malekpour MR, Manjunatha N, Mansouri B, Mansournia MA, Martinez-Raga J, Martinez-Villa FA, Matzopoulos R, Maulik PK, Mayeli M, McGrath JJ, Meena JK, Mehrabi Nasab E, Menezes RG, Mensink GBM, Mentis AFA, Meretoja A, Merga BT, Mestrovic T, Miao Jonasson J, Miazgowski B, Micheletti Gomide Nogueira de Sá AC, Miller TR, Mini GK, Mirica A, Mirijello A, Mirmoeeni S, Mirrakhimov EM, Misra S, Moazen B, Mobarakabadi M, Moccia M, Mohammad Y, Mohammadi E, Mohammadian-Hafshejani A, Mohammed TA, Moka N, Mokdad AH, Momtazmanesh S, Moradi Y, Mostafavi E, Mubarik S, Mullany EC, Mulugeta BT, Murillo-Zamora E, Murray CJL, Mwita JC, Naghavi M, Naimzada MD, Nangia V, Nayak BP, Negoi I, Negoi RI, Nejadghaderi SA, Nepal S, Neupane SPP, Neupane Kandel S, Nigatu YT, Nowroozi A, Nuruzzaman KM, Nzoputam CI, Obamiro KO, Ogbo FA, Oguntade AS, Okati-Aliabad H, Olakunde BO, Oliveira GMM, Omar Bali A, Omer E, Ortega-Altamirano DV, Otoiu A, Otstavnov SS, Oumer B, P A M, Padron-Monedero A, Palladino R, Pana A, Panda-Jonas S, Pandey A, Pandey A, Pardhan S, Parekh T, Park EK, Parry CDH, Pashazadeh Kan F, Patel J, Pati S, Patton GC, Paudel U, Pawar S, Peden AE, Petcu IR, Phillips MR, Pinheiro M, Plotnikov E, Pradhan PMS, Prashant A, Quan J, Radfar A, Rafiei A, Raghav PR, Rahimi-Movaghar V, Rahman A, Rahman MM, Rahman M, Rahmani AM, Rahmani S, Ranabhat CL, Ranasinghe P, Rao CR, Rasali DP, Rashidi MM, Ratan ZA, Rawaf DL, Rawaf S, Rawal L, Renzaho AMN, Rezaei N, Rezaei S, Rezaeian M, Riahi SM, Romero-Rodríguez E, Roth GA, Rwegerera GM, Saddik B, Sadeghi E, Sadeghian R, Saeed U, Saeedi F, Sagar R, Sahebkar A, Sahoo H, Sahraian MA, Saif-Ur-Rahman KM, Salahi S, Salimzadeh H, Samy AM, Sanmarchi F, Santric-Milicevic MM, Sarikhani Y, Sathian B, Saya GK, Sayyah M, Schmidt MI, Schutte AE, Schwarzinger M, Schwebel DC, Seidu AA, Senthil Kumar N, SeyedAlinaghi S, Seylani A, Sha F, Shahin S, Shahraki-Sanavi F, Shahrokhi S, Shaikh MA, Shaker E, Shakhmardanov MZ, Shams-Beyranvand M, Sheikhbahaei S, Sheikhi RA, Shetty A, Shetty JK, Shiferaw DS, Shigematsu M, Shiri R, Shirkoohi R, Shivakumar KM, Shivarov V, Shobeiri P, Shrestha R, Sidemo NB, Sigfusdottir ID, Silva DAS, Silva NTD, Singh JA, Singh S, Skryabin VY, Skryabina AA, Sleet DA, Solmi M, SOLOMON YONATAN, Song S, Song Y, Sorensen RJD, Soshnikov S, Soyiri IN, Stein DJ, Subba SH, Szócska M, Tabarés-Seisdedos R, Tabuchi T, Taheri M, Tan KK, Tareke M, Tarkang EE, Temesgen G, Temesgen WA, Temsah MH, Thankappan KR, Thapar R, Thomas NK, Tiruneh C, Todorovic J, Torrado M, Touvier M, Tovani-Palone MR, Tran MTN, Trias-Llimós S, Tripathy JP, Vakilian A, Valizadeh R, Varmaghani M, Varthya SB, Vasankari TJ, Vos T, Wagaye B, Waheed Y, Walde MT, Wang C, Wang Y, Wang YP, Westerman R, Wickramasinghe ND, Wubetu AD, Xu S, Yamagishi K, Yang L, Yesera GEE, Yigit A, Yiğit V, Yimaw AEAE, Yon DK, Yonemoto N, Yu C, Zadey S, Zahir M, Zare I, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Zhong C, Zmaili M, Zuniga YMH, Gakidou E. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020. Lancet 2022; 400:185-235. [PMID: 35843246 PMCID: PMC9289789 DOI: 10.1016/s0140-6736(22)00847-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. METHODS For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. FINDINGS The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. INTERPRETATION There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. FUNDING Bill & Melinda Gates Foundation.
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Sharma R, Abbasi-Kangevari M, Abd-Rabu R, Abidi H, Abu-Gharbieh E, Acuna JM, Adhikari S, Advani SM, Afzal MS, Aghaie Meybodi M, Ahinkorah BO, Ahmad S, Ahmadi A, Ahmadi S, Ahmed H, Ahmed LA, Ahmed MB, Al Hamad H, Alahdab F, Alanezi FM, Alanzi TM, Alhalaiqa FAN, Alimohamadi Y, Alipour V, Aljunid SM, Alkhayyat M, Almustanyir S, Al-Raddadi RM, Alvand S, Alvis-Guzman N, Amini S, Ancuceanu R, Anoushiravani A, Anoushirvani AA, Ansari-Moghaddam A, Arabloo J, Aryannejad A, Asghari Jafarabadi M, Athari SS, Ausloos F, Ausloos M, Awedew AF, Awoke MA, Ayana TM, Azadnajafabad S, Azami H, Azangou-Khyavy M, Azari Jafari A, Badiye AD, Bagherieh S, Bahadory S, Baig AA, Baker JL, Banach M, Barrow A, Berhie AY, Besharat S, Bhagat DS, Bhagavathula AS, Bhala N, Bhattacharyya K, Bhojaraja VS, Bibi S, Bijani A, Biondi A, Bjørge T, Bodicha BBA, Braithwaite D, Brenner H, Calina D, Cao C, Cao Y, Carreras G, Carvalho F, Cerin E, Chakinala RC, Cho WCS, Chu DT, Conde J, Costa VM, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Danielewicz A, Demeke FM, Demissie GD, Desai R, Dhamnetiya D, Dianatinasab M, Diaz D, Didehdar M, Doaei S, Doan LP, Dodangeh M, Eghbalian F, Ejeta DD, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Enyew DB, Eyayu T, Ezzeddini R, Fakhradiyev IR, Farooque U, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fattahi H, Fattahi N, Fereidoonnezhad M, Fernandes E, Fetensa G, Filip I, Fischer F, Foroutan M, Gaal PA, Gad MM, Gallus S, Garg T, Getachew T, Ghamari SH, Ghashghaee A, Ghith N, Gholamalizadeh M, Gholizadeh Navashenaq J, Gizaw AT, Glasbey JC, Golechha M, Goleij P, Gonfa KB, Gorini G, Guha A, Gupta S, Gupta VB, Gupta VK, Haddadi R, Hafezi-Nejad N, Haj-Mirzaian A, Halwani R, Haque S, Hariri S, Hasaballah AI, Hassanipour S, Hay SI, Herteliu C, Holla R, Hosseini MS, Hosseinzadeh M, Hostiuc M, Househ M, Huang J, Humayun A, Iavicoli I, Ilesanmi OS, Ilic IM, Ilic MD, Islami F, Iwagami M, Jahani MA, Jakovljevic M, Javaheri T, Jayawardena R, Jebai R, Jha RP, Joo T, Joseph N, Joukar F, Jozwiak JJ, Kabir A, Kalhor R, Kamath A, Kapoor N, Karaye IM, Karimi A, Kauppila JH, Kazemi A, Keykhaei M, Khader YS, Khajuria H, Khalilov R, Khanali J, Khayamzadeh M, Khodadost M, Kim H, Kim MS, Kisa A, Kisa S, Kolahi AA, Koohestani HR, Kopec JA, Koteeswaran R, Koyanagi A, Krishnamoorthy Y, Kumar GA, Kumar M, Kumar V, La Vecchia C, Lami FH, Landires I, Ledda C, Lee SW, Lee WC, Lee YY, Leong E, Li B, Lim SS, Lobo SW, Loureiro JA, Lunevicius R, Madadizadeh F, Mahmoodpoor A, Majeed A, Malekpour MR, Malekzadeh R, Malik AA, Mansour-Ghanaei F, Mantovani LG, Martorell M, Masoudi S, Mathur P, Meena JK, Mehrabi Nasab E, Mendoza W, Mentis AFA, Mestrovic T, Miao Jonasson J, Miazgowski B, Miazgowski T, Mijena GFW, Mirmoeeni S, Mirza-Aghazadeh-Attari M, Mirzaei H, Misra S, Mohammad KA, Mohammadi E, Mohammadi S, Mohammadi SM, Mohammadian-Hafshejani A, Mohammed S, Mohammed TA, Moka N, Mokdad AH, Mokhtari Z, Molokhia M, Momtazmanesh S, Monasta L, Moradi G, Moradzadeh R, Moraga P, Morgado-da-Costa J, Mubarik S, Mulita F, Naghavi M, Naimzada MD, Nam HS, Natto ZS, Nayak BP, Nazari J, Nazemalhosseini-Mojarad E, Negoi I, Nguyen CT, Nguyen SH, Noor NM, Noori M, Noori SMA, Nuñez-Samudio V, Nzoputam CI, Oancea B, Odukoya OO, Oguntade AS, Okati-Aliabad H, Olagunju AT, Olagunju TO, Ong S, Ostroff SM, Padron-Monedero A, Pakzad R, Pana A, Pandey A, Pashazadeh Kan F, Patel UK, Paudel U, Pereira RB, Perumalsamy N, Pestell RG, Piracha ZZ, Pollok RCG, Pourshams A, Pourtaheri N, Prashant A, Rabiee M, Rabiee N, Radfar A, Rafiei S, Rahman M, Rahmani AM, Rahmanian V, Rajai N, Rajesh A, Ramezani-Doroh V, Ramezanzadeh K, Ranabhat K, Rashedi S, Rashidi A, Rashidi M, Rashidi MM, Rastegar M, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Renzaho AMN, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Rezazadeh-Khadem S, Roshandel G, Saber-Ayad MM, Saberzadeh-Ardestani B, Saddik B, Sadeghi H, Saeed U, Sahebazzamani M, Sahebkar A, Salek Farrokhi A, Salimi A, Salimzadeh H, Samadi P, Samaei M, Samy AM, Sanabria J, Santric-Milicevic MM, Saqib MAN, Sarveazad A, Sathian B, Satpathy M, Schneider IJC, Šekerija M, Sepanlou SG, Seylani A, Sha F, Shafiee SM, Shaghaghi Z, Shahabi S, Shaker E, Sharifian M, Sharifi-Rad J, Sheikhbahaei S, Shetty JK, Shirkoohi R, Shobeiri P, Siddappa Malleshappa SK, Silva DAS, Silva Julian G, Singh AD, Singh JA, Siraj MS, Sivandzadeh GR, Skryabin VY, Skryabina AA, Socea B, Solmi M, Soltani-Zangbar MS, Song S, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Tabibian E, Taheri M, TaheriAbkenar Y, Taherkhani A, Talaat IM, Tan KK, Tbakhi A, Tesfaye B, Tiyuri A, Tollosa DN, Touvier M, Tran BX, Tusa BS, Ullah I, Ullah S, Vacante M, Valadan Tahbaz S, Veroux M, Vo B, Vos T, Wang C, Westerman R, Woldemariam M, Yahyazadeh Jabbari SH, Yang L, Yazdanpanah F, Yu C, Yuce D, Yunusa I, Zadnik V, Zahir M, Zare I, Zhang ZJ, Zoladl M. Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol 2022; 7:627-647. [PMID: 35397795 PMCID: PMC9192760 DOI: 10.1016/s2468-1253(22)00044-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades. METHODS Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990-2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. FINDINGS Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408-868 574) to 2·17 million (2·00-2·34), and deaths increased from 518 126 (493 682-537 877) to 1·09 million (1·02-1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3-23·0) per 100 000 to 26·7 (24·6-28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5-14·9) per 100 000 to 13·7 (12·6-14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7-320·7) per 100 000 to 295·5 (275·2-313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9-80·0] per 100 000), Monaco (60·7 [48·5-73·6] per 100 000), and Andorra (56·6 [42·8-71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0-37·1] per 100 000), Brunei (30·3 [26·6-34·1] per 100 000), and Hungary (28·6 [23·6-34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age <50 years), particularly in high Socio-demographic Index (SDI) countries. Globally, a diet low in milk (15·6%), smoking (13·3%), a diet low in calcium (12·9%), and alcohol use (9·9%) were the main contributors to colorectal cancer DALYs in 2019. INTERPRETATION The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions. FUNDING Bill & Melinda Gates Foundation.
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Dhahri A, Belkahla A, Laifi J, Gouadria S, Elhadi M, Dhahri J, Dhahri E. Crystal structure and dielectric properties of the Ca/Y co-substituted BaTiO3. INORG CHEM COMMUN 2022. [DOI: 10.1016/j.inoche.2022.109570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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