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Sadat N, Aherrahour Z, Osterloh A, Erdmann J, Fujita B, Ensminger S. Comparison of Different Calcification Media on Gene Expression Using a Porcine Aortic Valve Ex Vivo Assay. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- N. Sadat
- University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Z. Aherrahour
- Institute of Cardiogenetic, University of Lübeck, Lübeck, Deutschland
| | - A. Osterloh
- University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - J. Erdmann
- Institute of Cardiogenetic, University of Lübeck, Lübeck, Deutschland
| | - B. Fujita
- University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - S. Ensminger
- University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
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Balks FM, Saisho H, Fujita B, Schaller T, Sadat N, Ensminger S, Barkhausen J, Frydrychowicz A, Oechtering T. Ex-vivo 4D Fluss MRT zur Bestimmung des Einflusses der Aortotomie und unterschiedlicher Aortenklappenersatz-Verfahren auf aortale Flusscharakteristika. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- F M Balks
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Radiologie und Nuklearmedizin, Lübeck
| | - H Saisho
- Universität zu Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Lübeck
| | - B Fujita
- Universität zu Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Lübeck
| | - T Schaller
- Universität zu Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Lübeck
| | - N Sadat
- Universität zu Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Lübeck
| | - S Ensminger
- Universität zu Lübeck, Klinik für Herz- und thorakale Gefäßchirurgie, Lübeck
| | - J Barkhausen
- Universität zu Lübeck, Klinik für Radiologie und Nuklearmedizin, Lübeck
| | - A Frydrychowicz
- Universität zu Lübeck, Klinik für Radiologie und Nuklearmedizin, Lübeck
| | - T Oechtering
- University of Wisconsin, Department of Radiology, Madison, USA
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3
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Sadat N, Lojenburg JH, Scharfschwerdt M, Klinger M, Ensminger S, Fujita B. In Vitro Investigation of Calcification of Five Surgical Aortic Valve Bioprosthesis Models. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N. Sadat
- Department of Cardiac and Thoracic Vascular Surgery, Lübeck, Deutschland
| | - J. H. Lojenburg
- Department of Cardiac and Thoracic Vascular Surgery, Lübeck, Deutschland
| | - M. Scharfschwerdt
- University of Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - M. Klinger
- Institute for Anatomy, Medical Faculty, University Lübeck, Lübeck, Deutschland
| | - S. Ensminger
- Clinic for Heart and Thoracic Vessel Surgery, Lübeck, Deutschland
| | - B. Fujita
- Ratzeburger Allee 160, Lübeck, Deutschland
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Bruhn D, Schaller T, Sadat N, Fujita B, Ensminger S, Scharfschwerdt M. An In Vitro Model to Simulate Left Ventricular Contraction of Isolated Porcine Hearts for Mitral Valve Reconstruction. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- D. Bruhn
- University of Lübeck, Lübeck, Deutschland
| | | | - N. Sadat
- University of Lübeck, Lübeck, Deutschland
| | - B. Fujita
- University of Lübeck, Lübeck, Deutschland
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Sadat N, Lojenburg JH, Scharfschwerdt M, Klinger M, Ensminger S, Fujita B. Development of an Ex Vivo Porcine Aortic Valve Calcification Model for Hydrodynamic Testing. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N. Sadat
- Department of Cardiac and Thoracic Vascular Surgery, Lübeck, Deutschland
| | - J. H. Lojenburg
- Department of Cardiac and Thoracic Vascular Surgery, Lübeck, Deutschland
| | - M. Scharfschwerdt
- University of Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - M. Klinger
- Institute for anatomy, Medical Faculty, University Lübeck, Lübeck, Deutschland
| | - S. Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, Lübeck, Deutschland
| | - B. Fujita
- Department of Cardiac and Thoracic Vascular Surgery, Lübeck, Deutschland
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Sadat N, Scharfschwerdt M, Schaller T, Aboud A, Saisho H, Ensminger S, Fujita B. Systematic Investigation of Hydrodynamic Performance of Nine Aortic Valve Bioprostheses under Standardized Conditions: An In Vitro Study. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sadat N, Scharfschwerdt M, Schaller T, Aboud A, Saisho H, Ensminger S, Fujita B. Systematic Investigation of Hydrodynamic Performance of Nine Valve in Valve Prostheses under Standardized Conditions: An In Vitro Study. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saisho H, Balks M, Schaller T, Scharfschwerdt M, Aboud A, Sadat N, Frydrychowicz A, Ensminger S, Oechtering T, Fujita B. Investigation of Aortic Flow Patterns after Aortic Valve Replacement: Establishment of a New Ex Vivo 4D Flow MRI Model. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dieleman JL, Cao J, Chapin A, Chen C, Li Z, Liu A, Horst C, Kaldjian A, Matyasz T, Scott KW, Bui AL, Campbell M, Duber HC, Dunn AC, Flaxman AD, Fitzmaurice C, Naghavi M, Sadat N, Shieh P, Squires E, Yeung K, Murray CJL. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA 2020; 323:863-884. [PMID: 32125402 PMCID: PMC7054840 DOI: 10.1001/jama.2020.0734] [Citation(s) in RCA: 492] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time. OBJECTIVE To estimate US spending on health care according to 3 types of payers (public insurance [including Medicare, Medicaid, and other government programs], private insurance, or out-of-pocket payments) and by health condition, age group, sex, and type of care for 1996 through 2016. DESIGN AND SETTING Government budgets, insurance claims, facility records, household surveys, and official US records from 1996 through 2016 were collected to estimate spending for 154 health conditions. Spending growth rates (standardized by population size and age group) were calculated for each type of payer and health condition. EXPOSURES Ambulatory care, inpatient care, nursing care facility stay, emergency department care, dental care, and purchase of prescribed pharmaceuticals in a retail setting. MAIN OUTCOMES AND MEASURES National spending estimates stratified by health condition, age group, sex, type of care, and type of payer and modeled for each year from 1996 through 2016. RESULTS Total health care spending increased from an estimated $1.4 trillion in 1996 (13.3% of gross domestic product [GDP]; $5259 per person) to an estimated $3.1 trillion in 2016 (17.9% of GDP; $9655 per person); 85.2% of that spending was included in this study. In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance, 42.6% (95% CI, 42.5%-42.6%) by public insurance, and 9.4% (95% CI, 9.4%-9.4%) by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion (95% CI, $122.4-$146.9 billion) in spending, of which 57.2% (95% CI, 52.2%-61.2%) was paid by private insurance, 33.7% (95% CI, 30.0%-38.4%) by public insurance, and 9.2% (95% CI, 8.3%-10.4%) by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at $129.8 billion [95% CI, $116.3-$149.7 billion]) and most had private insurance (56.4% [95% CI, 52.6%-59.3%]). Diabetes accounted for the third highest amount of the health care spending (estimated at $111.2 billion [95% CI, $105.7-$115.9 billion]) and most had public insurance (49.8% [95% CI, 44.4%-56.0%]). Other conditions estimated to have substantial health care spending in 2016 were ischemic heart disease ($89.3 billion [95% CI, $81.1-$95.5 billion]), falls ($87.4 billion [95% CI, $75.0-$100.1 billion]), urinary diseases ($86.0 billion [95% CI, $76.3-$95.9 billion]), skin and subcutaneous diseases ($85.0 billion [95% CI, $80.5-$90.2 billion]), osteoarthritis ($80.0 billion [95% CI, $72.2-$86.1 billion]), dementias ($79.2 billion [95% CI, $67.6-$90.8 billion]), and hypertension ($79.0 billion [95% CI, $72.6-$86.8 billion]). The conditions with the highest spending varied by type of payer, age, sex, type of care, and year. After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9% (95% CI, 2.9%-2.9%); private insurance, 2.6% (95% CI, 2.6%-2.6%); and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%). CONCLUSIONS AND RELEVANCE Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance. Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.
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Affiliation(s)
| | - Jackie Cao
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Abby Chapin
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Carina Chen
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Zhiyin Li
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Angela Liu
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Cody Horst
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Taylor Matyasz
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Anthony L. Bui
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle
| | | | - Herbert C. Duber
- Institute for Health Metrics and Evaluation, Seattle, Washington
- Department of Emergency Medicine, University of Washington, Seattle
| | - Abe C. Dunn
- Bureau of Economic Analysis, Suitland, Maryland
| | | | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, Seattle, Washington
- Division of Hematology, Department of Medicine, University of Washington, Seattle
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Peter Shieh
- Bureau of Economic Analysis, Suitland, Maryland
| | | | - Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle
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Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, Marquez N, Abbasalizad-Farhangi M, Abbasi M, Abd-Allah F, Abdoli A, Abdollahi M, Abdollahpour I, Abdulkader RS, Abrigo MRM, Acharya D, Adebayo OM, Adekanmbi V, Adham D, Afshari M, Aghaali M, Ahmadi K, Ahmadi M, Ahmadpour E, Ahmed R, Akal CG, Akinyemi JO, Alahdab F, Alam N, Alamene GM, Alene KA, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Almalki MJ, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Amegah AK, Amini S, Amit AML, Anbari Z, Androudi S, Anjomshoa M, Ansari F, Antonio CAT, Arabloo J, Arefi Z, Aremu O, Armoon B, Arora A, Artaman A, Asadi A, Asadi-Aliabadi M, Ashraf-Ganjouei A, Assadi R, Ataeinia B, Atre SR, Quintanilla BPA, Ayanore MA, Azari S, Babaee E, Babazadeh A, Badawi A, Bagheri S, Bagherzadeh M, Baheiraei N, Balouchi A, Barac A, Bassat Q, Baune BT, Bayati M, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Belay YB, Bell B, Bell ML, Berbada DA, Bernstein RS, Bhattacharjee NV, Bhattarai S, Bhutta ZA, Bijani A, Bohlouli S, Breitborde NJK, Britton G, Browne AJ, Nagaraja SB, Busse R, Butt ZA, Car J, Cárdenas R, Castañeda-Orjuela CA, Cerin E, Chanie WF, Chatterjee P, Chu DT, Cooper C, Costa VM, Dalal K, Dandona L, Dandona R, Daoud F, Daryani A, Das Gupta R, Davis I, Davis Weaver N, Davitoiu DV, De Neve JW, Demeke FM, Demoz GT, Deribe K, Desai R, Deshpande A, Desyibelew HD, Dey S, Dharmaratne SD, Dhimal M, Diaz D, Doshmangir L, Duraes AR, Dwyer-Lindgren L, Earl L, Ebrahimi R, Ebrahimpour S, Effiong A, Eftekhari A, Ehsani-Chimeh E, El Sayed I, El Sayed Zaki M, El Tantawi M, El-Khatib Z, Emamian MH, Enany S, Eskandarieh S, Eyawo O, Ezalarab M, Faramarzi M, Fareed M, Faridnia R, Faro A, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad SM, Fernandes JC, Filip I, Fischer F, Foigt NA, Foroutan M, Francis JM, Fukumoto T, Fullman N, Gallus S, Gebre DG, Gebrehiwot TT, Gebremeskel GG, Gessner BD, Geta B, Gething PW, Ghadimi R, Ghadiri K, Ghajarzadeh M, Ghashghaee A, Gill PS, Gill TK, Golding N, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goulart BNG, Graetz N, Greaves F, Green MS, Guo Y, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Hamidi S, Haririan H, Haro JM, Hasankhani M, Hasanpoor E, Hasanzadeh A, Hassankhani H, Hassen HY, Hegazy MI, Hendrie D, Heydarpour F, Hird TR, Hoang CL, Hollerich G, Rad EH, Hoseini-Ghahfarokhi M, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Ilesanmi OS, Imani-Nasab MH, Iqbal U, Irvani SSN, Islam N, Islam SMS, Jürisson M, Balalami NJ, Jalali A, Javidnia J, Jayatilleke AU, Jenabi E, Ji JS, Jobanputra YB, Johnson K, Jonas JB, Shushtari ZJ, Jozwiak JJ, Kabir A, Kahsay A, Kalani H, Kalhor R, Karami M, Karki S, Kasaeian A, Kassebaum NJ, Keiyoro PN, Kemp GR, Khabiri R, Khader YS, Khafaie MA, Khan EA, Khan J, Khan MS, Khang YH, Khatab K, Khater A, Khater MM, Khatony A, Khazaei M, Khazaei S, Khazaei-Pool M, Khubchandani J, Kianipour N, Kim YJ, Kimokoti RW, Kinyoki DK, Kisa A, Kisa S, Kolola T, Kosen S, Koul PA, Koyanagi A, Kraemer MUG, Krishan K, Krohn KJ, Kugbey N, Kumar GA, Kumar M, Kumar P, Kuupiel D, Lacey B, Lad SD, Lami FH, Larsson AO, Lee PH, Leili M, Levine AJ, Li S, Lim LL, Listl S, Longbottom J, Lopez JCF, Lorkowski S, Magdeldin S, Abd El Razek HM, Abd El Razek MM, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Manafi N, Manda AL, Mansourian M, Martins-Melo FR, Masaka A, Massenburg BB, Maulik PK, Mayala BK, Mazidi M, McKee M, Mehrotra R, Mehta KM, Meles GG, Mendoza W, Menezes RG, Meretoja A, Meretoja TJ, Mestrovic T, Miller TR, Miller-Petrie MK, Mills EJ, Milne GJ, Mini GK, Mir SM, Mirjalali H, Mirrakhimov EM, Mohamadi E, Mohammad DK, Darwesh AM, Mezerji NMG, Mohammed AS, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi M, Moradi Y, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Mosapour A, Mousavi SM, Mueller UO, Muluneh AG, Mustafa G, Nabavizadeh B, Naderi M, Nagarajan AJ, Nahvijou A, Najafi F, Nangia V, Ndwandwe DE, Neamati N, Negoi I, Negoi RI, Ngunjiri JW, Thi Nguyen HL, Nguyen LH, Nguyen SH, Nielsen KR, Ningrum DNA, Nirayo YL, Nixon MR, Nnaji CA, Nojomi M, Noroozi M, Nosratnejad S, Noubiap JJ, Motlagh SN, Ofori-Asenso R, Ogbo FA, Oladimeji KE, Olagunju AT, Olfatifar M, Olum S, Olusanya BO, Oluwasanu MM, Onwujekwe OE, Oren E, Ortega-Altamirano DDV, Ortiz A, Osarenotor O, Osei FB, Osgood-Zimmerman AE, Otstavnov SS, Owolabi MO, P A M, Pagheh AS, Pakhale S, Panda-Jonas S, Pandey A, Park EK, Parsian H, Pashaei T, Patel SK, Pepito VCF, Pereira A, Perkins S, Pickering BV, Pilgrim T, Pirestani M, Piroozi B, Pirsaheb M, Plana-Ripoll O, Pourjafar H, Puri P, Qorbani M, Quintana H, Rabiee M, Rabiee N, Radfar A, Rafiei A, Rahim F, Rahimi Z, Rahimi-Movaghar V, Rahimzadeh S, Rajati F, Raju SB, Ramezankhani A, Ranabhat CL, Rasella D, Rashedi V, Rawal L, Reiner RC, Renzaho AMN, Rezaei S, Rezapour A, Riahi SM, Ribeiro AI, Roever L, Roro EM, Roser M, Roshandel G, Roshani D, Rostami A, Rubagotti E, Rubino S, Sabour S, Sadat N, Sadeghi E, Saeedi R, Safari Y, Safari-Faramani R, Safdarian M, Sahebkar A, Salahshoor MR, Salam N, Salamati P, Salehi F, Zahabi SS, Salimi Y, Salimzadeh H, Salomon JA, Sambala EZ, Samy AM, Santric Milicevic MM, Jose BPS, Saraswathy SYI, Sarmiento-Suárez R, Sartorius B, Sathian B, Saxena S, Sbarra AN, Schaeffer LE, Schwebel DC, Sepanlou SG, Seyedmousavi S, Shaahmadi F, Shaikh MA, Shams-Beyranvand M, Shamshirian A, Shamsizadeh M, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharifi H, Sharma J, Sharma R, Sheikh A, Shields C, Shigematsu M, Shiri R, Shiue I, Shuval K, Siddiqi TJ, Silva JP, Singh JA, Sinha DN, Sisay MM, Sisay S, Sliwa K, Smith DL, Somayaji R, Soofi M, Soriano JB, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Sykes BL, Sylaja PN, Tabarés-Seisdedos R, Tabb KM, Tabuchi T, Taveira N, Temsah MH, Terkawi AS, Tessema ZT, Thankappan KR, Thirunavukkarasu S, To QG, Tovani-Palone MR, Tran BX, Tran KB, Ullah I, Usman MS, Uthman OA, Vahedian-Azimi A, Valdez PR, van Boven JFM, Vasankari TJ, Vasseghian Y, Veisani Y, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov V, Vos T, Vu GT, Vujcic IS, Waheed Y, Wakefield J, Wang H, Wang Y, Wang YP, Ward JL, Weintraub RG, Weldegwergs KG, Weldesamuel GT, Westerman R, Wiysonge CS, Wondafrash DZ, Woyczynski L, Wu AM, Xu G, Yadegar A, Yamada T, Yazdi-Feyzabadi V, Yilgwan CS, Yip P, Yonemoto N, Lebni JY, Younis MZ, Yousefifard M, Yousof HASA, Yu C, Yusefzadeh H, Zabeh E, Moghadam TZ, Bin Zaman S, Zamani M, Zandian H, Zangeneh A, Zerfu TA, Zhang Y, Ziapour A, Zodpey S, Murray CJL, Hay SI. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. Nature 2019; 574:353-358. [PMID: 31619795 PMCID: PMC6800389 DOI: 10.1038/s41586-019-1545-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022]
Abstract
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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Affiliation(s)
- Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael L Collison
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laurie B Marczak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amber Sligar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Stefanie Watson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Neal Marquez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | | | - Amir Abdoli
- Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Abdollahi
- The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Abdollahpour
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
| | | | - Michael R M Abrigo
- Research Department, Philippine Institute for Development Studies, Quezon City, The Philippines
| | - Dilaram Acharya
- Department of Preventive Medicine, Dongguk University, Gyeongju, South Korea
- Department of Community Medicine, Kathmandu University, Devdaha, Nepal
| | | | | | - Davoud Adham
- School of Health, Ardabil University of Medical Science, Ardabil, Iran
| | - Mahdi Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammad Aghaali
- Department of Epidemiology and Biostatistics, Qom University of Medical Sciences, Qom, Iran
| | - Keivan Ahmadi
- School of Pharmacy, University of Lincoln, Lincoln, UK
| | - Mehdi Ahmadi
- Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Ahmadpour
- Department of Parasitology and Mycology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rushdia Ahmed
- James P. Grant School of Public Health, Brac University, Dhaka, Bangladesh
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Chalachew Genet Akal
- Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Joshua O Akinyemi
- Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | - Noore Alam
- Prevention Division, Queensland Health, Herston, Queensland, Australia
| | | | - Kefyalew Addis Alene
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Cyrus Alinia
- Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, Iran
| | - Vahid Alipour
- Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, Kuwait University, Safat, Kuwait
- International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
| | - Mohammed J Almalki
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- Jazan University, Jazan, Saudi Arabia
| | - Hesham M Al-Mekhlafi
- Medical Research Center, Jazan University, Jazan, Saudi Arabia
- Department of Medical Parasitology, Sana'a University, Sana'a, Yemen
| | | | - Nelson Alvis-Guzman
- Research Group in Health Economics, Universidad de Cartagena, Cartagena, Colombia
- Research Group in Hospital Management and Health Policies, Universidad de la Costa, Barranquilla, Colombia
| | | | - Saeed Amini
- Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
| | - Arianna Maever Loreche Amit
- Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, The Philippines
- Online Programs for Applied Learning, Johns Hopkins University, Baltimore, MD, USA
| | - Zohreh Anbari
- Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
| | - Sofia Androudi
- Department of Medicine, University of Thessaly, Volos, Greece
| | - Mina Anjomshoa
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fereshteh Ansari
- Research Center for Evidence Based Medicine-Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, The Philippines
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zohreh Arefi
- Department of Health Promotion and Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Olatunde Aremu
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Bahram Armoon
- School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amit Arora
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Al Artaman
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anvar Asadi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Asadi-Aliabadi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Ashraf-Ganjouei
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Assadi
- Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahar Ataeinia
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sachin R Atre
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, MD, USA
- Dr D. Y. Patil Medical College, Pune, India
| | - Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
| | - Martin Amogre Ayanore
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Samad Azari
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Babaee
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alaa Badawi
- Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Soghra Bagheri
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Nafiseh Baheiraei
- Tissue Engineering and Applied Cell Sciences Division, Tarbiat Modares University, Tehran, Iran
- Division of Diseases, Advanced Technologies Research Group, Tehran, Iran
| | - Abbas Balouchi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Quique Bassat
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Mohsen Bayati
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neeraj Bedi
- Jazan University, Jazan, Saudi Arabia
- Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Yared Belete Belay
- Pharmacoepidemiology and Social Pharmacy, Mekelle University, Mekelle, Ethiopia
| | - Brent Bell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA
| | | | - Robert S Bernstein
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
- Department of Global Health, University of South Florida, Tampa, FL, USA
| | | | - Suraj Bhattarai
- London School of Hygiene & Tropical Medicine, London, UK
- Nepal Academy of Science & Technology, Patan, Nepal
| | - Zulfiqar A Bhutta
- The Centre for Global Child Health, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Somayeh Bohlouli
- Department of Veterinary Medicine, Karaj Islamic Azad University, Kermanshah, Iran
| | - Nicholas J K Breitborde
- Department of Psychology, Ohio State University, Columbus, OH, USA
- Psychiatry and Behavioral Health Department, Ohio State University, Columbus, OH, USA
| | - Gabrielle Britton
- Neuroscience Department, Institute for Scientific Research and High Technology Services, City of Knowledge, Panama
- Gorgas Memorial Institute for Health Studies, Panama, Panama
| | - Annie J Browne
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | - Reinhard Busse
- Department for Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Zahid A Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Josip Car
- Centre for Population Health Sciences, Nanyang Technological University, Singapore, Singapore
- Global Ehealth Unit, Imperial College London, London, UK
| | - Rosario Cárdenas
- Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
| | - Carlos A Castañeda-Orjuela
- Colombian National Health Observatory, National Institute of Health, Bogota, Colombia
- Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
| | - Ester Cerin
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- School of Public Health, University of Hong Kong, Hong Kong, China
| | | | - Pranab Chatterjee
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Cyrus Cooper
- Department of Rheumatology, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Vera M Costa
- Applied Molecular Biosciences Unit (UCIBIO), University of Porto, Porto, Portugal
| | - Koustuv Dalal
- Institute of Public Health Kalyani, Kalyani, India
- School of Health Science, Orebro University, Orebro, Sweden
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Public Health Foundation of India, Gurugram, India
| | - Rakhi Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Public Health Foundation of India, Gurugram, India
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rajat Das Gupta
- James P. Grant School of Public Health, Brac University, Dhaka, Bangladesh
| | - Ian Davis
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dragos Virgil Davitoiu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Surgery, Clinical Emergency Hospital St Pantelimon, Bucharest, Romania
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | | | - Gebre Teklemariam Demoz
- School of Pharmacy, Aksum University, Aksum, Ethiopia
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede Deribe
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Meghnath Dhimal
- Health Research Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Daniel Diaz
- Center of Complexity Sciences, National Autonomous University of Mexico, Mexico City, Mexico
- Facultad de Medicina Veterinaria y Zootecnia, Autonomous University of Sinaloa, Culiacan Rosales, Mexico
| | - Leila Doshmangir
- Department of Health Policy and Economy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Andre R Duraes
- School of Medicine, Federal University of Bahia, Salvador, Brazil
- Diretoria Médica, Roberto Santos General Hospital, Salvador, Brazil
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Roya Ebrahimi
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Andem Effiong
- Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Aziz Eftekhari
- Department of Toxicology and Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Basic Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Elham Ehsani-Chimeh
- National Institute for Health Researchers, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman El Sayed
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | | | - Maha El Tantawi
- Pediatric Dentistry and Dental Public Health, Alexandria University, Alexandria, Egypt
- Preventive Dental Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shymaa Enany
- Department of Microbiology and Immunology, Suez Canal University, Ismailia, Egypt
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Oghenowede Eyawo
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maha Ezalarab
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Mohammad Fareed
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Roghiyeh Faridnia
- Department of Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Andre Faro
- Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
| | - Ali Akbar Fazaeli
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Fazlzadeh
- Environmental Health Engineering, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, Ardabil University of Medical Science, Ardabil, Iran
| | - Netsanet Fentahun
- Department of Public Health Nutrition, Bahir Dar University, Bahir Dar, Ethiopia
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
- Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - João C Fernandes
- Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal
| | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, CA, USA
- Department of Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Florian Fischer
- Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany
| | - Nataliya A Foigt
- Institute of Gerontology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | | | - Joel Msafiri Francis
- Clinical Medicine and Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Takeshi Fukumoto
- Gene Expression & Regulation Program, Cancer Institute (W.I.A.), Philadelphia, PA, USA
- Department of Dermatology, Kobe University, Kobe, Japan
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Silvano Gallus
- Department of Environmental Health Science, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | | | | | | | - Bradford D Gessner
- Vaccines Department, Pfizer, Collegeville, PA, USA
- Agency of Preventive Medicine, Paris, France
| | - Birhanu Geta
- Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - Peter W Gething
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Reza Ghadimi
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Mahsa Ghajarzadeh
- Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ghashghaee
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
| | | | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Nick Golding
- School of BioSciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nelson G M Gomes
- Department of Chemistry, University of Porto, Porto, Portugal
- REQUIMTE/LAQV, Porto, Portugal
| | - Philimon N Gona
- Nursing and Health Sciences Department, University of Massachusetts Boston, Boston, MA, USA
| | - Sameer Vali Gopalani
- Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Federated States of Micronesia
| | - Giuseppe Gorini
- Occupational and Environmental Epidemiology Section, Cancer Prevention and Research Institute, Florence, Italy
| | | | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Health Improvement Directorate, Public Health England, London, UK
| | | | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
| | - Arvin Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arya Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Brian James Hall
- Global and Community Mental Health Research Group, University of Macau, Macao, China
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | | | - Josep Maria Haro
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain
- Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi De Llobregat, Spain
| | - Milad Hasankhani
- School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Hasanpoor
- Healthcare Management, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Amir Hasanzadeh
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Hadi Hassankhani
- School of Nursing and Midwifery Tabriz University of Medical Sciences, Tabriz, Iran
- Independent Consultant, Tabriz, Iran
| | - Hamid Yimam Hassen
- Public Health Department, Mizan-Tepi University, Teppi, Ethiopia
- Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Antwerp, Belgium
| | | | - Delia Hendrie
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Fatemeh Heydarpour
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Thomas R Hird
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Gillian Hollerich
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Naznin Hossain
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Department of Pharmacology and Therapeutics, University of Dhaka, Dhaka, Bangladesh
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hosseinzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Computer Science Department, University of Human Development, Sulaimaniyah, Iraq
| | - Mihaela Hostiuc
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Bucharest Emergency Hospital, Bucharest, Romania
| | - Sorin Hostiuc
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mowafa Househ
- Division of Information and Computing Technology, Hamad Bin Khalifa University, Doha, Qatar
- Qatar Foundation for Education, Science and Community Development, Doha, Qatar
| | - Mohamed Hsairi
- Faculty of Medicine Tunis, Medicine School of Tunis, Baab Saadoun, Tunisia
| | | | | | - Usman Iqbal
- Global Health and Development Department, Taipei Medical University, Taipei City, Taiwan
| | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Harvard University, Boston, MA, USA
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Amir Jalali
- Psychiatric Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Javidnia
- Department of Medical Mycology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Achala Upendra Jayatilleke
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ensiyeh Jenabi
- School of Midwifery, A.T. Still University, Mesa, AZ, USA
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China
| | | | - Kimberly Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Heidelberg, Germany
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jacek Jerzy Jozwiak
- Faculty of Medicine and Health Sciences, University of Opole, Opole, Poland
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amaha Kahsay
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | - Hamed Kalani
- Mazandaran University of Medical Sciences, Sari, Iran
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Manoochehr Karami
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Surendra Karki
- Research and Development, Australian Red Cross Blood Service, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amir Kasaeian
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | | | - Grant Rodgers Kemp
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Michigan State University, East Lansing, MI, USA
| | - Roghayeh Khabiri
- Tabriz Health Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
| | - Morteza Abdullatif Khafaie
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Junaid Khan
- Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University, Seoul, South Korea
- Department of Health Policy and Management, Seoul National University, Seoul, South Korea
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
- Department of Arts and Sciences, Ohio University, Zanesville, OH, USA
| | - Amir Khater
- Internal Medicine and Gastroenterology Department, National Hepatology and Tropical Research Institute, Cairo, Egypt
| | - Mona M Khater
- Department of Medical Parasitology, Cairo University, Cairo, Egypt
| | | | - Mohammad Khazaei
- Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Khazaei-Pool
- Department of Public Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Neda Kianipour
- Kermanshah University of Medical Sciences, Kermanshah, Iran
- School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yun Jin Kim
- School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
| | | | - Damaris K Kinyoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Adnan Kisa
- Department of Health Management and Health Economics, Kristiania University College, Oslo, Norway
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Sezer Kisa
- Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tufa Kolola
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ai Koyanagi
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi De Llobregat, Spain
| | - Moritz U G Kraemer
- Department of Zoology, University of Oxford, Oxford, UK
- Medical School, Harvard University, Boston, MA, USA
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India
| | - Kris J Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nuworza Kugbey
- Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
- Psychology and Health Promotion, University of Kwazulu-Natal, Durban, South Africa
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Department of Psychology, University College London, London, UK
| | | | - Desmond Kuupiel
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
- Nursing, St John of God Hospital, Duayaw Nkwanta, Ghana
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford Biomedical Research Centre, National Institute for Health Research (NIHR), Oxford, UK
| | - Sheetal D Lad
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Faris Hasan Lami
- Department of Community and Family Medicine, Academy of Medical Science, Baghdad, Iraq
| | - Anders O Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Chemistry and Pharmacology, Uppsala University Hospital, Uppsala, Sweden
| | - Paul H Lee
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Mostafa Leili
- Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Aubrey J Levine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lee-Ling Lim
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China
| | - Stefan Listl
- Department of Dentistry, Radboud University, Nijmegen, The Netherlands
- Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Joshua Longbottom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jaifred Christian F Lopez
- Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, The Philippines
- Alliance for Improving Health Outcomes, Quezon City, The Philippines
| | - Stefan Lorkowski
- Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (NUTRICARD), Jena, Germany
| | - Sameh Magdeldin
- Physiology Department, Suez Canal University, Ismailia, Egypt
- Proteomics and Metabolomics Unit, Suez Canal University, Ismailia, Egypt
| | | | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Afshin Maleki
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
- Department Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ana-Laura Manda
- Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Morteza Mansourian
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | | | - Anthony Masaka
- Faculty of Health and Education, Botho University-Botswana, Gaborone, Botswana
| | | | - Pallab K Maulik
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Research Department, The George Institute for Global Health, New Delhi, India
| | - Benjamin K Mayala
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Mazidi
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ravi Mehrotra
- Preventive Oncology Department, National Institute of Cancer Prevention and Research, Noida, India
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Walter Mendoza
- Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
| | - Ritesh G Menezes
- Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Atte Meretoja
- Neurocenter, Helsinki University Hospital, Helsinki, Finland
- School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Ted R Miller
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Pacific Institute for Research & Evaluation, Calverton, MD, USA
| | - Molly K Miller-Petrie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Edward J Mills
- Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - George J Milne
- Department of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia
| | - G K Mini
- Department of Public Health, Amrita Institute of Medical Sciences, Kochi, India
| | - Seyed Mostafa Mir
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Hamed Mirjalali
- Foodborne and Waterborne Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erkin M Mirrakhimov
- Faculty of General Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
| | - Efat Mohamadi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Dara K Mohammad
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Food Technology, College of Agriculture, Salahaddin University-Erbil, Erbil, Iraq
| | - Aso Mohammad Darwesh
- Information Technology Department, University of Human Development, Sulaimaniyah, Iraq
| | | | | | - Shafiu Mohammed
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mariam Molokhia
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Yoshan Moodley
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masoud Moradi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yousef Moradi
- Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Paula Moraga
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Abbas Mosapour
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
- Department of Clinical Biochemistry, Tarbiat Modares University, Tehran, Iran
| | - Seyyed Meysam Mousavi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ulrich Otto Mueller
- Federal Institute for Population Research, Wiesbaden, Germany
- Center for Population and Health, Wiesbaden, Germany
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Ghulam Mustafa
- Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
- Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
| | - Behnam Nabavizadeh
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Naderi
- Operating Room Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahamarshan Jayaraman Nagarajan
- Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India
- Research and Analytics, Bioinsilico Technologies, Chennai, India
| | - Azin Nahvijou
- Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Nahid Neamati
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Ionut Negoi
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Irina Negoi
- Anatomy and Embryology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Cardio-aid, Bucharest, Romania
| | | | | | - Long Hoang Nguyen
- Center for Excellence in Behavioral Health, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Son Hoang Nguyen
- Center for Excellence in Behavioral Health, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Katie R Nielsen
- Global Health Department, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Dina Nur Anggraini Ningrum
- State University of Semarang, Public Health Science Department, Kota Semarang, Indonesia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | | | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Public Health Science Department, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shirin Nosratnejad
- Department of Health Economics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
- Independent Consultant, Accra, Ghana
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Kelechi E Oladimeji
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
- Center for the Aid Program of Research in South Africa (CAPRISA) TB and HIV Pathogenesis Unit, United Nations Programme on HIV/AIDS (UNAIDS), Durban, South Africa
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Meysam Olfatifar
- Gastroenterology and Liver Disease Research Center, A.C.S. Medical College and Hospital, Tehran, Iran
| | - Solomon Olum
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
- Ghent University, Ghent, Belgium
| | | | | | - Obinna E Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria
| | - Eyal Oren
- University of Washington, Seattle, WA, USA
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - Alberto Ortiz
- School of Medicine, Autonomous University of Madrid, Madrid, Spain
- Department of Nephrology and Hypertension, The Institute for Health Research Foundation Jiménez Díaz University Hospital, Madrid, Spain
| | | | - Frank B Osei
- Faculty of Geoinformation Science and Earth Observation, University of Twente, Enschede, The Netherlands
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | | | - Stanislav S Otstavnov
- Analytical Center, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Committee for the Comprehensive Assessment of Medical Devices and Information Technology, Health Technology Assessment Association, Moscow, Russia
| | - Mayowa Ojo Owolabi
- Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Mahesh P A
- Department of Tb & Respiratory Medicine, Jagadguru Sri Shivarathreeswara University, Mysore, India
| | - Abdol Sattar Pagheh
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
| | - Hadi Parsian
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Tahereh Pashaei
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sangram Kishor Patel
- Research and Evaluation, Population Council, New Delhi, India
- Indian Institute of Health Management Research University, Jaipur, India
| | | | - Alexandre Pereira
- Department of Genetics, Harvard University, Boston, MA, USA
- Laboratory of Genetics and Molecular Cardiology, University of São Paulo, Sao Paulo, Brazil
| | - Samantha Perkins
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Brandon V Pickering
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Majid Pirestani
- Parasitology and Entomology Department, Tarbiat Modares University, Tehran, Iran
| | - Bakhtiar Piroozi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | | | - Hadi Pourjafar
- Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Parul Puri
- International Institute for Population Sciences, Mumbai, India
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hedley Quintana
- Gorgas Memorial Institute for Health Studies, Panama, Panama
| | - Mohammad Rabiee
- Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Amir Radfar
- College of Graduate Health Sciences, A.T. Still University, Mesa, AZ, USA
- Medichem, Barcelona, Spain
| | - Alireza Rafiei
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fakher Rahim
- Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zohreh Rahimi
- Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Rahimzadeh
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rajati
- Department of Health Education & Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Critical Care Quality Improvement Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Chhabi Lal Ranabhat
- Policy Research Institute, Kathmandu, Nepal
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
| | - Davide Rasella
- Institute of Public Health, Federal University of Bahia, Salvador, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Lal Rawal
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Social Science and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Riahi
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Elias Merdassa Roro
- Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Max Roser
- Martin School, University of Oxford, Oxford, UK
| | - Gholamreza Roshandel
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Daem Roshani
- Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Enrico Rubagotti
- School of Biotechnology, Ikiam Amazon Regional University, Tena, Ecuador
- Department of Ocean Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Siamak Sabour
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ehsan Sadeghi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Saeedi
- Department of Health, Safety and Environment (HSE), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yahya Safari
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Safdarian
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Nasir Salam
- Department of Pathology, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Health and Policy Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Farkhonde Salehi
- Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saleh Salehi Zahabi
- Department of Radiology and Nuclear Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Taleghani Hospital, Kermanshah, Iran
| | - Yahya Salimi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamideh Salimzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Joshua A Salomon
- Center for Health Policy & Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | | | - Bruno Piassi Sao Jose
- Post-graduate Program in Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sivan Yegnanarayana Iyer Saraswathy
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, India
- PSG-FAIMER South Asia Regional Institute, Coimbatore, India
| | - Rodrigo Sarmiento-Suárez
- Department of Health and Society, Faculty of Medicine, University of Applied and Environmental Sciences, Bogotá, Colombia
| | - Benn Sartorius
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Brijesh Sathian
- Surgery Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Alyssa N Sbarra
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lauren E Schaeffer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedmojtaba Seyedmousavi
- Center of Expertise in Microbiology, Tehran University of Medical Sciences, Tehran, Iran
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Faramarz Shaahmadi
- Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Mehran Shams-Beyranvand
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Amir Shamshirian
- Medical Laboratory Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Shamsizadeh
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mehdi Sharif
- Department of Laboratory Sciences, Karaj Islamic Azad University, Kermanshah, Iran
- Department of Basic Sciences, Karaj Islamic Azad University, Kermanshah, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Jayendra Sharma
- Policy and Planning Division, Ministry of Health, Riyadh, Saudi Arabia
| | - Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aziz Sheikh
- Division of General Internal Medicine and Primary Care, Harvard University, Boston, MA, USA
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Chloe Shields
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ivy Shiue
- Institute of Medical Epidemiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Kerem Shuval
- School of Public Health, University of Haifa, Haifa, Israel
| | - Tariq J Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - João Pedro Silva
- Applied Molecular Biosciences Unit (UCIBIO), University of Porto, Porto, Portugal
| | - Jasvinder A Singh
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dhirendra Narain Sinha
- Department of Epidemiology, School of Preventive Oncology, Patna, India
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Solomon Sisay
- Medical Division, German Leprosy and TB Relief Association Ethiopia, Addis Ababa, Ethiopia
| | - Karen Sliwa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ranjani Somayaji
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | | | - Agus Sudaryanto
- Department of Nursing, Muhammadiyah University of Surakarta, Kartasura, Indonesia
| | | | - Bryan L Sykes
- Department of Criminology, Law and Society, University of California Irvine, Irvine, CA, USA
| | - P N Sylaja
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rafael Tabarés-Seisdedos
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Karen M Tabb
- School of Social Work, University of Illinois, Urbana, IL, USA
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Nuno Taveira
- University Institute 'Egas Moniz', Monte Da Caparica, Portugal
- Research Institute for Medicines, Faculty of Pharmacy of Lisbon, University of Lisbon, Lisbon, Portugal
| | - Mohamad-Hani Temsah
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Sulieman Terkawi
- Anesthesiology Department, University of Virginia, Charlottesville, VA, USA
- Syrian Expatriate Medical Association (SEMA), Charlottesville, VA, USA
| | | | | | | | - Quyen G To
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Khanh Bao Tran
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
- Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
| | - Irfan Ullah
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
- TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
| | - Muhammad Shariq Usman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Amir Vahedian-Azimi
- Department of Education and Health, Trauma Research Center, Tehran, Iran
- Critical and Intensive Care Department, Trauma Research Center, Tehran, Iran
| | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Job F M van Boven
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Yasser Vasseghian
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Narayanaswamy Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Francesco S Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Occupational Health Unit, Sant'orsola Malpighi Hospital, Bologna, Italy
| | - Sergey Konstantinovitch Vladimirov
- Department of Information Technologies and Management, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Department of Information and Internet Technologies, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vasily Vlassov
- Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Giang Thu Vu
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | | | - Yasir Waheed
- Foundation University Medical College, Foundation University, Rawalpindi, Pakistan
| | - Jon Wakefield
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
| | - Yuan-Pang Wang
- Department of Psychiatry, University of São Paulo, Sao Paulo, Brazil
| | - Joseph L Ward
- Institute of Child Health, University College London, London, UK
| | - Robert G Weintraub
- Cardiology Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | | | - Ronny Westerman
- Competence Center of Mortality-Follow-Up, Federal Institute for Population Research, Wiesbaden, Germany
| | - Charles Shey Wiysonge
- Cochrane South Africa, Medical Research Council South Africa, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Dawit Zewdu Wondafrash
- Department of Pharmacology and Toxicology, Mekelle University, Mekelle, Ethiopia
- Department of Pharmacology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lauren Woyczynski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ai-Min Wu
- Zhejiang Spine Research Center, Wenzhou Medical University, Wenzhou, China
| | - Gelin Xu
- School of Medicine, Nanjing University, Nanjing, China
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tomohide Yamada
- Department of Diabetes and Metabolic Diseases, University of Tokyo, Tokyo, Japan
| | - Vahid Yazdi-Feyzabadi
- Department of Health Management, Policy and Economics, Kerman University of Medical Sciences, Kerman, Iran
- Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Christopher Sabo Yilgwan
- Department of Pediatrics, University of Jos, Jos, Nigeria
- Department of Pediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Paul Yip
- Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Javad Yoosefi Lebni
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Mustafa Z Younis
- Health Economics & Finance, Global Health, Jackson State University, Jackson, MS, USA
- Research Center for Public Health, Tsinghua University, Peking, China
| | - Mahmoud Yousefifard
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Hasan Yusefzadeh
- Department of Health Management and Economics, A.C.S. Medical College and Hospital, Tehran, Iran
| | - Erfan Zabeh
- Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran
- Electrical Engineering, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Telma Zahirian Moghadam
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
- Department of Community Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Alireza Zangeneh
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Taddese Alemu Zerfu
- Maternal and Child Wellbeing Unit, African Population Health Research Centre, Nairobi, Kenya
- Public Health Department, Dilla University, Dilla, Ethiopia
| | - Yunquan Zhang
- Department of Preventative Medicine, Wuhan University, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Arash Ziapour
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Sanjay Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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Chang AY, Cowling K, Micah AE, Chapin A, Chen CS, Ikilezi G, Sadat N, Tsakalos G, Wu J, Younker T, Zhao Y, Zlavog BS, Abbafati C, Ahmed AE, Alam K, Alipour V, Aljunid SM, Almalki MJ, Alvis-Guzman N, Ammar W, Andrei CL, Anjomshoa M, Antonio CAT, Arabloo J, Aremu O, Ausloos M, Avila-Burgos L, Awasthi A, Ayanore MA, Azari S, Azzopardi-Muscat N, Bagherzadeh M, Bärnighausen TW, Baune BT, Bayati M, Belay YB, Belay YA, Belete H, Berbada DA, Berman AE, Beuran M, Bijani A, Busse R, Cahuana-Hurtado L, Cámera LA, Catalá-López F, Chauhan BG, Constantin MM, Crowe CS, Cucu A, Dalal K, De Neve JW, Deiparine S, Demeke FM, Do HP, Dubey M, El Tantawi M, Eskandarieh S, Esmaeili R, Fakhar M, Fazaeli AA, Fischer F, Foigt NA, Fukumoto T, Fullman N, Galan A, Gamkrelidze A, Gezae KE, Ghajar A, Ghashghaee A, Goginashvili K, Haakenstad A, Haghparast Bidgoli H, Hamidi S, Harb HL, Hasanpoor E, Hassen HY, Hay SI, Hendrie D, Henok A, Heredia-Pi I, Herteliu C, Hoang CL, Hole MK, Homaie Rad E, Hossain N, Hosseinzadeh M, Hostiuc S, Ilesanmi OS, Irvani SSN, Jakovljevic M, Jalali A, James SL, Jonas JB, Jürisson M, Kadel R, Karami Matin B, Kasaeian A, Kasaye HK, Kassaw MW, Kazemi Karyani A, Khabiri R, Khan J, Khan MN, Khang YH, Kisa A, Kissimova-Skarbek K, Kohler S, Koyanagi A, Krohn KJ, Leung R, Lim LL, Lorkowski S, Majeed A, Malekzadeh R, Mansourian M, Mantovani LG, Massenburg BB, McKee M, Mehta V, Meretoja A, Meretoja TJ, Milevska Kostova N, Miller TR, Mirrakhimov EM, Mohajer B, Mohammad Darwesh A, Mohammed S, Mohebi F, Mokdad AH, Morrison SD, Mousavi SM, Muthupandian S, Nagarajan AJ, Nangia V, Negoi I, Nguyen CT, Nguyen HLT, Nguyen SH, Nosratnejad S, Oladimeji O, Olgiati S, Olusanya JO, Onwujekwe OE, Otstavnov SS, Pana A, Pereira DM, Piroozi B, Prada SI, Qorbani M, Rabiee M, Rabiee N, Rafiei A, Rahim F, Rahimi-Movaghar V, Ram U, Ranabhat CL, Ranta A, Rawaf DL, Rawaf S, Rezaei S, Roro EM, Rostami A, Rubino S, Salahshoor M, Samy AM, Sanabria J, Santos JV, Santric Milicevic MM, Sao Jose BP, Savic M, Schwendicke F, Sepanlou SG, Sepehrimanesh M, Sheikh A, Shrime MG, Sisay S, Soltani S, Soofi M, Soofi M, Srinivasan V, Tabarés-Seisdedos R, Torre A, Tovani-Palone MR, Tran BX, Tran KB, Undurraga EA, Valdez PR, van Boven JFM, Vargas V, Veisani Y, Violante FS, Vladimirov SK, Vlassov V, Vollmer S, Vu GT, Wolfe CDA, Yonemoto N, Younis MZ, Yousefifard M, Zaman SB, Zangeneh A, Zegeye EA, Ziapour A, Chew A, Murray CJL, Dieleman JL. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet 2019; 393:2233-2260. [PMID: 31030984 PMCID: PMC6548764 DOI: 10.1016/s0140-6736(19)30841-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING Bill & Melinda Gates Foundation.
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Sadat N, Torregroza C, Scheiber D, Gomez C, Westenfeld R, von der Beek J, Knorr I, Akhyari P, Sager M, Lichtenberg A, Saeed D. Reproducible Model for Chronic Stable Heart Failure in Ovine Species. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.614] [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: 11/28/2022] Open
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Gomez C, Torregroza C, Sadat N, Scheiber D, von der Beek J, Westenfeld R, Knorr J, Akhyari P, Sager M, Lichtenberg A, Saeed D. Does Severe Tricuspid Valve Insufficiency Impact the Performance of the left Ventricular Assist Devices? Acute Animal Studies. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C. Gomez
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - C. Torregroza
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - N. Sadat
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - D. Scheiber
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - J. von der Beek
- Department of Animal Research and Animal Protection Task, Heinrich Heine University, Düsseldorf, Germany
| | - R. Westenfeld
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - J. Knorr
- Department of Animal Research and Animal Protection Task, Heinrich Heine University, Düsseldorf, Germany
| | - P. Akhyari
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - M. Sager
- Department of Animal Research and Animal Protection Task, Heinrich Heine University, Düsseldorf, Germany
| | - A. Lichtenberg
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - D. Saeed
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Moses MW, Pedroza P, Baral R, Bloom S, Brown J, Chapin A, Compton K, Eldrenkamp E, Fullman N, Mumford JE, Nandakumar V, Rosettie K, Sadat N, Shonka T, Flaxman A, Vos T, Murray CJL, Weaver MR. Funding and services needed to achieve universal health coverage: applications of global, regional, and national estimates of utilisation of outpatient visits and inpatient admissions from 1990 to 2016, and unit costs from 1995 to 2016. Lancet Public Health 2018; 4:e49-e73. [PMID: 30551974 PMCID: PMC6323358 DOI: 10.1016/s2468-2667(18)30213-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/18/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND To inform plans to achieve universal health coverage (UHC), we estimated utilisation and unit cost of outpatient visits and inpatient admissions, did a decomposition analysis of utilisation, and estimated additional services and funds needed to meet a UHC standard for utilisation. METHODS We collated 1175 country-years of outpatient data on utilisation from 130 countries and 2068 country-years of inpatient data from 128 countries. We did meta-regression analyses of annual visits and admissions per capita by sex, age, location, and year with DisMod-MR, a Bayesian meta-regression tool. We decomposed changes in total number of services from 1990 to 2016. We used data from 795 National Health Accounts to estimate shares of outpatient and inpatient services in total health expenditure by location and year and estimated unit costs as expenditure divided by utilisation. We identified standards of utilisation per disability-adjusted life-year and estimated additional services and funds needed. FINDINGS In 2016, the global age-standardised outpatient utilisation rate was 5·42 visits (95% uncertainty interval [UI] 4·88-5·99) per capita and the inpatient utilisation rate was 0·10 admissions (0·09-0·11) per capita. Globally, 39·35 billion (95% UI 35·38-43·58) visits and 0·71 billion (0·65-0·77) admissions were provided in 2016. Of the 58·65% increase in visits since 1990, population growth accounted for 42·95%, population ageing for 8·09%, and higher utilisation rates for 7·63%; results for the 67·96% increase in admissions were 44·33% from population growth, 9·99% from population ageing, and 13·55% from increases in utilisation rates. 2016 unit cost estimates (in 2017 international dollars [I$]) ranged from I$2 to I$478 for visits and from I$87 to I$22 543 for admissions. The annual cost of 8·20 billion (6·24-9·95) additional visits and 0·28 billion (0·25-0·30) admissions in low-income and lower-middle income countries in 2016 was I$503·12 billion (404·35-605·98) or US$158·10 billion (126·58-189·67). INTERPRETATION UHC plans can be based on utilisation and unit costs of current health systems and guided by standards of utilisation of outpatient visits and inpatient admissions that achieve the highest coverage of personal health services at the lowest cost. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Mark W Moses
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Paola Pedroza
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Sabina Bloom
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jonathan Brown
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Abby Chapin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly Compton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erika Eldrenkamp
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - John Everett Mumford
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vishnu Nandakumar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Katherine Rosettie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tom Shonka
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chris J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marcia R Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Ackerman IN, Adamu AA, Adebayo OM, Adekanmbi V, Adetokunboh OO, Adib MG, Adsuar JC, Afanvi KA, Afarideh M, Afshin A, Agarwal G, Agesa KM, Aggarwal R, Aghayan SA, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemiju T, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Mekhlafi HM, Al-Raddadi RM, Alahdab F, Alam K, Alam T, Alashi A, Alavian SM, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alouani MML, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Antonio CAT, Anwari P, Arabloo J, Arauz A, Aremu O, Ariani F, Armoon B, Ärnlöv J, Arora A, Artaman A, Aryal KK, Asayesh H, Asghar RJ, Ataro Z, Atre SR, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayer R, Azzopardi PS, Babazadeh A, Badali H, Badawi A, Bali AG, Ballesteros KE, Ballew SH, Banach M, Banoub JAM, Banstola A, Barac A, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Belachew AB, Belay YA, Bell ML, Bello AK, Bensenor IM, Bernabe E, Bernstein RS, Beuran M, Beyranvand T, Bhala N, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Blacker BF, Blyth FM, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brainin M, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko AN, Britton G, Brugha T, Buchbinder R, Busse R, Butt ZA, Cahuana-Hurtado L, Cano J, Cárdenas R, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Cercy KM, Cerin E, Chaiah Y, Chang AR, Chang HY, Chang JC, Charlson FJ, Chattopadhyay A, Chattu VK, Chaturvedi P, Chiang PPC, Chin KL, Chitheer A, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Collado-Mateo D, Cooper C, Coresh J, Cortesi PA, Cortinovis M, Costa M, Cousin E, Criqui MH, Cromwell EA, Cross M, Crump JA, Dadi AF, Dandona L, Dandona R, Dargan PI, Daryani A, Das Gupta R, Das Neves J, Dasa TT, Davey G, Davis AC, Davitoiu DV, De Courten B, De La Hoz FP, De Leo D, De Neve JW, Degefa MG, Degenhardt L, Deiparine S, Dellavalle RP, Demoz GT, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dinberu MT, Dirac MA, Djalalinia S, Doan L, Dokova K, Doku DT, Dorsey ER, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Echko MM, Edvardsson D, Effiong A, Ehrlich JR, El Bcheraoui C, El Sayed Zaki M, El-Khatib Z, Elkout H, Elyazar IRF, Enayati A, Endries AY, Er B, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Esteghamati S, Fakhim H, Fallah Omrani V, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrari AJ, Feyissa GT, Filip I, Fischer F, Fitzmaurice C, Foigt NA, Foreman KJ, Fox J, Frank TD, Fukumoto T, Fullman N, Fürst T, Furtado JM, Futran ND, Gall S, Ganji M, Gankpe FG, Garcia-Basteiro AL, Gardner WM, Gebre AK, Gebremedhin AT, Gebremichael TG, Gelano TF, Geleijnse JM, Genova-Maleras R, Geramo YCD, Gething PW, Gezae KE, Ghadiri K, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Ghosh R, Ghoshal AG, Giampaoli S, Gill PS, Gill TK, Ginawi IA, Giussani G, Gnedovskaya EV, Goldberg EM, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Gorman TM, Goulart AC, Goulart BNG, Grada A, Grams ME, Grosso G, Gugnani HC, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Haghparast Bidgoli H, Hagos TB, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hawley CN, Hay RJ, Hay SI, Hedayatizadeh-Omran A, Heibati B, Hendrie D, Henok A, Herteliu C, Heydarpour S, Hibstu DT, Hoang HT, Hoek HW, Hoffman HJ, Hole MK, Homaie Rad E, Hoogar P, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huynh CK, Iburg KM, Ikeda CT, Ileanu B, Ilesanmi OS, Iqbal U, Irvani SSN, Irvine CMS, Islam SMS, Islami F, Jacobsen KH, Jahangiry L, Jahanmehr N, Jain SK, Jakovljevic M, Javanbakht M, Jayatilleke AU, Jeemon P, Jha RP, Jha V, Ji JS, Johnson CO, Jonas JB, Jozwiak JJ, Jungari SB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Kanchan T, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kawakami N, Karyani AK, Keighobadi MM, Keiyoro PN, Kemmer L, Kemp GR, Kengne AP, Keren A, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan MS, Khan MA, Khang YH, Khazaei M, Khoja AT, Khosravi A, Khosravi MH, Kiadaliri AA, Kiirithio DN, Kim CI, Kim D, Kim P, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knudsen AKS, Kocarnik JM, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kyu HH, Lad DP, Lad SD, Lafranconi A, Lalloo R, Lallukka T, Lami FH, Lansingh VC, Latifi A, Lau KMM, Lazarus JV, Leasher JL, Ledesma JR, Lee PH, Leigh J, Leung J, Levi M, Lewycka S, Li S, Li Y, Liao Y, Liben ML, Lim LL, Lim SS, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Lucchesi LR, Lunevicius R, Lyons RA, Ma S, Macarayan ERK, Mackay MT, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Mahotra NB, Mai HT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Manhertz T, Mansournia MA, Mantovani LG, Mapoma CC, Maravilla JC, Marcenes W, Marks A, Martins-Melo FR, Martopullo I, März W, Marzan MB, Mashamba-Thompson TP, Massenburg BB, Mathur MR, Matsushita K, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mejia-Rodriguez F, Mekonen T, Melese A, Melku M, Meltzer M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezerji NMG, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miltz B, Mini GK, Mirarefin M, Mirrakhimov EM, Misganaw AT, Mitchell PB, Mitiku H, Moazen B, Mohajer B, Mohammad KA, Mohammadifard N, Mohammadnia-Afrouzi M, Mohammed MA, Mohammed S, Mohebi F, Moitra M, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-Da-Costa J, Morrison SD, Moschos MM, Mountjoy-Venning WC, Mousavi SM, Mruts KB, Muche AA, Muchie KF, Mueller UO, Muhammed OS, Mukhopadhyay S, Muller K, Mumford JE, Murhekar M, Musa J, Musa KI, Mustafa G, Nabhan AF, Nagata C, Naghavi M, Naheed A, Nahvijou A, Naik G, Naik N, Najafi F, Naldi L, Nam HS, Nangia V, Nansseu JR, Nascimento BR, Natarajan G, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngunjiri JW, Nguyen AQ, Nguyen HT, Nguyen HLT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen NB, Nguyen SH, Nichols E, Ningrum DNA, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Ong KL, Ong SK, Oren E, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, P A M, Pacella R, Pakpour AH, Pana A, Panda-Jonas S, Parisi A, Park EK, Parry CDH, Patel S, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paulson KR, Pearce N, Pereira DM, Perico N, Pesudovs K, Pham HQ, Phillips MR, Pigott DM, Pillay JD, Piradov MA, Pirsaheb M, Pishgar F, Plana-Ripoll O, Plass D, Polinder S, Popova S, Postma MJ, Pourshams A, Poustchi H, Prabhakaran D, Prakash S, Prakash V, Purcell CA, Purwar MB, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman MA, Rahman SU, Rai RK, Rajati F, Ram U, Ranjan P, Ranta A, Rao PC, Rawaf DL, Rawaf S, Reddy KS, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro ALP, Roberts NLS, Robinson SR, Roever L, Ronfani L, Roshandel G, Rostami A, Roth GA, Roy A, Rubagotti E, Sachdev PS, Sadat N, Saddik B, Sadeghi E, Saeedi Moghaddam S, Safari H, Safari Y, Safari-Faramani R, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salam N, Salama JS, Salamati P, Saleem K, Saleem Z, Salimi Y, Salomon JA, Salvi SS, Salz I, Samy AM, Sanabria J, Sang Y, Santomauro DF, 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Stanaway JD, Stein DJ, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Subart ML, Sudaryanto A, Sufiyan MB, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse BT, Tandon N, Tassew SG, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekalign TG, Tekelemedhin SW, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Teweldemedhin M, Thankappan KR, Thomas N, Tilahun B, To QG, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Troeger CE, Truelsen TC, Tsilimbaris MK, Tsoi D, Tudor Car L, Tuzcu EM, Ukwaja KN, Ullah I, Undurraga EA, Unutzer J, Updike RL, Usman MS, Uthman OA, Vaduganathan M, Vaezi A, Valdez PR, Varughese S, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vosoughi K, Vujcic IS, Wagnew FS, Waheed Y, Waller SG, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weiss DJ, Weldegebreal F, Weldegwergs KG, Werdecker A, West TE, Whiteford HA, Widecka J, Wijeratne T, Wilner LB, Wilson S, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Woolf AD, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang K, Zhao Z, Zhou M, Zodpey S, Zucker I, Vos T, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-1858. [PMID: 30496104 PMCID: PMC6227754 DOI: 10.1016/s0140-6736(18)32279-7] [Citation(s) in RCA: 7041] [Impact Index Per Article: 1173.5] [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: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING Bill & Melinda Gates Foundation.
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Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, Pletcher MA, Smith AE, Tang K, Yuan CW, Brown JC, Friedman J, He J, Heuton KR, Holmberg M, Patel DJ, Reidy P, Carter A, Cercy K, Chapin A, Douwes-Schultz D, Frank T, Goettsch F, Liu PY, Nandakumar V, Reitsma MB, Reuter V, Sadat N, Sorensen RJD, Srinivasan V, Updike RL, York H, Lopez AD, Lozano R, Lim SS, Mokdad AH, Vollset SE, Murray CJL. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet 2018; 392:2052-2090. [PMID: 30340847 PMCID: PMC6227505 DOI: 10.1016/s0140-6736(18)31694-5] [Citation(s) in RCA: 1063] [Impact Index Per Article: 177.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/29/2018] [Accepted: 07/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Understanding potential trajectories in health and drivers of health is crucial to guiding long-term investments and policy implementation. Past work on forecasting has provided an incomplete landscape of future health scenarios, highlighting a need for a more robust modelling platform from which policy options and potential health trajectories can be assessed. This study provides a novel approach to modelling life expectancy, all-cause mortality and cause of death forecasts -and alternative future scenarios-for 250 causes of death from 2016 to 2040 in 195 countries and territories. METHODS We modelled 250 causes and cause groups organised by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) hierarchical cause structure, using GBD 2016 estimates from 1990-2016, to generate predictions for 2017-40. Our modelling framework used data from the GBD 2016 study to systematically account for the relationships between risk factors and health outcomes for 79 independent drivers of health. We developed a three-component model of cause-specific mortality: a component due to changes in risk factors and select interventions; the underlying mortality rate for each cause that is a function of income per capita, educational attainment, and total fertility rate under 25 years and time; and an autoregressive integrated moving average model for unexplained changes correlated with time. We assessed the performance by fitting models with data from 1990-2006 and using these to forecast for 2007-16. Our final model used for generating forecasts and alternative scenarios was fitted to data from 1990-2016. We used this model for 195 countries and territories to generate a reference scenario or forecast through 2040 for each measure by location. Additionally, we generated better health and worse health scenarios based on the 85th and 15th percentiles, respectively, of annualised rates of change across location-years for all the GBD risk factors, income per person, educational attainment, select intervention coverage, and total fertility rate under 25 years in the past. We used the model to generate all-cause age-sex specific mortality, life expectancy, and years of life lost (YLLs) for 250 causes. Scenarios for fertility were also generated and used in a cohort component model to generate population scenarios. For each reference forecast, better health, and worse health scenarios, we generated estimates of mortality and YLLs attributable to each risk factor in the future. FINDINGS Globally, most independent drivers of health were forecast to improve by 2040, but 36 were forecast to worsen. As shown by the better health scenarios, greater progress might be possible, yet for some drivers such as high body-mass index (BMI), their toll will rise in the absence of intervention. We forecasted global life expectancy to increase by 4·4 years (95% UI 2·2 to 6·4) for men and 4·4 years (2·1 to 6·4) for women by 2040, but based on better and worse health scenarios, trajectories could range from a gain of 7·8 years (5·9 to 9·8) to a non-significant loss of 0·4 years (-2·8 to 2·2) for men, and an increase of 7·2 years (5·3 to 9·1) to essentially no change (0·1 years [-2·7 to 2·5]) for women. In 2040, Japan, Singapore, Spain, and Switzerland had a forecasted life expectancy exceeding 85 years for both sexes, and 59 countries including China were projected to surpass a life expectancy of 80 years by 2040. At the same time, Central African Republic, Lesotho, Somalia, and Zimbabwe had projected life expectancies below 65 years in 2040, indicating global disparities in survival are likely to persist if current trends hold. Forecasted YLLs showed a rising toll from several non-communicable diseases (NCDs), partly driven by population growth and ageing. Differences between the reference forecast and alternative scenarios were most striking for HIV/AIDS, for which a potential increase of 120·2% (95% UI 67·2-190·3) in YLLs (nearly 118 million) was projected globally from 2016-40 under the worse health scenario. Compared with 2016, NCDs were forecast to account for a greater proportion of YLLs in all GBD regions by 2040 (67·3% of YLLs [95% UI 61·9-72·3] globally); nonetheless, in many lower-income countries, communicable, maternal, neonatal, and nutritional (CMNN) diseases still accounted for a large share of YLLs in 2040 (eg, 53·5% of YLLs [95% UI 48·3-58·5] in Sub-Saharan Africa). There were large gaps for many health risks between the reference forecast and better health scenario for attributable YLLs. In most countries, metabolic risks amenable to health care (eg, high blood pressure and high plasma fasting glucose) and risks best targeted by population-level or intersectoral interventions (eg, tobacco, high BMI, and ambient particulate matter pollution) had some of the largest differences between reference and better health scenarios. The main exception was sub-Saharan Africa, where many risks associated with poverty and lower levels of development (eg, unsafe water and sanitation, household air pollution, and child malnutrition) were projected to still account for substantive disparities between reference and better health scenarios in 2040. INTERPRETATION With the present study, we provide a robust, flexible forecasting platform from which reference forecasts and alternative health scenarios can be explored in relation to a wide range of independent drivers of health. Our reference forecast points to overall improvements through 2040 in most countries, yet the range found across better and worse health scenarios renders a precarious vision of the future-a world with accelerating progress from technical innovation but with the potential for worsening health outcomes in the absence of deliberate policy action. For some causes of YLLs, large differences between the reference forecast and alternative scenarios reflect the opportunity to accelerate gains if countries move their trajectories toward better health scenarios-or alarming challenges if countries fall behind their reference forecasts. Generally, decision makers should plan for the likely continued shift toward NCDs and target resources toward the modifiable risks that drive substantial premature mortality. If such modifiable risks are prioritised today, there is opportunity to reduce avoidable mortality in the future. However, CMNN causes and related risks will remain the predominant health priority among lower-income countries. Based on our 2040 worse health scenario, there is a real risk of HIV mortality rebounding if countries lose momentum against the HIV epidemic, jeopardising decades of progress against the disease. Continued technical innovation and increased health spending, including development assistance for health targeted to the world's poorest people, are likely to remain vital components to charting a future where all populations can live full, healthy lives. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kyle J Foreman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Neal Marquez
- Department of Sociology, University of Washington, Seattle, WA, USA
| | - Andrew Dolgert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kai Fukutaki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Madeline McGaughey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Martin A Pletcher
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amanda E Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kendrick Tang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chun-Wei Yuan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jonathan C Brown
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joseph Friedman
- School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Mollie Holmberg
- Department of Geography, University of British Columbia, Vancouver, BC, Canada
| | - Disha J Patel
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly Cercy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Abigail Chapin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dirk Douwes-Schultz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tahvi Frank
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Falko Goettsch
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Patrick Y Liu
- School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vishnu Nandakumar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marissa B Reitsma
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vince Reuter
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vinay Srinivasan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Rachel L Updike
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Hunter York
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; National Institute of Public Health, Cuernavaca, Mexico
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Stein Emil Vollset
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Ackerman IN, Adamu AA, Adebayo OM, Adekanmbi V, Adetokunboh OO, Adib MG, Adsuar JC, Afanvi KA, Afarideh M, Afshin A, Agarwal G, Agesa KM, Aggarwal R, Aghayan SA, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemiju T, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Mekhlafi HM, Al-Raddadi RM, Alahdab F, Alam K, Alam T, Alashi A, Alavian SM, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alouani MML, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Antonio CAT, Anwari P, Arabloo J, Arauz A, Aremu O, Ariani F, Armoon B, Ärnlöv J, Arora A, Artaman A, Aryal KK, Asayesh H, Asghar RJ, Ataro Z, Atre SR, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayer R, Azzopardi PS, Babazadeh A, Badali H, Badawi A, Bali AG, Ballesteros KE, Ballew SH, Banach M, Banoub JAM, Banstola A, Barac A, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Belachew AB, Belay YA, Bell ML, Bello AK, Bensenor IM, Bernabe E, Bernstein RS, Beuran M, Beyranvand T, Bhala N, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Blacker BF, Blyth FM, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brainin M, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko AN, Britton G, Brugha T, Buchbinder R, Busse R, Butt ZA, Cahuana-Hurtado L, Cano J, Cárdenas R, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Cercy KM, Cerin E, Chaiah Y, Chang AR, Chang HY, Chang JC, Charlson FJ, Chattopadhyay A, Chattu VK, Chaturvedi P, Chiang PPC, Chin KL, Chitheer A, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Collado-Mateo D, Cooper C, Coresh J, Cortesi PA, Cortinovis M, Costa M, Cousin E, Criqui MH, Cromwell EA, Cross M, Crump JA, Dadi AF, Dandona L, Dandona R, Dargan PI, Daryani A, Das Gupta R, Das Neves J, Dasa TT, Davey G, Davis AC, Davitoiu DV, De Courten B, De La Hoz FP, De Leo D, De Neve JW, Degefa MG, Degenhardt L, Deiparine S, Dellavalle RP, Demoz GT, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dinberu MT, Dirac MA, Djalalinia S, Doan L, Dokova K, Doku DT, Dorsey ER, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Echko MM, Edvardsson D, Effiong A, Ehrlich JR, El Bcheraoui C, El Sayed Zaki M, El-Khatib Z, Elkout H, Elyazar IRF, Enayati A, Endries AY, Er B, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Esteghamati S, Fakhim H, Fallah Omrani V, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrari AJ, Feyissa GT, Filip I, Fischer F, Fitzmaurice C, Foigt NA, Foreman KJ, Fox J, Frank TD, Fukumoto T, Fullman N, Fürst T, Furtado JM, Futran ND, Gall S, Ganji M, Gankpe FG, Garcia-Basteiro AL, Gardner WM, Gebre AK, Gebremedhin AT, Gebremichael TG, Gelano TF, Geleijnse JM, Genova-Maleras R, Geramo YCD, Gething PW, Gezae KE, Ghadiri K, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Ghosh R, Ghoshal AG, Giampaoli S, Gill PS, Gill TK, Ginawi IA, Giussani G, Gnedovskaya EV, Goldberg EM, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Gorman TM, Goulart AC, Goulart BNG, Grada A, Grams ME, Grosso G, Gugnani HC, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Haghparast Bidgoli H, Hagos TB, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hawley CN, Hay RJ, Hay SI, Hedayatizadeh-Omran A, Heibati B, Hendrie D, Henok A, Herteliu C, Heydarpour S, Hibstu DT, Hoang HT, Hoek HW, Hoffman HJ, Hole MK, Homaie Rad E, Hoogar P, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huynh CK, Iburg KM, Ikeda CT, Ileanu B, Ilesanmi OS, Iqbal U, Irvani SSN, Irvine CMS, Islam SMS, Islami F, Jacobsen KH, Jahangiry L, Jahanmehr N, Jain SK, Jakovljevic M, Javanbakht M, Jayatilleke AU, Jeemon P, Jha RP, Jha V, Ji JS, Johnson CO, Jonas JB, Jozwiak JJ, Jungari SB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Kanchan T, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kawakami N, Karyani AK, Keighobadi MM, Keiyoro PN, Kemmer L, Kemp GR, Kengne AP, Keren A, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan MS, Khan MA, Khang YH, Khazaei M, Khoja AT, Khosravi A, Khosravi MH, Kiadaliri AA, Kiirithio DN, Kim CI, Kim D, Kim P, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knudsen AKS, Kocarnik JM, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kyu HH, Lad DP, Lad SD, Lafranconi A, Lalloo R, Lallukka T, Lami FH, Lansingh VC, Latifi A, Lau KMM, Lazarus JV, Leasher JL, Ledesma JR, Lee PH, Leigh J, Leung J, Levi M, Lewycka S, Li S, Li Y, Liao Y, Liben ML, Lim LL, Lim SS, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Lucchesi LR, Lunevicius R, Lyons RA, Ma S, Macarayan ERK, Mackay MT, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Mahotra NB, Mai HT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Manhertz T, Mansournia MA, Mantovani LG, Mapoma CC, Maravilla JC, Marcenes W, Marks A, Martins-Melo FR, Martopullo I, März W, Marzan MB, Mashamba-Thompson TP, Massenburg BB, Mathur MR, Matsushita K, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mejia-Rodriguez F, Mekonen T, Melese A, Melku M, Meltzer M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezerji NMG, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miltz B, Mini GK, Mirarefin M, Mirrakhimov EM, Misganaw AT, Mitchell PB, Mitiku H, Moazen B, Mohajer B, Mohammad KA, Mohammadifard N, Mohammadnia-Afrouzi M, Mohammed MA, Mohammed S, Mohebi F, Moitra M, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-Da-Costa J, Morrison SD, Moschos MM, Mountjoy-Venning WC, Mousavi SM, Mruts KB, Muche AA, Muchie KF, Mueller UO, Muhammed OS, Mukhopadhyay S, Muller K, Mumford JE, Murhekar M, Musa J, Musa KI, Mustafa G, Nabhan AF, Nagata C, Naghavi M, Naheed A, Nahvijou A, Naik G, Naik N, Najafi F, Naldi L, Nam HS, Nangia V, Nansseu JR, Nascimento BR, Natarajan G, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngunjiri JW, Nguyen AQ, Nguyen HT, Nguyen HLT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen NB, Nguyen SH, Nichols E, Ningrum DNA, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Ong KL, Ong SK, Oren E, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, P A M, Pacella R, Pakpour AH, Pana A, Panda-Jonas S, Parisi A, Park EK, Parry CDH, Patel S, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paulson KR, Pearce N, Pereira DM, Perico N, Pesudovs K, Pham HQ, Phillips MR, Pigott DM, Pillay JD, Piradov MA, Pirsaheb M, Pishgar F, Plana-Ripoll O, Plass D, Polinder S, Popova S, Postma MJ, Pourshams A, Poustchi H, Prabhakaran D, Prakash S, Prakash V, Purcell CA, Purwar MB, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman MA, Rahman SU, Rai RK, Rajati F, Ram U, Ranjan P, Ranta A, Rao PC, Rawaf DL, Rawaf S, Reddy KS, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro ALP, Roberts NLS, Robinson SR, Roever L, Ronfani L, Roshandel G, Rostami A, Roth GA, Roy A, Rubagotti E, Sachdev PS, Sadat N, Saddik B, Sadeghi E, Saeedi Moghaddam S, Safari H, Safari Y, Safari-Faramani R, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salam N, Salama JS, Salamati P, Saleem K, Saleem Z, Salimi Y, Salomon JA, Salvi SS, Salz I, Samy AM, Sanabria J, Sang Y, Santomauro DF, Santos IS, Santos JV, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Saylan M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma M, Sharma R, She J, Sheikh A, Shi P, Shibuya K, Shigematsu M, Shiri R, Shirkoohi R, Shishani K, Shiue I, Shokraneh F, Shoman H, Shrime MG, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silveira DGA, Singam NSV, Singh JA, Singh NP, Singh V, Sinha DN, Skiadaresi E, Slepak ELN, Sliwa K, Smith DL, Smith M, Soares Filho AM, Sobaih BH, Sobhani S, Sobngwi E, Soneji SS, Soofi M, Soosaraei M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein DJ, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Subart ML, Sudaryanto A, Sufiyan MB, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse BT, Tandon N, Tassew SG, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekalign TG, Tekelemedhin SW, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Teweldemedhin M, Thankappan KR, Thomas N, Tilahun B, To QG, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Troeger CE, Truelsen TC, Tsilimbaris MK, Tsoi D, Tudor Car L, Tuzcu EM, Ukwaja KN, Ullah I, Undurraga EA, Unutzer J, Updike RL, Usman MS, Uthman OA, Vaduganathan M, Vaezi A, Valdez PR, Varughese S, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vosoughi K, Vujcic IS, Wagnew FS, Waheed Y, Waller SG, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weiss DJ, Weldegebreal F, Weldegwergs KG, Werdecker A, West TE, Whiteford HA, Widecka J, Wijeratne T, Wilner LB, Wilson S, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Woolf AD, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang K, Zhao Z, Zhou M, Zodpey S, Zucker I, Vos T, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-1858. [PMID: 30496104 PMCID: PMC6227754 DOI: 10.1016/s0140-6736(18)32279-7#] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 08/12/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING Bill & Melinda Gates Foundation.
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Fullman N, Yearwood J, Abay SM, Abbafati C, Abd-Allah F, Abdela J, Abdelalim A, Abebe Z, Abebo TA, Aboyans V, Abraha HN, Abreu DMX, Abu-Raddad LJ, Adane AA, Adedoyin RA, Adetokunboh O, Adhikari TB, Afarideh M, Afshin A, Agarwal G, Agius D, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Aichour MTE, Akibu M, Akinyemi RO, Akinyemiju TF, Akseer N, Al Lami FH, Alahdab F, Al-Aly Z, Alam K, Alam T, Alasfoor D, Albittar MI, Alene KA, Al-Eyadhy A, Ali SD, Alijanzadeh M, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen C, Alomari MA, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amenu K, Ammar W, Amoako YA, Anber N, Andrei CL, Androudi S, Antonio CAT, Araújo VEM, Aremu O, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asfaw ET, Asgedom SW, Asghar RJ, Ashebir MM, Asseffa NA, Atey TM, Atre SR, Atteraya MS, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayalew AA, Ayele HT, Ayer R, Ayuk TB, Azzopardi P, Azzopardi-Muscat N, Babalola TK, Badali H, Badawi A, Banach M, Banerjee A, Banstola A, Barber RM, Barboza MA, Barker-Collo SL, Bärnighausen T, Barquera S, Barrero LH, Bassat Q, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Bekele BB, Belachew AB, Belay SA, Belay YA, Bell ML, Bello AK, Bennett DA, Bennett JR, Bensenor IM, Berhe DF, Bernabé E, Bernstein RS, Beuran M, Bhalla A, Bhatt P, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Birungi C, Biryukov S, Bizuneh H, Bolliger IW, Bolt K, Bou-Orm IR, Bozorgmehr K, Brady OJ, Brazinova A, Breitborde NJK, Brenner H, Britton G, Brugha TS, Butt ZA, Cahuana-Hurtado L, Campos-Nonato IR, Campuzano JC, Car J, Car M, Cárdenas R, Carrero JJ, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Catalá-López F, Cercy K, Chalek J, Chang HY, Chang JC, Chattopadhyay A, Chaturvedi P, Chiang PPC, Chisumpa VH, Choi JYJ, Christensen H, Christopher DJ, Chung SC, Ciobanu LG, Cirillo M, Colombara D, Conti S, Cooper C, Cornaby L, Cortesi PA, Cortinovis M, Costa Pereira A, Cousin E, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Daba AK, Dachew BA, Dadi AF, Dandona L, Dandona R, Dargan PI, Daryani A, Daryani M, Das J, Das SK, das Neves J, Davis Weaver N, Davletov K, de Courten B, De Leo D, De Neve JW, Dellavalle RP, Demoz G, Deribe K, Des Jarlais DC, Dey S, Dharmaratne SD, Dhimal M, Djalalinia S, Doku DT, Dolan K, Dorsey ER, dos Santos KPB, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duncan BB, Echko M, Edessa D, Edvardsson D, Ehrlich JR, Eldrenkamp E, El-Khatib ZZ, Endres M, Endries AY, Eshrati B, Eskandarieh S, Esteghamati A, Fakhar M, Farag T, Faramarzi M, Faraon EJA, Faro A, Farzadfar F, Fatusi A, Fazeli MS, Feigin VL, Feigl AB, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Fijabi DO, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Flor LS, Foigt N, Foreman KJ, Frostad JJ, Fürst T, Futran ND, Gakidou E, Gallus S, Gambashidze K, Gamkrelidze A, Ganji M, Gebre AK, Gebrehiwot TT, Gebremedhin AT, Gelaw YA, Geleijnse JM, Geremew D, Gething PW, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Gill PS, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin WW, Goli S, Gomez-Dantes H, Gona PN, Goodridge A, Gopalani SV, Goryakin Y, Goulart AC, Grada A, Griswold M, Grosso G, Gugnani HC, Guo Y, Gupta R, Gupta R, Gupta T, Gupta T, Gupta V, Haagsma JA, Hachinski V, Hafezi-Nejad N, Hailu GB, Hamadeh RR, Hamidi S, Hankey GJ, Harb HL, Harewood HC, Harikrishnan S, Haro JM, Hassen HY, Havmoeller R, Hawley C, Hay SI, He J, Hearps SJC, Hegazy MI, Heibati B, Heidari M, Hendrie D, Henry NJ, Herrera Ballesteros VH, Herteliu C, Hibstu DT, Hiluf MK, Hoek HW, Homaie Rad E, Horita N, Hosgood HD, Hosseini M, Hosseini SR, Hostiuc M, Hostiuc S, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Iburg KM, Idris F, Igumbor EU, Ikeda C, Ileanu BV, Ilesanmi OS, Innos K, Irvani SSN, Irvine CMS, Islami F, Jacobs TA, Jacobsen KH, Jahanmehr N, Jain R, Jain SK, Jakovljevic MB, Jalu MT, Jamal AA, Javanbakht M, Jayatilleke AU, Jeemon P, Jha RP, Jha V, Jóúwiak J, John O, Johnson SC, Jonas JB, Joshua V, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Kar C, Karanikolos M, Karch A, Karema CK, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kaul A, Kawakami N, Kazanjan K, Kebede S, Keiyoro PN, Kemp GR, Kengne AP, Kereselidze M, Ketema EB, Khader YS, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan G, Khan MN, Khan MA, Khanal MN, Khang YH, Khater MM, Khoja ATA, Khosravi A, Khubchandani J, Kibret GD, Kiirithio DN, Kim D, Kim YJ, Kimokoti RW, Kinfu Y, Kinra S, Kisa A, Kissoon N, Kochhar S, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishan K, Krohn KJ, Kuate Defo B, Kumar GA, Kumar P, Kutz M, Kuzin I, Kyu HH, Lad DP, Lafranconi A, Lal DK, Lalloo R, Lam H, Lan Q, Lang JJ, Lansingh VC, Lansky S, Larsson A, Latifi A, Lazarus JV, Leasher JL, Lee PH, Legesse Y, Leigh J, Leshargie CT, Leta S, Leung J, Leung R, Levi M, Li Y, Liang J, Liben ML, Lim LL, Lim SS, Lind M, Linn S, Listl S, Liu P, Liu S, Lodha R, Lopez AD, Lorch SA, Lorkowski S, Lotufo PA, Lucas TCD, Lunevicius R, Lurton G, Lyons RA, Maalouf F, Macarayan ERK, Mackay MT, Maddison ER, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manhertz T, Manguerra H, Mansournia MA, Mantovani LG, Manyazewal T, Mapoma CC, Margono C, Martinez-Raga J, Martins SCO, Martins-Melo FR, Martopullo I, März W, Massenburg BB, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehata S, Mehrotra R, Mehta KM, Mehta V, Meier T, Mejia-Rodriguez F, Meles KG, Melku M, Memiah P, Memish ZA, Mendoza W, Mengiste DA, Mengistu DT, Menota BG, Mensah GA, Meretoja A, Meretoja TJ, Mezgebe HB, Miazgowski T, Micha R, Milam R, Millear A, Miller TR, Mini GK, Minnig S, Mirica A, Mirrakhimov EM, Misganaw A, Mitchell PB, Mlashu FW, Moazen B, Mohammad KA, Mohammadibakhsh R, Mohammed E, Mohammed MA, Mohammed S, Mokdad AH, Mola GL, Molokhia M, Momeniha F, Monasta L, Montañez Hernandez JC, Moosazadeh M, Moradi-Lakeh M, Moraga P, Morawska L, Moreno Velasquez I, Mori R, Morrison SD, Moses M, Mousavi SM, Mueller UO, Murhekar M, Murthy GVS, Murthy S, Musa J, Musa KI, Mustafa G, Muthupandian S, Nagata C, Nagel G, Naghavi M, Naheed A, Naik GA, Naik N, Najafi F, Naldi L, Nangia V, Nansseu JRN, Narayan KMV, Nascimento BR, Negoi I, Negoi RI, Newton CR, Ngunjiri JW, Nguyen G, Nguyen L, Nguyen TH, Nichols E, Ningrum DNA, Nolte E, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Nyandwi A, Obermeyer CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Oliveira PPVD, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortega-Altamirano DV, Ortiz A, Ozdemir R, PA M, Pain AW, Palone MRT, Pana A, Panda-Jonas S, Pandian JD, Park EK, Parsian H, Patel T, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paudel D, Pedroso MDM, Pedroza SP, Pereira DM, Perico N, Peterson H, Petzold M, Peykari N, Phillips MR, Piel FB, Pigott DM, Pillay JD, Piradov MA, Polinder S, Pond CD, Postma MJ, Pourmalek F, Prakash S, Prakash V, Prasad N, Prasad NM, Purcell C, Qorbani M, Quintana HK, Radfar A, Rafay A, Rafiei A, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahman SU, Rai RK, Raju SB, Ram U, Rana SM, Rankin Z, Rasella D, Rawaf DL, Rawaf S, Ray SE, Razo-García CA, Reddy P, Reiner RC, Reis C, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Rios Blancas MJ, Rivera JA, Roever L, Ronfani L, Roshandel G, Rostami A, Roth GA, Rothenbacher D, Roy A, Roy N, Ruhago GM, Sabde YD, Sachdev PS, Sadat N, Safdarian M, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salama J, Salamati P, Saldanha RDF, Salimzadeh H, Salomon JA, Samy AM, Sanabria JR, Sancheti PK, Sanchez-Niño MD, Santomauro D, Santos IS, Santric Milicevic MM, Sarker AR, Sarrafzadegan N, Sartorius B, Satpathy M, Savic M, Sawhney M, Saxena S, Saylan MI, Schaeffner E, Schmidhuber J, Schmidt MI, Schneider IJC, Schumacher AE, Schutte AE, Schwebel DC, Schwendicke F, Sekerija M, Sepanlou SG, Servan-Mori EE, Shafieesabet A, Shaikh MA, Shakh-Nazarova M, Shams-Beyranvand M, Sharafi H, Sharif-Alhoseini M, Shariful Islam SM, Sharma M, Sharma R, She J, Sheikh A, Shfare MT, Shi P, Shields C, Shigematsu M, Shinohara Y, Shiri R, Shirkoohi R, Shiue I, Shrime MG, Shukla SR, Siabani S, Sigfusdottir ID, Silberberg DH, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh L, Singh NP, Singh V, Sinha DN, Sinke AH, Sisay M, Skirbekk V, Sliwa K, Smith A, Soares Filho AM, Sobaih BHA, Somai M, Soneji S, Soofi M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein DJ, Stokes MA, Sturua L, Sufiyan MB, Suliankatchi RA, Sunguya BF, Sur PJ, Sykes BL, Sylaja PN, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse AH, Taffere GR, Tandon N, Tariku AT, Taveira N, Tehrani-Banihashemi A, Temam Shifa G, Temsah MH, Terkawi AS, Tesema AG, Tesfaye DJ, Tessema B, Thakur JS, Thomas N, Thompson MJ, Tillmann T, To QG, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Torre A, Tortajada M, Tran BX, Tran KB, Tripathi A, Tripathy SP, Troeger C, Truelsen T, Tsoi D, Tudor Car L, Tuem KB, Tyrovolas S, Uchendu US, Ukwaja KN, Ullah I, Updike R, Uthman OA, Uzochukwu BSC, Valdez PR, van Boven JFM, Varughese S, Vasankari T, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wagnew F, Waheed Y, Wallin MT, Walson JL, Wang Y, Wang YP, Wassie MM, Weaver MR, Weiderpass E, Weintraub RG, Weiss J, Weldegwergs KG, Werdecker A, West TE, Westerman R, White RG, Whiteford HA, Widecka J, Winkler AS, Wiysonge CS, Wolfe CDA, Wondimkun YA, Workicho A, Wyper GMA, Xavier D, Xu G, Yan LL, Yano Y, Yaseri M, Yimer NB, Yin P, Yip P, Yirsaw BD, Yonemoto N, Yonga G, Yoon SJ, Yotebieng M, Younis MZ, Yu C, Zadnik V, Zaidi Z, Zaki MES, Zaman SB, Zamani M, Zenebe ZM, Zhou M, Zhu J, Zimsen SRM, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL, Lozano R. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet 2018; 391:2236-2271. [PMID: 29893224 PMCID: PMC5986687 DOI: 10.1016/s0140-6736(18)30994-2] [Citation(s) in RCA: 504] [Impact Index Per Article: 84.0] [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: 01/29/2018] [Revised: 03/23/2018] [Accepted: 04/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. FINDINGS In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. INTERPRETATION GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations. FUNDING Bill & Melinda Gates Foundation.
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Dieleman JL, Sadat N, Chang AY, Fullman N, Abbafati C, Acharya P, Adou AK, Ahmad Kiadaliri A, Alam K, Alizadeh-Navaei R, Alkerwi A, Ammar W, Antonio CAT, Aremu O, Asgedom SW, Atey TM, Avila-Burgos L, Ayer R, Badali H, Banach M, Banstola A, Barac A, Belachew AB, Birungi C, Bragazzi NL, Breitborde NJK, Cahuana-Hurtado L, Car J, Catalá-López F, Chapin A, Chen CS, Dandona L, Dandona R, Daryani A, Dharmaratne SD, Dubey M, Edessa D, Eldrenkamp E, Eshrati B, Faro A, Feigl AB, Fenny AP, Fischer F, Foigt N, Foreman KJ, Ghimire M, Goli S, Hailu AD, Hamidi S, Harb HL, Hay SI, Hendrie D, Ikilezi G, Javanbakht M, John D, Jonas JB, Kaldjian A, Kasaeian A, Kasahun YC, Khalil IA, Khang YH, Khubchandani J, Kim YJ, Kinge JM, Kosen S, Krohn KJ, Kumar GA, Lafranconi A, Lam H, Listl S, Magdy Abd El Razek H, Magdy Abd El Razek M, Majeed A, Malekzadeh R, Malta DC, Martinez G, Mensah GA, Meretoja A, Micah A, Miller TR, Mirrakhimov EM, Mlashu FW, Mohammed E, Mohammed S, Moses M, Mousavi SM, Naghavi M, Nangia V, Ngalesoni FN, Nguyen CT, Nguyen TH, Niriayo Y, Noroozi M, Owolabi MO, Patel T, Pereira DM, Polinder S, Qorbani M, Rafay A, Rafiei A, Rahimi-Movaghar V, Rai RK, Ram U, Ranabhat CL, Ray SE, Reiner RC, Sajadi HS, Santoro R, Santos JV, Sarker AR, Sartorius B, Satpathy M, Sepanlou SG, Shaikh MA, Sharif M, She J, Sheikh A, Shrime MG, Sisay M, Soneji S, Soofi M, Sorensen RJD, Tadesse H, Tao T, Templin T, Tesema AG, Thapa S, Tobe-Gai R, Topor-Madry R, Tran BX, Tran KB, Tran TT, Undurraga EA, Vasankari T, Violante FS, Werdecker A, Wijeratne T, Xu G, Yonemoto N, Younis MZ, Yu C, Zaki MES, Zlavog B, Murray CJL. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016-40. Lancet 2018; 391:1783-1798. [PMID: 29678341 PMCID: PMC5946843 DOI: 10.1016/s0140-6736(18)30697-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. METHODS We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. FINDINGS In the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4-5·1) per year, followed by lower-middle-income countries (4·0%, 3·6-4·5) and low-income countries (2·2%, 1·7-2·8). Despite global growth, per capita health spending was projected to range from only $40 (24-65) to $413 (263-668) in 2040 in low-income countries, and from $140 (90-200) to $1699 (711-3423) in lower-middle-income countries. Globally, the share of health spending covered by pooled resources would range widely, from 19·8% (10·3-38·6) in Nigeria to 97·9% (96·4-98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to 5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030. INTERPRETATION We chart future scenarios for health spending and its relationship with UHC. Ensuring that all countries have sustainable pooled health resources is crucial to the achievement of UHC. FUNDING The Bill & Melinda Gates Foundation.
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Torregroza C, Sadat N, von der Beek J, Scheiber D, Knorr I, Sager M, Akhyari P, Lichtenberg A, Saeed D. Establishing Chronic Stable Heart Failure in Ovine Model; is It Feasible? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.580] [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: 10/17/2022] Open
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Saeed D, Loforte A, Pappalardo F, Attisani M, Wieloch R, Sadat N, Boeken U, Albert A, Lichtenberg A. Selecting Ideal VAD Candidates in Patients on Venoarterial Membrane Oxygenation: Can We Identify the “Point of No Return”? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D. Saeed
- Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | - R. Wieloch
- Heinrich Heine University, Düsseldorf, Germany
| | - N. Sadat
- Heinrich Heine University, Düsseldorf, Germany
| | - U. Boeken
- Heinrich Heine University, Düsseldorf, Germany
| | - A. Albert
- Heinrich Heine University, Düsseldorf, Germany
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Torregroza C, Sadat N, von der Beek J, Scheiber D, Akhyari P, Lichtenberg A, Saeed D. Establishing Chronic Stable Heart Failure in Ovine Model: Is It Feasible? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - N. Sadat
- Heinrich Heine University, Düsseldorf, Germany
| | | | - D. Scheiber
- Heinrich Heine University, Düsseldorf, Germany
| | - P. Akhyari
- Heinrich Heine University, Düsseldorf, Germany
| | | | - D. Saeed
- Heinrich Heine University, Düsseldorf, Germany
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Sadat N, von der Beek J, Torregroza C, Scheiber D, Akhyari P, Lichtenberg A, Saeed D. Impact of Severe Tricuspid Valve Insufficiency on the Performance of Left Ventricular Device. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- N. Sadat
- Heinrich Heine University, Düsseldorf, Germany
| | | | | | - D. Scheiber
- Heinrich Heine University, Düsseldorf, Germany
| | - P. Akhyari
- Heinrich Heine University, Düsseldorf, Germany
| | | | - D. Saeed
- Heinrich Heine University, Düsseldorf, Germany
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Dieleman JL, Squires E, Bui AL, Campbell M, Chapin A, Hamavid H, Horst C, Li Z, Matyasz T, Reynolds A, Sadat N, Schneider MT, Murray CJL. Factors Associated With Increases in US Health Care Spending, 1996-2013. JAMA 2017; 318:1668-1678. [PMID: 29114831 PMCID: PMC5818797 DOI: 10.1001/jama.2017.15927] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth. OBJECTIVE To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity. DESIGN AND SETTING Data on the 5 factors from 1996 through 2013 were extracted for 155 health conditions, 36 age and sex groups, and 6 types of care from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation's US Disease Expenditure 2013 project. Decomposition analysis was performed to estimate the association between changes in these factors and changes in health care spending and to estimate the variability across health conditions and types of care. EXPOSURES Change in population size, population aging, disease prevalence or incidence, service utilization, or service price and intensity. MAIN OUTCOMES AND MEASURES Change in health care spending from 1996 through 2013. RESULTS After adjustments for price inflation, annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased by $933.5 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion. Increases in US population size were associated with a 23.1% (uncertainty interval [UI], 23.1%-23.1%), or $269.5 (UI, $269.0-$270.0) billion, spending increase; aging of the population was associated with an 11.6% (UI, 11.4%-11.8%), or $135.7 (UI, $133.3-$137.7) billion, spending increase. Changes in disease prevalence or incidence were associated with spending reductions of 2.4% (UI, 0.9%-3.8%), or $28.2 (UI, $10.5-$44.4) billion, whereas changes in service utilization were not associated with a statistically significant change in spending. Changes in service price and intensity were associated with a 50.0% (UI, 45.0%-55.0%), or $583.5 (UI, $525.2-$641.4) billion, spending increase. The influence of these 5 factors varied by health condition and type of care. For example, the increase in annual diabetes spending between 1996 and 2013 was $64.4 (UI, $57.9-$70.6) billion; $44.4 (UI, $38.7-$49.6) billion of this increase was pharmaceutical spending. CONCLUSIONS AND RELEVANCE Increases in US health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending.
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Affiliation(s)
| | - Ellen Squires
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Anthony L. Bui
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - Abigail Chapin
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Hannah Hamavid
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Cody Horst
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Zhiyin Li
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Taylor Matyasz
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Alex Reynolds
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, Seattle, Washington
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Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abebo TA, Abera SF, Aboyans V, Abu-Raddad LJ, Ackerman IN, Adamu AA, Adetokunboh O, Afarideh M, Afshin A, Agarwal SK, Aggarwal R, Agrawal A, Agrawal S, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akinyemi RO, Akseer N, Al Lami FH, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alasfoor D, Alene KA, Ali R, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Maskari F, Al-Raddadi R, Alsharif U, Alsowaidi S, Altirkawi KA, Amare AT, Amini E, Ammar W, Amoako YA, Andersen HH, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Assadi R, Atey TM, Atnafu NT, Atre SR, Avila-Burgos L, Avokphako EFGA, Awasthi A, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Bannick MS, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Basu S, Battista B, Battle KE, Baune BT, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bennett DA, Bensenor IM, Benson J, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhatt S, Bhutta ZA, Biadgilign S, Bicer BK, Bienhoff K, Bikbov B, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Boneya DJ, Boufous S, Bourne RRA, Brazinova A, Brugha TS, Buchbinder R, Bulto LNB, Bumgarner BR, Butt ZA, Cahuana-Hurtado L, Cameron E, Car M, Carabin H, Carapetis JR, Cárdenas R, Carpenter DO, Carrero JJ, Carter A, Carvalho F, Casey DC, Caso V, Castañeda-Orjuela CA, Castle CD, Catalá-López F, Chang HY, Chang JC, Charlson FJ, Chen H, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Christopher DJ, Ciobanu LG, Cirillo M, Colombara D, Cooper C, Cortesi PA, Criqui MH, Crump JA, Dadi AF, Dalal K, Dandona L, Dandona R, das Neves J, Davitoiu DV, de Courten B, De Leo DD, Defo BK, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Des Jarlais DC, Dey S, Dharmaratne SD, Dhillon PK, Dicker D, Ding EL, Djalalinia S, Do HP, Dorsey ER, dos Santos KPB, Douwes-Schultz D, Doyle KE, Driscoll TR, Dubey M, Duncan BB, El-Khatib ZZ, Ellerstrand J, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Fanuel FBB, Farinha CSES, Faro A, Farzadfar F, Fazeli MS, Feigin VL, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Flor LS, Foigt N, Foreman KJ, Franklin RC, Fullman N, Fürst T, Furtado JM, Futran ND, Gakidou E, Ganji M, Garcia-Basteiro AL, Gebre T, Gebrehiwot TT, Geleto A, Gemechu BL, Gesesew HA, Gething PW, Ghajar A, Gibney KB, Gill PS, Gillum RF, Ginawi IAM, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gold AL, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goto A, Goulart AC, Griswold M, Gugnani HC, Gupta R, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Hailu GB, Hailu AD, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hanson SW, Hao Y, Harb HL, Hareri HA, Haro JM, Harvey J, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, Hay RJ, Henry NJ, Heredia-Pi IB, Hernandez JM, Heydarpour P, Hoek HW, Hoffman HJ, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Htet AS, Hu G, Huang H, Huynh C, Iburg KM, Igumbor EU, Ikeda C, Irvine CMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jassal SK, Javanbakht M, Jayaraman SP, Jeemon P, Jensen PN, Jha V, Jiang G, John D, Johnson SC, Johnson CO, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Kan H, Karam NE, Karch A, Karema CK, Kasaeian A, Kassa GM, Kassaw NA, Kassebaum NJ, Kastor A, Katikireddi SV, Kaul A, Kawakami N, Keiyoro PN, Kengne AP, Keren A, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kim YJ, Kim D, Kim P, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishnaswami S, Krohn KJ, Kumar GA, Kumar P, Kumar S, Kyu HH, Lal DK, Lalloo R, Lambert N, Lan Q, Larsson A, Lavados PM, Leasher JL, Lee PH, Lee JT, Leigh J, Leshargie CT, Leung J, Leung R, Levi M, Li Y, Li Y, Li Kappe D, Liang X, Liben ML, Lim SS, Linn S, Liu PY, Liu A, Liu S, Liu Y, Lodha R, Logroscino G, London SJ, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Macarayan ERK, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahdavi M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Manhertz T, Mantilla A, Mantovani LG, Mapoma CC, Marczak LB, Martinez-Raga J, Martins-Melo FR, Martopullo I, März W, Mathur MR, Mazidi M, McAlinden C, McGaughey M, McGrath JJ, McKee M, McNellan C, Mehata S, Mehndiratta MM, Mekonnen TC, Memiah P, Memish ZA, Mendoza W, Mengistie MA, Mengistu DT, Mensah GA, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Mills EJ, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mitchell PB, Mohammad KA, Mohammadi A, Mohammed KE, Mohammed S, Mohanty SK, Mokdad AH, Mollenkopf SK, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Mori R, Morozoff C, Morrison SD, Moses M, Mountjoy-Venning C, Mruts KB, Mueller UO, Muller K, Murdoch ME, Murthy GVS, Musa KI, Nachega JB, Nagel G, Naghavi M, Naheed A, Naidoo KS, Naldi L, Nangia V, Natarajan G, Negasa DE, Negoi RI, Negoi I, Newton CR, Ngunjiri JW, Nguyen TH, Nguyen QL, Nguyen CT, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nolte S, Nong VM, Norrving B, Noubiap JJN, O'Donnell MJ, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju TO, Olagunju AT, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortiz A, Osgood-Zimmerman A, Osman M, Owolabi MO, PA M, Pacella RE, Pana A, Panda BK, Papachristou C, Park EK, Parry CD, Parsaeian M, Patten SB, Patton GC, Paulson K, Pearce N, Pereira DM, Perico N, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Plass D, Pletcher MA, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Prasad NM, Prasad N, Purcell C, Qorbani M, Quansah R, Quintanilla BPA, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman M, Rai RK, Rajsic S, Ram U, Ranabhat CL, Rankin Z, Rao PC, Rao PV, Rawaf S, Ray SE, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Ribeiro AL, Ronfani L, Roshandel G, Roth GA, Roy A, Rubagotti E, Ruhago GM, Saadat S, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Salama J, Saleem HOB, Salomon JA, Salvi SS, Samy AM, Sanabria JR, Santomauro D, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Servan-Mori EE, Setegn T, Shackelford KA, Shaheen A, Shaikh MA, Shamsipour M, Shariful Islam SM, Sharma J, Sharma R, She J, Shi P, Shields C, Shifa GT, Shigematsu M, Shinohara Y, Shiri R, Shirkoohi R, Shirude S, Shishani K, Shrime MG, Sibai AM, Sigfusdottir ID, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh NP, Sinha DN, Skiadaresi E, Skirbekk V, Slepak EL, Sligar A, Smith DL, Smith M, Sobaih BHA, Sobngwi E, Sorensen RJD, Sousa TCM, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein MB, Stein DJ, Steiner TJ, Steiner C, Steinke S, Stokes MA, Stovner LJ, Strub B, Subart M, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Taffere GR, Takala JS, Tandon N, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekelab T, Terkawi AS, Tesfaye DJ, Tesssema B, Thamsuwan O, Thomas KE, Thrift AG, Tiruye TY, Tobe-Gai R, Tollanes MC, Tonelli M, Topor-Madry R, Tortajada M, Touvier M, Tran BX, Tripathi S, Troeger C, Truelsen T, Tsoi D, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Updike R, Uthman OA, Uzochukwu BSC, van Boven JFM, Varughese S, Vasankari T, Venkatesh S, Venketasubramanian N, Vidavalur R, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Wadilo F, Wakayo T, Wang YP, Weaver M, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Wolfe CDA, Woodbrook R, Woolf AD, Workicho A, Xavier D, Xu G, Yadgir S, Yaghoubi M, Yakob B, Yan LL, Yano Y, Ye P, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zegeye EA, Zenebe ZM, Zhang X, Zhou M, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1211-1259. [PMID: 28919117 PMCID: PMC5605509 DOI: 10.1016/s0140-6736(17)32154-2] [Citation(s) in RCA: 4400] [Impact Index Per Article: 628.6] [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: 05/08/2017] [Revised: 07/22/2017] [Accepted: 07/26/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. METHODS We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228). INTERPRETATION The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. FUNDING Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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Wang H, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Adedeji IA, Adedoyin RA, Adetifa IMO, Adetokunboh O, Afshin A, Aggarwal R, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akanda AS, Akinyemiju TF, Akseer N, Al Lami FH, Alabed S, Alahdab F, Al-Aly Z, Alam K, Alam N, Alasfoor D, Aldridge RW, Alene KA, Al-Eyadhy A, Alhabib S, Ali R, Alizadeh-Navaei R, Aljunid SM, Alkaabi JM, Alkerwi A, Alla F, Allam SD, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Ameh EA, Amini E, Ammar W, Amoako YA, Anber N, Andrei CL, Androudi S, Ansari H, Ansha MG, Antonio CAT, Anwari P, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Asghar RJ, Assadi R, Assaye AM, Atey TM, Atre SR, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Babalola TK, Bacha U, Badawi A, Balakrishnan K, Balalla S, Barac A, Barber RM, Barboza MA, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bello AK, Bennett DA, Bennett JR, Bensenor IM, Benson J, Berhane A, Berhe DF, Bernabé E, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhaumik S, Bhutta ZA, Bicer BK, Bidgoli HH, Bikbov B, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bjerregaard P, Blosser CD, Boneya DJ, Boufous S, Bourne RRA, Brazinova A, Breitborde NJK, Brenner H, Brugha TS, Bukhman G, Bulto LNB, Bumgarner BR, Burch M, Butt ZA, Cahill LE, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Car M, Cárdenas R, Carpenter DO, Carrero JJ, Carter A, Castañeda-Orjuela CA, Castro FF, Castro RE, Catalá-López F, Chen H, Chiang PPC, Chibalabala M, Chisumpa VH, Chitheer AA, Choi JYJ, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colquhoun SM, Coresh J, Criqui MH, Cromwell EA, Crump JA, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, de Courten B, De Leo D, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dherani MK, Diaz-Torné C, Ding EL, Dixit P, Djalalinia S, Do HP, Doku DT, Donnelly CA, dos Santos KPB, Douwes-Schultz D, Driscoll TR, Duan L, Dubey M, Duncan BB, Dwivedi LK, Ebrahimi H, El Bcheraoui C, Ellingsen CL, Enayati A, Endries AY, Ermakov SP, Eshetie S, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Fanuel FBB, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Filip I, Fischer F, Foigt N, Foreman KJ, Frank T, Franklin RC, Fraser M, Friedman J, Frostad JJ, Fullman N, Fürst T, Furtado JM, Futran ND, Gakidou E, Gambashidze K, Gamkrelidze A, Gankpé FG, Garcia-Basteiro AL, Gebregergs GB, Gebrehiwot TT, Gebrekidan KG, Gebremichael MW, Gelaye AA, Geleijnse JM, Gemechu BL, Gemechu KS, Genova-Maleras R, Gesesew HA, Gething PW, Gibney KB, Gill PS, Gillum RF, Giref AZ, Girma BW, Giussani G, Goenka S, Gomez B, Gona PN, Gopalani SV, Goulart AC, Graetz N, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Haagsma JA, Hafezi-Nejad N, Hakuzimana A, Halasa YA, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Hareri HA, Harikrishnan S, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, He F, Heredia-Pi IB, Herteliu C, Hilawe EH, Hoek HW, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huang H, Iburg KM, Igumbor EU, Ileanu BV, Inoue M, Irenso AA, Irvine CMS, Islam SMS, Islam N, Jacobsen KH, Jaenisch T, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayatilleke AU, Jeemon P, Jensen PN, Jha V, Jin Y, John D, John O, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Karthikeyan G, Kasaeian A, Kassaw NA, Kassebaum NJ, Kastor A, Katikireddi SV, Kaul A, Kawakami N, Kazanjan K, Keiyoro PN, Kelbore SG, Kemp AH, Kengne AP, Keren A, Kereselidze M, Kesavachandran CN, Ketema EB, Khader YS, Khalil IA, Khan EA, Khan G, Khang YH, Khera S, Khoja ATA, Khosravi MH, Kibret GD, Kieling C, Kim YJ, Kim CI, Kim D, Kim P, Kim S, Kimokoti RW, Kinfu Y, Kishawi S, Kissoon N, Kivimaki M, Knudsen AK, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kuate Defo B, Kuipers EJ, Kulikoff XR, Kulkarni VS, Kumar GA, Kumar P, Kumsa FA, Kutz M, Lachat C, Lagat AK, Lager ACJ, Lal DK, Lalloo R, Lambert N, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Laxmaiah A, Lee PH, Leigh J, Leung J, Leung R, Levi M, Li Y, Liao Y, Liben ML, Lim SS, Linn S, Lipshultz SE, Liu S, Lodha R, Logroscino G, Lorch SA, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Ma S, Macarayan ER, Machado IE, Mackay MT, Magdy Abd El Razek M, Magis-Rodriguez C, Mahdavi M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marczak LB, Marks GB, Martin EA, Martinez-Raga J, Martins-Melo FR, Massano J, Maulik PK, Mayosi BM, Mazidi M, McAlinden C, McGarvey ST, McGrath JJ, McKee M, Mehata S, Mehndiratta MM, Mehta KM, Meier T, Mekonnen TC, Meles KG, Memiah P, Memish ZA, Mendoza W, Mengesha MM, Mengistie MA, Mengistu DT, Menon GR, Menota BG, Mensah GA, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Mikesell J, Miller TR, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohammad KA, Mohammadi A, Mohammed KE, Mohammed S, Mohan MBV, Mohanty SK, Mokdad AH, Mollenkopf SK, Molokhia M, Monasta L, Montañez Hernandez JC, Montico M, Mooney MD, Moore AR, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Morrison SD, Mruts KB, Mueller UO, Mullany E, Muller K, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naidoo KS, Nanda L, Nangia V, Nascimento BR, Natarajan G, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Ningrum DNA, Nisar MI, Nomura M, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Nyakarahuka L, O'Donnell MJ, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olusanya BO, Olusanya JO, Oren E, Ortiz A, Osgood-Zimmerman A, Ota E, Owolabi MO, Oyekale AS, PA M, Pacella RE, Pakhale S, Pana A, Panda BK, Panda-Jonas S, Park EK, Parsaeian M, Patel T, Patten SB, Patton GC, Paudel D, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pervaiz A, Pesudovs K, Peterson CB, Petri WA, Petzold M, Phillips MR, Piel FB, Pigott DM, Pishgar F, Plass D, Polinder S, Popova S, Postma MJ, Poulton RG, Pourmalek F, Prasad N, Purwar M, Qorbani M, Quintanilla BPA, Rabiee RHS, Radfar A, Rafay A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman SU, Rahman M, Rai RK, Rajsic S, Ram U, Rana SM, Ranabhat CL, Rao PV, Rawaf S, Ray SE, Rego MAS, Rehm J, Reiner RC, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Rivas JC, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy A, Rubagotti E, Ruhago GM, Saadat S, Sabde YD, Sachdev PS, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Sahebkar A, Sahraian MA, Salama J, Salamati P, Salomon JA, Salvi SS, Samy AM, Sanabria JR, Sanchez-Niño MD, Santos IS, Santric Milicevic MM, Sarmiento-Suarez R, Sartorius B, Satpathy M, Sawhney M, Saxena S, Saylan MI, Schmidt MI, Schneider IJC, Schulhofer-Wohl S, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Seid AM, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Sharma J, Sharma R, She J, Shen J, Shetty BP, Shi P, Shibuya K, Shifa GT, Shigematsu M, Shiri R, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Silpakit N, Silva DAS, Silva JP, Silveira DGA, Sindi S, Singh JA, Singh PK, Singh A, Singh V, Sinha DN, Skarbek KAK, Skiadaresi E, Sligar A, Smith DL, Sobaih BHA, Sobngwi E, Soneji S, Soriano JB, Sreeramareddy CT, Srinivasan V, Stathopoulou V, Steel N, Stein DJ, Steiner C, Stöckl H, Stokes MA, Strong M, Sufiyan MB, Suliankatchi RA, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Tadese F, Tandon N, Tanne D, Tarajia M, Tavakkoli M, Taveira N, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Temsah MH, Terkawi AS, Tesema CL, Tesssema B, Theis A, Thomas N, Thompson AH, Thomson AJ, Thrift AG, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tortajada M, Tran BX, Truelsen T, Trujillo U, Tsilimparis N, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uthman OA, Uzochukwu BSC, van Boven JFM, Varakin YY, Varughese S, Vasankari T, Vasconcelos AMN, Velasquez IM, Venketasubramanian N, Vidavalur R, Violante FS, Vishnu A, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Waid JL, Wakayo T, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wesana J, Wijeratne T, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Workicho A, Workie SB, Xavier D, Xu G, Yaghoubi M, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yimam HH, Yip P, Yirsaw BD, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zeeb H, Zenebe ZM, Zerfu TA, Zhang AL, Zhang X, Zodpey S, Zuhlke LJ, Lopez AD, Murray CJL. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1084-1150. [PMID: 28919115 PMCID: PMC5605514 DOI: 10.1016/s0140-6736(17)31833-0] [Citation(s) in RCA: 488] [Impact Index Per Article: 69.7] [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: 01/17/2017] [Revised: 05/21/2017] [Accepted: 06/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. INTERPRETATION Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. FUNDING Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abera SF, Aboyans V, Abu-Raddad LJ, Abu-Rmeileh NME, Abyu GY, Adedeji IA, Adetokunboh O, Afarideh M, Agrawal A, Agrawal S, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Akinyemi RO, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alasfoor D, Alene KA, Ali K, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Ansari H, Antó JM, Antonio CAT, Anwari P, Arian N, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Atey TM, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Ballew SH, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Batis C, Battle KE, Baumgarner BR, Baune BT, Beardsley J, Bedi N, Beghi E, Bell ML, Bennett DA, Bennett JR, Bensenor IM, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhansali A, Bhutta ZA, Bicer BK, Bikbov B, Birungi C, Biryukov S, Blosser CD, Boneya DJ, Bou-Orm IR, Brauer M, Breitborde NJK, Brenner H, Brugha TS, Bulto LNB, Butt ZA, Cahuana-Hurtado L, Cárdenas R, Carrero JJ, Castañeda-Orjuela CA, Catalá-López F, Cercy K, Chang HY, Charlson FJ, Chimed-Ochir O, Chisumpa VH, Chitheer AA, Christensen H, Christopher DJ, Cirillo M, Cohen AJ, Comfort H, Cooper C, Coresh J, Cornaby L, Cortesi PA, Criqui MH, Crump JA, Dandona L, Dandona R, das Neves J, Davey G, Davitoiu DV, Davletov K, de Courten B, Defo BK, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Deshpande A, Dharmaratne SD, Ding EL, Djalalinia S, Do HP, Dokova K, Doku DT, Donkelaar AV, Dorsey ER, Driscoll TR, Dubey M, Duncan BB, Duncan S, Ebrahimi H, El-Khatib ZZ, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Faraon EJA, Farinha CSES, Faro A, Farzadfar F, Fay K, Feigin VL, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Foreman KJ, Frostad JJ, Fullman N, Fürst T, Furtado JM, Ganji M, Garcia-Basteiro AL, Gebrehiwot TT, Geleijnse JM, Geleto A, Gemechu BL, Gesesew HA, Gething PW, Ghajar A, Gibney KB, Gill PS, Gillum RF, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gona PN, Goodridge A, Gopalani SV, Goryakin Y, Goulart AC, Graetz N, Gugnani HC, Guo J, Gupta R, Gupta T, Gupta V, Gutiérrez RA, Hachinski V, Hafezi-Nejad N, Hailu GB, Hamadeh RR, Hamidi S, Hammami M, Handal AJ, Hankey GJ, Hanson SW, Harb HL, Hareri HA, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, Hedayati MT, Hendrie D, Heredia-Pi IB, Hernandez JCM, Hoek HW, Horita N, Hosgood HD, Hostiuc S, Hoy DG, Hsairi M, Hu G, Huang JJ, Huang H, Ibrahim NM, Iburg KM, Ikeda C, Inoue M, Irvine CMS, Jackson MD, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jauregui A, Javanbakht M, Jeemon P, Johansson LRK, Johnson CO, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Karch A, Karema CK, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kawakami N, Keiyoro PN, Kelbore SG, Kemmer L, Kengne AP, Kesavachandran CN, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kim JY, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Knibbs LD, Knudsen AK, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kromhout H, Kumar GA, Kutz M, Kyu HH, Lal DK, Lalloo R, Lallukka T, Lan Q, Lansingh VC, Larsson A, Lee PH, Lee A, Leigh J, Leung J, Levi M, Levy TS, Li Y, Li Y, Liang X, Liben ML, Linn S, Liu P, Lodha R, Logroscino G, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Macarayan ERK, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Mantovani LG, Mapoma CC, Martin RV, Martinez-Raga J, Martins-Melo FR, Mathur MR, Matsushita K, Matzopoulos R, Mazidi M, McAlinden C, McGrath JJ, Mehata S, Mehndiratta MM, Meier T, Melaku YA, Memiah P, Memish ZA, Mendoza W, Mengesha MM, Mensah GA, Mensink GBM, Mereta ST, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohammad KA, Mohammed KE, Mohammed S, Mohan MBV, Mokdad AH, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Morrison SD, Mountjoy-Venning C, Mueller UO, Mullany EC, Muller K, Murthy GVS, Musa KI, Naghavi M, Naheed A, Nangia V, Natarajan G, Negoi RI, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nomura M, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Ota E, Owolabi MO, PA M, Pacella RE, Pana A, Panda BK, Panda-Jonas S, Pandian JD, Papachristou C, Park EK, Parry CD, Patten SB, Patton GC, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Pillay JD, Piradov MA, Pishgar F, Plass D, Pletcher MA, Polinder S, Popova S, Poulton RG, Pourmalek F, Prasad N, Purcell C, Qorbani M, Radfar A, Rafay A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahman M, Rai RK, Rajsic S, Ram U, Rawaf S, Rehm CD, Rehm J, Reiner RC, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Reynales-Shigematsu LM, Rezaei S, Ribeiro AL, Rivera JA, Roba KT, Rojas-Rueda D, Roman Y, Room R, Roshandel G, Roth GA, Rothenbacher D, Rubagotti E, Rushton L, Sadat N, Safdarian M, Safi S, Safiri S, Sahathevan R, Salama J, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Sánchez-Pimienta TG, Santomauro D, Santos IS, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Shariful Islam SM, Sharma J, Sharma R, She J, Shen J, Shi P, Shibuya K, Shields C, Shiferaw MS, Shigematsu M, Shin MJ, Shiri R, Shirkoohi R, Shishani K, Shoman H, Shrime MG, Sigfusdottir ID, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh V, Sinha DN, Skiadaresi E, Slepak EL, Smith DL, Smith M, Sobaih BHA, Sobngwi E, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Srinivasan V, Steel N, Stein DJ, Steiner C, Steinke S, Stokes MA, Strub B, Subart M, Sufiyan MB, Suliankatchi RA, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Takahashi K, Takala JS, Tandon N, Tanner M, Tarekegn YL, Tavakkoli M, Tegegne TK, Tehrani-Banihashemi A, Terkawi AS, Tesssema B, Thakur JS, Thamsuwan O, Thankappan KR, Theis AM, Thomas ML, Thomson AJ, Thrift AG, Tillmann T, Tobe-Gai R, Tobollik M, Tollanes MC, Tonelli M, Topor-Madry R, Torre A, Tortajada M, Touvier M, Tran BX, Truelsen T, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Uneke CJ, Updike R, Uthman OA, van Boven JFM, Varughese S, Vasankari T, Veerman LJ, Venkateswaran V, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wadilo F, Wakayo T, Wallin MT, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Workicho A, Xavier D, Xu G, Yadgir S, Yakob B, Yan LL, Yaseri M, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zavala-Arciniega L, Zhang X, Zimsen SRM, Zipkin B, Zodpey S, Lim SS, Murray CJL. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1345-1422. [PMID: 28919119 PMCID: PMC5614451 DOI: 10.1016/s0140-6736(17)32366-8] [Citation(s) in RCA: 1552] [Impact Index Per Article: 221.7] [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: 05/29/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. METHODS We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. FINDINGS Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. INTERPRETATION Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. FUNDING The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
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Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Aboyans V, Adetokunboh O, Afshin A, Agrawal A, Ahmadi A, Ahmed MB, Aichour AN, Aichour MTE, Aichour I, Aiyar S, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alene KA, Al-Eyadhy A, Ali SD, Alizadeh-Navaei R, Alkaabi JM, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Anber N, Andersen HH, Andrei CL, Androudi S, Ansari H, Antonio CAT, Anwari P, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Atey TM, Avila-Burgos L, Avokpaho EFG, Awasthi A, Babalola TK, Bacha U, Balakrishnan K, Barac A, Barboza MA, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Baune BT, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bennett JR, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beuran M, Bhatt S, Biadgilign S, Bienhoff K, Bikbov B, Bisanzio D, Bourne RRA, Breitborde NJK, Bulto LNB, Bumgarner BR, Butt ZA, Cahuana-Hurtado L, Cameron E, Campuzano JC, Car J, Cárdenas R, Carrero JJ, Carter A, Casey DC, Castañeda-Orjuela CA, Catalá-López F, Charlson FJ, Chibueze CE, Chimed-Ochir O, Chisumpa VH, Chitheer AA, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colombara D, Cooper C, Cowie BC, Criqui MH, Dandona L, Dandona R, Dargan PI, das Neves J, Davitoiu DV, Davletov K, de Courten B, Defo BK, Degenhardt L, Deiparine S, Deribe K, Deribew A, Dey S, Dicker D, Ding EL, Djalalinia S, Do HP, Doku DT, Douwes-Schultz D, Driscoll TR, Dubey M, Duncan BB, Echko M, El-Khatib ZZ, Ellingsen CL, Enayati A, Ermakov SP, Erskine HE, Eskandarieh S, Esteghamati A, Estep K, Farinha CSES, Faro A, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Finegold S, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Frank T, Fraser M, Fullman N, Fürst T, Furtado JM, Gakidou E, Garcia-Basteiro AL, Gebre T, Gebregergs GB, Gebrehiwot TT, Gebremichael DY, Geleijnse JM, Genova-Maleras R, Gesesew HA, Gething PW, Gillum RF, Giref AZ, Giroud M, Giussani G, Godwin WW, Gold AL, Goldberg EM, Gona PN, Gopalani SV, Gouda HN, Goulart AC, Griswold M, Gupta R, Gupta T, Gupta V, Gupta PC, Haagsma JA, Hafezi-Nejad N, Hailu AD, Hailu GB, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Hareri HA, Hassanvand MS, Havmoeller R, Hay SI, He F, Hedayati MT, Henry NJ, Heredia-Pi IB, Herteliu C, Hoek HW, Horino M, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Huynh C, Iburg KM, Ikeda C, Ileanu BV, Irenso AA, Irvine CMS, Islam SMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayaraman SP, Jeemon P, Jha V, John D, Johnson CO, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Karch A, Karimi SM, Karimkhani C, Kasaeian A, Kassaw NA, Kassebaum NJ, Katikireddi SV, Kawakami N, Keiyoro PN, Kemmer L, Kesavachandran CN, Khader YS, Khan EA, Khang YH, Khoja ATA, Khosravi MH, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kievlan D, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kissoon N, Kivimaki M, Knudsen AK, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kulikoff XR, Kumar GA, Kumar P, Kutz M, Kyu HH, Lal DK, Lalloo R, Lambert TLN, Lan Q, Lansingh VC, Larsson A, Lee PH, Leigh J, Leung J, Levi M, Li Y, Li Kappe D, Liang X, Liben ML, Lim SS, Liu PY, Liu A, Liu Y, Lodha R, Logroscino G, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Ma S, Macarayan ERK, Maddison ER, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Manguerra H, Manyazewal T, Mapoma CC, Marczak LB, Markos D, Martinez-Raga J, Martins-Melo FR, Martopullo I, McAlinden C, McGaughey M, McGrath JJ, Mehata S, Meier T, Meles KG, Memiah P, Memish ZA, Mengesha MM, Mengistu DT, Menota BG, Mensah GA, Meretoja TJ, Meretoja A, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohamed IA, Mohammad KA, Mohammadi A, Mohammed S, Mokdad AH, Mola GLD, Mollenkopf SK, Molokhia M, Monasta L, Montañez JC, Montico M, Mooney MD, Moradi-Lakeh M, Moraga P, Morawska L, Morozoff C, Morrison SD, Mountjoy-Venning C, Mruts KB, Muller K, Murthy GVS, Musa KI, Nachega JB, Naheed A, Naldi L, Nangia V, Nascimento BR, Nasher JT, Natarajan G, Negoi I, Ngunjiri JW, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nong VM, Noubiap JJN, Ogbo FA, Oh IH, Okoro A, Olagunju AT, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortiz A, Osman M, Ota E, PA M, Pacella RE, Pakhale S, Pana A, Panda BK, Panda-Jonas S, Papachristou C, Park EK, Patten SB, Patton GC, Paudel D, Paulson K, Pereira DM, Perez-Ruiz F, Perico N, Pervaiz A, Petzold M, Phillips MR, Pigott DM, Pinho C, Plass D, Pletcher MA, Polinder S, Postma MJ, Pourmalek F, Purcell C, Qorbani M, Quintanilla BPA, Radfar A, Rafay A, Rahimi-Movaghar V, Rahman MHU, Rahman M, Rai RK, Ranabhat CL, Rankin Z, Rao PC, Rath GK, Rawaf S, Ray SE, Rehm J, Reiner RC, Reitsma MB, Remuzzi G, Rezaei S, Rezai MS, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Ruhago GM, SA R, Saadat S, Sachdev PS, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Salama J, Salamati P, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Santomauro D, Santos IS, Santric Milicevic MM, Sartorius B, Satpathy M, Schmidt MI, Schneider IJC, Schulhofer-Wohl S, Schutte AE, Schwebel DC, Schwendicke F, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Sharma J, Sharma R, She J, Sheikhbahaei S, Shey M, Shi P, Shields C, Shigematsu M, Shiri R, Shirude S, Shiue I, Shoman H, Shrime MG, Sigfusdottir ID, Silpakit N, Silva JP, Singh JA, Singh A, Skiadaresi E, Sligar A, Smith DL, Smith A, Smith M, Sobaih BHA, Soneji S, Sorensen RJD, Soriano JB, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein DJ, Steiner C, Steinke S, Stokes MA, Strong M, Strub B, Subart M, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Tabarés-Seisdedos R, Tadakamadla SK, Takahashi K, Takala JS, Talongwa RT, Tarawneh MR, Tavakkoli M, Taveira N, Tegegne TK, Tehrani-Banihashemi A, Temsah MH, Terkawi AS, Thakur JS, Thamsuwan O, Thankappan KR, Thomas KE, Thompson AH, Thomson AJ, Thrift AG, Tobe-Gai R, Topor-Madry R, Torre A, Tortajada M, Towbin JA, Tran BX, Troeger C, Truelsen T, Tsoi D, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Updike R, Uthman OA, Uzochukwu BSC, van Boven JFM, Vasankari T, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Vos T, Wakayo T, Wallin MT, Wang YP, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whetter B, Whiteford HA, Wijeratne T, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Workicho A, Xavier D, Xiao Q, Xu G, Yaghoubi M, Yakob B, Yano Y, Yaseri M, Yimam HH, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zegeye EA, Zenebe ZM, Zerfu TA, Zhang AL, Zhang X, Zipkin B, Zodpey S, Lopez AD, Murray CJL. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1151-1210. [PMID: 28919116 PMCID: PMC5605883 DOI: 10.1016/s0140-6736(17)32152-9] [Citation(s) in RCA: 2992] [Impact Index Per Article: 427.4] [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: 03/15/2017] [Revised: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. METHODS We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. FINDINGS The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. INTERPRETATION The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. FUNDING Bill & Melinda Gates Foundation.
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Fullman N, Barber RM, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abera SF, Aboyans V, Abu-Raddad LJ, Abu-Rmeileh NME, Adedeji IA, Adetokunboh O, Afshin A, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akinyemi RO, Akseer N, Al-Aly Z, Alam K, Alam N, Alasfoor D, Alene KA, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Ansari H, Antonio CAT, Anwari P, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Assadi R, Atey TM, Atre SR, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Bannick MS, Barac A, Barker-Collo SL, Bärnighausen T, Barrero LH, Basu S, Battle KE, Baune BT, Beardsley J, Bedi N, Beghi E, Béjot Y, Bell ML, Bennett DA, Bennett JR, Bensenor IM, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhatt S, Bhutta ZA, Bicer BK, Bidgoli HH, Bikbov B, Bilal AI, Birungi C, Biryukov S, Bizuayehu HM, Blosser CD, Boneya DJ, Bose D, Bou-Orm IR, Brauer M, Breitborde NJK, Brugha TS, Bulto LNB, Butt ZA, Cahuana-Hurtado L, Cameron E, Campuzano JC, Carabin H, Cárdenas R, Carrero JJ, Carter A, Casey DC, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cercy K, Chang HY, Chang JC, Charlson FJ, Chew A, Chisumpa VH, Chitheer AA, Christensen H, Christopher DJ, Cirillo M, Cooper C, Criqui MH, Cromwell EA, Crump JA, Dandona L, Dandona R, Dargan PI, das Neves J, Davitoiu DV, de Courten B, De Steur H, Defo BK, Degenhardt L, Deiparine S, Deribe K, deVeber GA, Ding EL, Djalalinia S, Do HP, Dokova K, Doku DT, Donkelaar AV, Dorsey ER, Driscoll TR, Dubey M, Duncan BB, Ebel BE, Ebrahimi H, El-Khatib ZZ, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Faraon EJA, Farinha CSES, Faro A, Farzadfar F, Fazeli MS, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Foreman KJ, Frank T, Franklin RC, Friedman J, Frostad JJ, Fürst T, Furtado JM, Gakidou E, Garcia-Basteiro AL, Gebrehiwot TT, Geleijnse JM, Geleto A, Gemechu BL, Gething PW, Gibney KB, Gill PS, Gillum RF, Giref AZ, Gishu MD, Giussani G, Glenn SD, Godwin WW, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goryakin Y, Griswold M, Gugnani HC, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Hailu GB, Hamadeh RR, Hammami M, Hankey GJ, Harb HL, Hareri HA, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, He J, Hendrie D, Henry NJ, Heredia-Pi IB, Hoek HW, Holmberg M, Horita N, Hosgood HD, Hostiuc S, Hoy DG, Hsairi M, Htet AS, Huang JJ, Huang H, Huynh C, Iburg KM, Ikeda C, Inoue M, Irvine CMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jauregui A, Javanbakht M, Jeemon P, Jha V, John D, Johnson CO, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Karch A, Karema CK, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kawakami N, Keiyoro PN, Kelbore SG, Kemmer L, Kengne AP, Kesavachandran CN, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kieling C, Kim JY, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kulikoff XR, Kumar GA, Kumar Lal D, Kutz MJ, Kyu HH, Lalloo R, Lansingh VC, Larsson A, Lazarus JV, Lee PH, Leigh J, Leung J, Leung R, Levi M, Li Y, Liben ML, Linn S, Liu PY, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Mackay MT, Maddison ER, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Mantovani LG, Manyazewal T, Mapoma CC, Marks GB, Martin RV, Martinez-Raga J, Martins-Melo FR, Martopullo I, Mathur MR, Mazidi M, McAlinden C, McGaughey M, McGrath JJ, McKee M, Mehata S, Mehndiratta MM, Meier T, Meles KG, Memish ZA, Mendoza W, Mengesha MM, Mengistie MA, Mensah GA, Mensink GBM, Mereta ST, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mitchell PB, Mohammad KA, Mohammed KE, Mohammed S, Mohan MBV, Mokdad AH, Mollenkopf SK, Monasta L, Montañez Hernandez JC, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Morrison SD, Moses MW, Mountjoy-Venning C, Mueller UO, Muller K, Murthy GVS, Musa KI, Naghavi M, Naheed A, Naidoo KS, Nangia V, Natarajan G, Negoi RI, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nomura M, Nong VM, Norheim OF, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Oren E, Ortiz A, Owolabi MO, PA M, Pana A, Panda BK, Panda-Jonas S, Papachristou C, Park EK, Patton GC, Paulson K, Pereira DM, Perico DN, Pesudovs K, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Piradov MA, Pishgar F, Poulton RG, Pourmalek F, Qorbani M, Radfar A, Rafay A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahman M, Rai RK, Rajsic S, Ram U, Ranabhat CL, Rao PC, Rawaf S, Reidy P, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rios Blancas MJ, Rivas JC, Roba KT, Rojas-Rueda D, Rokni MB, Roshandel G, Roth GA, Roy A, Rubagotti E, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Salama J, Salomon JA, Samy AM, Sanabria JR, Santomauro D, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Saylan MI, Schmidt MI, Schneider IJC, Schneider MT, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Shariful Islam SM, Sharma J, Sharma R, She J, Shi P, Shibuya K, Shields C, Shifa GT, Shiferaw MS, Shigematsu M, Shin MJ, Shiri R, Shirkoohi R, Shirude S, Shishani K, Shoman H, Shrime MG, Silberberg DH, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh V, Sinha DN, Skiadaresi E, Slepak EL, Sligar A, Smith DL, Smith A, Smith M, Sobaih BHA, Sobngwi E, Soljak M, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein DJ, Steiner C, Steinke S, Stokes MA, Strub B, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Sylte DO, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Tandon N, Tao T, Tarekegn YL, Tavakkoli M, Taveira N, Tegegne TK, Terkawi AS, Tessema GA, Thakur JS, Thankappan KR, Thrift AG, Tiruye TY, Tobe-Gai R, Topor-Madry R, Torre A, Tortajada M, Tran BX, Troeger C, Truelsen T, Tsoi D, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Uneke CJ, Updike R, Uthman OA, van Boven JFM, Varughese S, Vasankari T, Venketasubramanian N, Vidavalur R, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wadilo F, Wakayo T, Wallin MT, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Xavier D, Xu G, Yadgir S, Yakob B, Yan LL, Yano Y, Yaseri M, Ye P, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zavala-Arciniega L, Zhang X, Zipkin B, Zodpey S, Lim SS, Murray CJL. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017; 390:1423-1459. [PMID: 28916366 PMCID: PMC5603800 DOI: 10.1016/s0140-6736(17)32336-x] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [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: 06/15/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. METHODS We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment. FINDINGS Globally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past. INTERPRETATION GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations. FUNDING Bill & Melinda Gates Foundation.
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Dieleman J, Campbell M, Chapin A, Eldrenkamp E, Fan VY, Haakenstad A, Kates J, Liu Y, Matyasz T, Micah A, Reynolds A, Sadat N, Schneider MT, Sorensen R, Evans T, Evans D, Kurowski C, Tandon A, Abbas KM, Abera SF, Kiadaliri AA, Ahmed KY, Ahmed MB, Alam K, Alizadeh-Navaei R, Alkerwi A, Amini E, Ammar W, Amrock SM, Antonio CAT, Atey TM, Avila-Burgos L, Awasthi A, Barac A, Bernal OA, Beyene AS, Beyene TJ, Birungi C, Bizuayehu HM, Breitborde NJK, Cahuana-Hurtado L, Castro RE, Catalia-Lopez F, Dalal K, Dandona L, Dandona R, de Jager P, Dharmaratne SD, Dubey M, Farinha CSES, Faro A, Feigl AB, Fischer F, Fitchett JRA, Foigt N, Giref AZ, Gupta R, Hamidi S, Harb HL, Hay SI, Hendrie D, Horino M, Jürisson M, Jakovljevic MB, Javanbakht M, John D, Jonas JB, Karimi SM, Khang YH, Khubchandani J, Kim YJ, Kinge JM, Krohn KJ, Kumar GA, El Razek HMA, El Razek MMA, Majeed A, Malekzadeh R, Masiye F, Meier T, Meretoja A, Miller TR, Mirrakhimov EM, Mohammed S, Nangia V, Olgiati S, Osman AS, Owolabi MO, Patel T, Caicedo AJP, Pereira DM, Perelman J, Polinder S, Rafay A, Rahimi-Movaghar V, Rai RK, Ram U, Ranabhat CL, Roba HS, Salama J, Savic M, Sepanlou SG, Shrime MG, Talongwa RT, Ao BJT, Tediosi F, Tesema AG, Thomson AJ, Tobe-Gai R, Topor-Madry R, Undurraga EA, Vasankari T, Violante FS, Werdecker A, Wijeratne T, Xu G, Yonemoto N, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Murray CJL. Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet 2017; 389:1981-2004. [PMID: 28433256 PMCID: PMC5440770 DOI: 10.1016/s0140-6736(17)30874-7] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [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: 01/07/2017] [Revised: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. METHODS We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. FINDINGS Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. INTERPRETATION Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage. FUNDING The Bill & Melinda Gates Foundation.
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Dieleman JL, Sadat N. Health economics - Authors' reply. Lancet 2017; 389:1880. [PMID: 28513445 DOI: 10.1016/s0140-6736(16)31721-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/12/2016] [Indexed: 10/19/2022]
Affiliation(s)
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, Seattle WA 98121, USA
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Skirbekk V, Ottersen T, Hamavid H, Sadat N, Dieleman JL. Vast Majority Of Development Assistance For Health Funds Target Those Below Age Sixty. Health Aff (Millwood) 2017; 36:926-930. [DOI: 10.1377/hlthaff.2016.1370] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Vegard Skirbekk
- Vegard Skirbekk ( ) is a senior researcher at the Norwegian Institute of Public Health, in Oslo, and a professor of Population and Family Health at the Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, in New York City
| | - Trygve Ottersen
- Trygve Ottersen is executive director of the Norwegian Institute of Public Health and an associate professor in the Global Health Policy Group, Department of Community Medicine and Global Health and Centre for Global Health, University of Oslo
| | - Hannah Hamavid
- Hannah Hamavid was a data analyst at the Institute for Health Metrics and Evaluation, University of Washington, in Seattle, at the time this work was conducted
| | - Nafis Sadat
- Nafis Sadat is a researcher at the Institute for Health Metrics and Evaluation, University of Washington
| | - Joseph L. Dieleman
- Joseph L. Dieleman is an assistant professor at the Institute for Health Metrics and Evaluation, University of Washington
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Saeed D, Wieloch R, Petrov G, Maxhera B, Abdeen M, Sadat N, Boeken U, Lichtenberg A, Albert A. Bridge to Bridge Strategy: The Challenging Task of Selecting Ideal VAD Candidates on Short Term Circulatory Support. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.931] [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: 10/19/2022] Open
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Maxhera B, Albert A, Westenfeld R, Sadat N, Petrov G, Lichtenberg A, Saeed D. The Correlation of Aortic Valve Opening Status and Stroke Risk in Patients Supported with HeartWare HVAD. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- B. Maxhera
- Düsseldorf University Hospital, Clinic for Cardiovascular Surgery, Düsseldorf, Germany
| | - A. Albert
- Düsseldorf University Hospital, Clinic for Cardiovascular Surgery, Düsseldorf, Germany
| | - R. Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf University Hospital, Düsseldorf, Germany
| | - N. Sadat
- Düsseldorf University Hospital, Clinic for Cardiovascular Surgery, Düsseldorf, Germany
| | - G. Petrov
- Düsseldorf University Hospital, Clinic for Cardiovascular Surgery, Düsseldorf, Germany
| | - A. Lichtenberg
- Düsseldorf University Hospital, Clinic for Cardiovascular Surgery, Düsseldorf, Germany
| | - D. Saeed
- Düsseldorf University Hospital, Clinic for Cardiovascular Surgery, Düsseldorf, Germany
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Wieloch R, Albert A, Maxhera B, Sadat N, Boeken U, Westenfeld R, Lichtenberg A, Saeed D. Implantation of a Left Ventricular Assist Device in a Patient with a Congenitally Corrected Transposition of the Great Arteries and a Situs Inversus Totalis. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R. Wieloch
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - A. Albert
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - B. Maxhera
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - N. Sadat
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - U. Boeken
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - R. Westenfeld
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - A. Lichtenberg
- Klink für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - D. Saeed
- Klink für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Dieleman JL, Schneider MT, Haakenstad A, Singh L, Sadat N, Birger M, Reynolds A, Templin T, Hamavid H, Chapin A, Murray CJL. Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet 2016; 387:2536-44. [PMID: 27086170 DOI: 10.1016/s0140-6736(16)30168-4] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Disbursements of development assistance for health (DAH) have risen substantially during the past several decades. More recently, the international community's attention has turned to other international challenges, introducing uncertainty about the future of disbursements for DAH. METHODS We collected audited budget statements, annual reports, and project-level records from the main international agencies that disbursed DAH from 1990 to the end of 2015. We standardised and combined records to provide a comprehensive set of annual disbursements. We tracked each dollar of DAH back to the source and forward to the recipient. We removed transfers between agencies to avoid double-counting and adjusted for inflation. We classified assistance into nine primary health focus areas: HIV/AIDS, tuberculosis, malaria, maternal health, newborn and child health, other infectious diseases, non-communicable diseases, Ebola, and sector-wide approaches and health system strengthening. For our statistical analysis, we grouped these health focus areas into two categories: MDG-related focus areas (HIV/AIDS, tuberculosis, malaria, child and newborn health, and maternal health) and non-MDG-related focus areas (other infectious diseases, non-communicable diseases, sector-wide approaches, and other). We used linear regression to test for structural shifts in disbursement patterns at the onset of the Millennium Development Goals (MDGs; ie, from 2000) and the global financial crisis (impact estimated to occur in 2010). We built on past trends and associations with an ensemble model to estimate DAH through the end of 2040. FINDINGS In 2015, US$36·4 billion of DAH was disbursed, marking the fifth consecutive year of little change in the amount of resources provided by global health development partners. Between 2000 and 2009, DAH increased at 11·3% per year, whereas between 2010 and 2015, annual growth was just 1·2%. In 2015, 29·7% of DAH was for HIV/AIDS, 17·9% was for child and newborn health, and 9·8% was for maternal health. Linear regression identifies three distinct periods of growth in DAH. Between 2000 and 2009, MDG-related DAH increased by $290·4 million (95% uncertainty interval [UI] 174·3 million to 406·5 million) per year. These increases were significantly greater than were increases in non-MDG DAH during the same period (p=0·009), and were also significantly greater than increases in the previous period (p<0·0001). Between 2000 and 2009, growth in DAH was highest for HIV/AIDS, malaria, and tuberculosis. Since 2010, DAH for maternal health and newborn and child health has continued to climb, although DAH for HIV/AIDS and most other health focus areas has remained flat or decreased. Our estimates of future DAH based on past trends and associations present a wide range of potential futures, although our mean estimate of $64·1 billion (95% UI $30·4 billion to $161·8 billion) shows an increase between now and 2040, although with a large uncertainty interval. INTERPRETATION Our results provide evidence of two substantial shifts in DAH growth during the past 26 years. DAH disbursements increased faster in the first decade of the 2000s than in the 1990s, but DAH associated with the MDGs increased the most out of all focus areas. Since 2010, limited growth has characterised DAH and we expect this pattern to persist. Despite the fact that DAH is still growing, albeit minimally, DAH is shifting among the major health focus areas, with relatively little growth for HIV/AIDS, malaria, and tuberculosis. These changes in the growth and focus of DAH will have critical effects on health services in some low-income countries. Coordination and collaboration between donors and domestic governments is more important than ever because they have a great opportunity and responsibility to ensure robust health systems and service provision for those most in need. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | | | - Lavanya Singh
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Maxwell Birger
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Alex Reynolds
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Tara Templin
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Hannah Hamavid
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Abigail Chapin
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
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Dieleman JL, Templin T, Sadat N, Reidy P, Chapin A, Foreman K, Haakenstad A, Evans T, Murray CJL, Kurowski C. National spending on health by source for 184 countries between 2013 and 2040. Lancet 2016; 387:2521-35. [PMID: 27086174 DOI: 10.1016/s0140-6736(16)30167-2] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [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] [Indexed: 01/15/2023]
Abstract
BACKGROUND A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at similar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected. METHODS We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks. FINDINGS Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42-22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9-3·4) in high-income countries, 3·4% (2·4-4·2) in upper-middle-income countries, 3·0% (2·3-3·6) in lower-middle-income countries, and 2·4% (1·6-3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending. INTERPRETATION Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Tara Templin
- Institute for Heath Metrics and Evaluation, Seattle, WA, USA
| | - Nafis Sadat
- Institute for Heath Metrics and Evaluation, Seattle, WA, USA
| | - Patrick Reidy
- Institute for Heath Metrics and Evaluation, Seattle, WA, USA
| | - Abigail Chapin
- Institute for Heath Metrics and Evaluation, Seattle, WA, USA
| | - Kyle Foreman
- Institute for Heath Metrics and Evaluation, Seattle, WA, USA
| | | | - Tim Evans
- World Bank Group, Washington, DC, USA
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Templin T, Sadat N, Chapin A, Dieleman JL. Estimating future health spending by source in 184 countries, 2013–2040. The Lancet Global Health 2016. [DOI: 10.1016/s2214-109x(16)30038-9] [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: 10/22/2022] Open
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Poudel-Bochmann B, Sadat N, Pinto A, Barth M, Fomin A, Albert A, Boeken U, Lichtenberg A, Akhyari P. Insulin-like growth factor-1 in calcified human aortic valves. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332621] [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: 10/27/2022]
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Poulsen S, Beiruti N, Sadat N. A comparison of retention and the effect on caries of fissure sealing with a glass-ionomer and a resin-based sealant. Community Dent Oral Epidemiol 2001; 29:298-301. [PMID: 11515644 DOI: 10.1034/j.1600-0528.2001.290409.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the retention and the caries preventive effect of a glass-ionomer developed for fissure sealing (Fuji III) and a chemically polymerized resin-based fissure sealant (Delton). DESIGN A split mouth randomized design using contralateral teeth. SETTING WHO Regional Demonstration, Training and Research Center for Oral Health, Damascus, Syrian Arab Republic. SAMPLE AND METHODS 179 children, 7 years old at the start of the study, were recruited from schools close to the Center. Only children with at least one pair of permanent first molars that were caries free or only had incipient lesions were included in the study. Follow-up examinations for sealant retention were done after 6 months, 1 year, 2 years and 3 years. The number of children available for reexamination was 129 (after 6 months); 121 (after 1 year); 115 (after 2 years) and 116 (after 3 years). Four dental hygienists were trained in the sealant procedures and did approximately one fourth of the sealants each. RESULTS After 3 years the glass-ionomer sealant was completely lost in almost 90% of the teeth compared to less than 10% of the resin sealed teeth. After 3 years the relative risk of a tooth sealed with glass-ionomer over that of a tooth sealed with resin was 3.38 (95% CL: 1.98; 5.79). This finding was consistent over type of tooth. CONCLUSIONS The glass-ionomer sealant tested in the present study had poorer retention and less caries protective effect than the resin-based sealant used.
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Affiliation(s)
- S Poulsen
- Department of Community Oral Health and Pediatric Dentistry, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark.
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