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Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abolhassani H, Aboyans V, Abrams EM, Abreu LG, Abrigo MRM, Abu-Raddad LJ, Abushouk AI, Acebedo A, Ackerman IN, Adabi M, Adamu AA, Adebayo OM, Adekanmbi V, Adelson JD, Adetokunboh OO, Adham D, Afshari M, Afshin A, Agardh EE, Agarwal G, Agesa KM, Aghaali M, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmadpour E, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Al-Aly Z, Alam K, Alam N, Alam S, Alam T, Alanzi TM, Albertson SB, Alcalde-Rabanal JE, Alema NM, Ali M, Ali S, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Aminorroaya A, Amiri F, Amit AML, Amugsi DA, Amul GGH, Anderlini D, Andrei CL, Andrei T, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Ariani F, Ärnlöv J, Aryal KK, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari B, Ashbaugh C, Atnafu DD, Atre SR, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, Babaee E, Badawi A, Bagherzadeh M, Bakhshaei MH, Bakhtiari A, Balakrishnan S, Balalla S, Balassyano S, Banach M, Banik PC, Bannick MS, Bante AB, Baraki AG, Barboza MA, Barker-Collo SL, Barthelemy CM, Barua L, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Beghi E, Béjot Y, Bello AK, Bender RG, Bennett DA, Bennitt FB, Bensenor IM, Benziger CP, Berhe K, Bernabe E, Bertolacci GJ, Bhageerathy R, Bhala N, Bhandari D, Bhardwaj P, Bhattacharyya K, Bhutta ZA, Bibi S, Biehl MH, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisanzio D, Bisignano C, Biswas RK, Bohlouli S, Bohluli M, Bolla SRR, Boloor A, Boon-Dooley AS, Borges G, Borzì AM, Bourne R, Brady OJ, Brauer M, Brayne C, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko NI, Britton GB, Bryazka D, Buchbinder R, Bumgarner BR, Busse R, Butt ZA, Caetano dos Santos FL, Cámera LLAA, Campos-Nonato IR, Car J, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castle CD, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang AR, Charlson FJ, Chattu VK, Chaturvedi S, Chimed-Ochir O, Chin KL, Cho DY, Christensen H, Chu DT, Chung MT, Cicuttini FM, Ciobanu LG, Cirillo M, Collins EL, Compton K, Conti S, Cortesi PA, Costa VM, Cousin E, Cowden RG, Cowie BC, Cromwell EA, Cross DH, Crowe CS, Cruz JA, Cunningham M, Dahlawi SMA, Damiani G, Dandona L, Dandona R, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davletov K, De Leo D, Dean FE, DeCleene NK, Deen A, Degenhardt L, Dellavalle RP, Demeke FM, Demsie DG, Denova-Gutiérrez E, Dereje ND, Dervenis N, Desai R, Desalew A, Dessie GA, Dharmaratne SD, Dhungana GP, Dianatinasab M, Diaz D, Dibaji Forooshani ZS, Dingels ZV, Dirac MA, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshi CP, Doshmangir L, Douiri A, Doxey MC, Driscoll TR, Dunachie SJ, Duncan BB, Duraes AR, Eagan AW, Ebrahimi Kalan M, Edvardsson D, Ehrlich JR, El Nahas N, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, Elhabashy HR, El-Jaafary SI, Elyazar IRF, Emamian MH, Emmons-Bell S, Erskine HE, Eshrati B, Eskandarieh S, Esmaeilnejad S, Esmaeilzadeh F, Esteghamati A, Estep K, Etemadi A, Etisso AE, Farahmand M, Faraj A, Fareed M, Faridnia R, Farinha CSES, Farioli A, Faro A, Faruque M, Farzadfar F, Fattahi N, Fazlzadeh M, Feigin VL, Feldman R, Fereshtehnejad SM, Fernandes E, Ferrari AJ, Ferreira ML, Filip I, Fischer F, Fisher JL, Fitzgerald R, Flohr C, Flor LS, Foigt NA, Folayan MO, Force LM, Fornari C, Foroutan M, Fox JT, Freitas M, Fu W, Fukumoto T, Furtado JM, Gad MM, Gakidou E, Galles NC, Gallus S, Gamkrelidze A, Garcia-Basteiro AL, Gardner WM, Geberemariyam BS, Gebrehiwot AM, Gebremedhin KB, Gebreslassie AAAA, Gershberg Hayoon A, Gething PW, Ghadimi M, Ghadiri K, Ghafourifard M, Ghajar A, Ghamari F, Ghashghaee A, Ghiasvand H, Ghith N, Gholamian A, Gilani SA, Gill PS, Gitimoghaddam M, Giussani G, Goli S, Gomez RS, Gopalani SV, Gorini G, Gorman TM, Gottlich HC, Goudarzi H, Goulart AC, Goulart BNG, Grada A, Grivna M, Grosso G, Gubari MIM, Gugnani HC, Guimaraes ALS, Guimarães RA, Guled RA, Guo G, Guo Y, Gupta R, Haagsma JA, Haddock B, Hafezi-Nejad N, Hafiz A, Hagins H, Haile LM, Hall BJ, Halvaei I, Hamadeh RR, Hamagharib Abdullah K, Hamilton EB, Han C, Han H, Hankey GJ, Haro JM, Harvey JD, Hasaballah AI, Hasanzadeh A, Hashemian M, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay RJ, Hay SI, Hayat K, Heidari B, Heidari G, Heidari-Soureshjani R, Hendrie D, Henrikson HJ, Henry NJ, Herteliu C, Heydarpour F, Hird TR, Hoek HW, Hole MK, Holla R, Hoogar P, Hosgood HD, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hsairi M, Hsieh VCR, Hu G, Huda TM, Hugo FN, Huynh CK, Hwang BF, Iannucci VC, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Ippolito H, Irvani SSN, Islam MM, Islam M, Islam SMS, Islami F, Iso H, Ivers RQ, Iwu CCD, Iyamu IO, Jaafari J, Jacobsen KH, Jadidi-Niaragh F, Jafari H, Jafarinia M, Jahagirdar D, Jahani MA, Jahanmehr N, Jakovljevic M, Jalali A, Jalilian F, James SL, Janjani H, Janodia MD, Jayatilleke AU, Jeemon P, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, John O, John-Akinola YO, Johnson CO, Johnson SC, Jonas JB, Joo T, Joshi A, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalani H, Kalani R, Kalankesh LR, Kalhor R, Kamiab Z, Kanchan T, Karami Matin B, Karch A, Karim MA, Karimi SE, Kassa GM, Kassebaum NJ, Katikireddi SV, Kawakami N, Kayode GA, Keddie SH, Keller C, Kereselidze M, Khafaie MA, Khalid N, Khan M, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khodayari MT, Khundkar R, Kianipour N, Kieling C, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kissimova-Skarbek K, Kivimäki M, Kneib CJ, Knudsen AKS, Kocarnik JM, Kolola T, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kumar P, Kumar V, Kumaresh G, Kurmi OP, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lam JO, Lami FH, Landires I, Lang JJ, Lansingh VC, Larson SL, Larsson AO, Lasrado S, Lassi ZS, Lau KMM, Lavados PM, Lazarus JV, Ledesma JR, Lee PH, Lee SWH, LeGrand KE, Leigh J, Leonardi M, Lescinsky H, Leung J, Levi M, Lewington S, Li S, Lim LL, Lin C, Lin RT, Linehan C, Linn S, Liu HC, Liu S, Liu Z, Looker KJ, Lopez AD, Lopukhov PD, Lorkowski S, Lotufo PA, Lucas TCD, Lugo A, Lunevicius R, Lyons RA, Ma J, MacLachlan JH, Maddison ER, Maddison R, Madotto F, Mahasha PW, Mai HT, Majeed A, Maled V, Maleki S, Malekzadeh R, Malta DC, Mamun AA, Manafi A, Manafi N, Manguerra H, Mansouri B, Mansournia MA, Mantilla Herrera AM, Maravilla JC, Marks A, Martins-Melo FR, Martopullo I, Masoumi SZ, Massano J, Massenburg BB, Mathur MR, Maulik PK, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehri F, Mehta KM, Meitei WB, Memiah PTN, Mendoza W, Menezes RG, Mengesha EW, Mengesha MB, Mereke A, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Mihretie KM, Miller TR, Mills EJ, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Mirzaei-Alavijeh M, Misganaw AT, Mithra P, Moazen B, Moghadaszadeh M, Mohamadi E, Mohammad DK, Mohammad Y, Mohammad Gholi Mezerji N, Mohammadian-Hafshejani A, Mohammadifard N, Mohammadpourhodki R, Mohammed S, Mokdad AH, Molokhia M, Momen NC, Monasta L, Mondello S, Mooney MD, Moosazadeh M, Moradi G, Moradi M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Morales L, Morawska L, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Mosser JF, Mouodi S, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Munro SB, Muriithi MK, Musa KI, Muthupandian S, Naderi M, Nagarajan AJ, Nagel G, Naghshtabrizi B, Nair S, Nandi AK, Nangia V, Nansseu JR, Nayak VC, Nazari J, Negoi I, Negoi RI, Netsere HBN, Ngunjiri JW, Nguyen CT, Nguyen J, Nguyen M, Nguyen M, Nichols E, Nigatu D, Nigatu YT, Nikbakhsh R, Nixon MR, Nnaji CA, Nomura S, Norrving B, Noubiap JJ, Nowak C, Nunez-Samudio V, Oţoiu A, Oancea B, Odell CM, Ogbo FA, Oh IH, Okunga EW, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Oluwasanu MM, Omar Bali A, Omer MO, Ong KL, Onwujekwe OE, Orji AU, Orpana HM, Ortiz A, Ostroff SM, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakhare AP, Palladino R, Pana A, Panda-Jonas S, Pandey A, Park EK, Parmar PGK, Pasupula DK, Patel SK, Paternina-Caicedo AJ, Pathak A, Pathak M, Patten SB, Patton GC, Paudel D, Pazoki Toroudi H, Peden AE, Pennini A, Pepito VCF, Peprah EK, Pereira A, Pereira DM, Perico N, Pham HQ, Phillips MR, Pigott DM, Pilgrim T, Pilz TM, Pirsaheb M, Plana-Ripoll O, Plass D, Pokhrel KN, Polibin RV, Polinder S, Polkinghorne KR, Postma MJ, Pourjafar H, Pourmalek F, Pourmirza Kalhori R, Pourshams A, Poznańska A, Prada SI, Prakash V, Pribadi DRA, Pupillo E, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiee A, Rafiei A, Raggi A, Rahimi-Movaghar A, Rahman MA, Rajabpour-Sanati A, Rajati F, Ramezanzadeh K, Ranabhat CL, Rao PC, Rao SJ, Rasella D, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawal L, Razo C, Redford SB, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezai MS, Rezapour A, Rhinehart PA, Riahi SM, Ribeiro ALP, Ribeiro DC, Ribeiro D, Rickard J, Roberts NLS, Roberts S, Robinson SR, Roever L, Rolfe S, Ronfani L, Roshandel G, Roth GA, Rubagotti E, Rumisha SF, Sabour S, Sachdev PS, Saddik B, Sadeghi E, Sadeghi M, Saeidi S, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salahshoor MR, Salamati P, Salehi Zahabi S, Salem H, Salem MRR, Salimzadeh H, Salomon JA, Salz I, Samad Z, Samy AM, Sanabria J, Santomauro DF, Santos IS, Santos JV, Santric-Milicevic MM, Saraswathy SYI, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Sbarra AN, Schaeffer LE, Schiavolin S, Schmidt MI, Schutte AE, Schwebel DC, Schwendicke F, Senbeta AM, Senthilkumaran S, Sepanlou SG, Shackelford KA, Shadid J, Shahabi S, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharara F, Sheena BS, Sheikhtaheri A, Shetty RS, Shibuya K, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shirkoohi R, Shrime MG, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Simpson KE, Singh A, Singh JA, Skiadaresi E, Skou ST, Skryabin VY, Sobngwi E, Sokhan A, Soltani S, Sorensen RJD, Soriano JB, Sorrie MB, Soyiri IN, Sreeramareddy CT, Stanaway JD, Stark BA, Ştefan SC, Stein C, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Stubbs JL, Sudaryanto A, Sufiyan MB, Sulo G, Sultan I, Sykes BL, Sylte DO, Szócska M, Tabarés-Seisdedos R, Tabb KM, Tadakamadla SK, Taherkhani A, Tajdini M, Takahashi K, Taveira N, Teagle WL, Teame H, Tehrani-Banihashemi A, Teklehaimanot BF, Terrason S, Tessema ZT, Thankappan KR, Thomson AM, Tohidinik HR, Tonelli M, Topor-Madry R, Torre AE, Touvier M, Tovani-Palone MRR, Tran BX, Travillian R, Troeger CE, Truelsen TC, Tsai AC, Tsatsakis A, Tudor Car L, Tyrovolas S, Uddin R, Ullah S, Undurraga EA, Unnikrishnan B, Vacante M, Vakilian A, Valdez PR, Varughese S, Vasankari TJ, Vasseghian Y, Venketasubramanian N, Violante FS, Vlassov V, Vollset SE, Vongpradith A, Vukovic A, Vukovic R, Waheed Y, Walters MK, Wang J, Wang Y, Wang YP, Ward JL, Watson A, Wei J, Weintraub RG, Weiss DJ, Weiss J, Westerman R, Whisnant JL, Whiteford HA, Wiangkham T, Wiens KE, Wijeratne T, Wilner LB, Wilson S, Wojtyniak B, Wolfe CDA, Wool EE, Wu AM, Wulf Hanson S, Wunrow HY, Xu G, Xu R, Yadgir S, Yahyazadeh Jabbari SH, Yamagishi K, Yaminfirooz M, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeheyis TY, Yeshitila YG, Yip P, Yonemoto N, Yoon SJ, Yoosefi Lebni J, Younis MZ, Younker TP, Yousefi Z, Yousefifard M, Yousefinezhadi T, Yousuf AY, Yu C, Yusefzadeh H, Zahirian Moghadam T, Zaki L, Zaman SB, Zamani M, Zamanian M, Zandian H, Zangeneh A, Zastrozhin MS, Zewdie KA, Zhang Y, Zhang ZJ, Zhao JT, Zhao Y, Zheng P, Zhou M, Ziapour A, Zimsen SRM, Naghavi M, Murray CJL. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1204-1222. [PMID: 33069326 PMCID: PMC7567026 DOI: 10.1016/s0140-6736(20)30925-9] [Citation(s) in RCA: 8936] [Impact Index Per Article: 1787.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING Bill & Melinda Gates Foundation.
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Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atafar Z, Atnafu DD, Atout MMW, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Azene ZN, Badawi A, Badiye AD, Bahrami MA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Baldasseroni A, Ball K, Ballew SH, Balzi D, Banach M, Banerjee SK, Bante AB, Baraki AG, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barthelemy CM, Barua L, Basu S, Baune BT, Bayati M, Becker JS, Bedi N, Beghi E, Béjot Y, Bell ML, Bennitt FB, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhageerathy R, Bhala N, Bhandari D, Bhattacharyya K, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisignano C, Biswas RK, Bitew H, Bohlouli S, Bohluli M, Boon-Dooley AS, Borges G, Borzì AM, Borzouei S, Bosetti C, Boufous S, Braithwaite D, Breitborde NJK, Breitner S, Brenner H, Briant PS, Briko AN, Briko NI, Britton GB, Bryazka D, Bumgarner BR, Burkart K, Burnett RT, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cahill LE, 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Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1223-1249. [PMID: 33069327 PMCID: PMC7566194 DOI: 10.1016/s0140-6736(20)30752-2] [Citation(s) in RCA: 4570] [Impact Index Per Article: 914.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING Bill & Melinda Gates Foundation.
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Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20:795-820. [PMID: 34487721 PMCID: PMC8443449 DOI: 10.1016/s1474-4422(21)00252-0] [Citation(s) in RCA: 2517] [Impact Index Per Article: 629.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. METHODS We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. FINDINGS In 2019, there were 12·2 million (95% UI 11·0-13·6) incident cases of stroke, 101 million (93·2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6·55 million (6·00-7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8-12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1-6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0-73·0), prevalent strokes increased by 85·0% (83·0-88·0), deaths from stroke increased by 43·0% (31·0-55·0), and DALYs due to stroke increased by 32·0% (22·0-42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0-18·0), mortality decreased by 36·0% (31·0-42·0), prevalence decreased by 6·0% (5·0-7·0), and DALYs decreased by 36·0% (31·0-42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0-24·0) and incidence rates increased by 15·0% (12·0-18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5-3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5-3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57-8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97-3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01-1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7-90·8] DALYs or 55·5% [48·2-62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3-48·6] DALYs or 24·3% [15·7-33·2]), high fasting plasma glucose (28·9 million [19·8-41·5] DALYs or 20·2% [13·8-29·1]), ambient particulate matter pollution (28·7 million [23·4-33·4] DALYs or 20·1% [16·6-23·0]), and smoking (25·3 million [22·6-28·2] DALYs or 17·6% [16·4-19·0]). INTERPRETATION The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. FUNDING Bill & Melinda Gates Foundation.
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Wang H, Abbas KM, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abolhassani H, Abreu LG, Abrigo MRM, Abushouk AI, Adabi M, Adair T, Adebayo OM, Adedeji IA, Adekanmbi V, Adeoye AM, Adetokunboh OO, Advani SM, Afshin A, Aghaali M, Agrawal A, Ahmadi K, Ahmadieh H, Ahmed MB, Al-Aly Z, Alam K, Alam T, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Ali M, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Alizade H, Aljunid SM, Allebeck P, Almadi MAH, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Amini-Rarani M, Aminorroaya A, Amit AML, Ancuceanu R, Andrei CL, Androudi S, Angus C, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Anvari D, Appiah SCY, Arabloo J, Arab-Zozani M, Aravkin AY, Aremu O, Ärnlöv J, Aryal KK, Asadi-Pooya AA, Asgari S, Asghari Jafarabadi M, Atteraya MS, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azarian G, Babaee E, Badiye AD, Bagli E, Bahrami MA, Bakhtiari A, Balassyano S, Banach M, Banik PC, Barker-Collo SL, Bärnighausen TW, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Bell ML, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bertolacci GJ, Bhageerathy R, Bhala N, Bhattacharyya K, Bhutta ZA, Bijani A, Biondi A, Bisanzio D, Bisignano C, Biswas RK, Bjørge T, Bohlouli S, Bohluli M, Bolla SRR, Borzì AM, Borzouei S, Brady OJ, Braithwaite D, Brauer M, Briko AN, Briko NI, Bumgarner BR, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cai T, Callender CSKH, Cámera LLAA, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castelpietra G, Castro F, Catalá-López F, Cederroth CR, Cerin E, Chattu VK, Chin KL, Chu DT, Ciobanu LG, Cirillo M, Comfort H, Costa VM, Cowden RG, Cromwell EA, Croneberger AJ, Cunningham M, Dahlawi SMA, Damiani G, D'Amico E, Dandona L, Dandona R, Dargan PI, Darwesh AM, Daryani A, Das Gupta R, das Neves J, Davletov K, De Leo D, Denova-Gutiérrez E, Deribe K, Dervenis N, Desai R, Dhungana GP, Dias da Silva D, Diaz D, Dippenaar IN, Djalalinia S, Do HT, Dokova K, Doku DT, Dorostkar F, Doshi CP, Doshmangir L, Doyle KE, Dubljanin E, Duraes AR, Edvardsson D, Effiong A, El Sayed I, El Tantawi M, Elbarazi I, El-Jaafary SI, Emamian MH, Eskandarieh S, Esmaeilzadeh F, Estep K, Farahmand M, Faraj A, Fareed M, Faridnia R, Faro A, Farzadfar F, Fattahi N, Fazaeli AA, Fazlzadeh M, Feigin VL, Fereshtehnejad SM, Fernandes E, Ferreira ML, Filip I, Fischer F, Flohr C, Foigt NA, Folayan MO, Fomenkov AA, Freitas M, Fukumoto T, Fuller JE, Furtado JM, Gad MM, Gakidou E, Gallus S, Gebrehiwot AM, Gebremedhin KB, Gething PW, Ghamari F, Ghashghaee A, Gholamian A, Gilani SA, Gitimoghaddam M, Glushkova EV, Gnedovskaya EV, Gopalani SV, Goulart AC, Gugnani HC, Guo Y, Gupta R, Gupta SS, Haagsma JA, Haj-Mirzaian A, Haj-Mirzaian A, Halvaei I, Hamadeh RR, Hamagharib Abdullah K, Han C, Handiso DW, Hankey GJ, Haririan H, Haro JM, Hasaballah AI, Hassanipour S, Hassankhani H, Hay SI, Heibati B, Heidari-Soureshjani R, Henny K, Henry NJ, Herteliu C, Heydarpour F, Hole MK, Hoogar P, Hosgood HD, Hossain N, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hu G, Huda TM, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Imani-Nasab MH, Islam M, Iso H, Iwu CJ, Jaafari J, Jacobsen KH, Jahagirdar D, Jahanmehr N, Jalali A, Jalilian F, James SL, Janjani H, Jenabi E, Jha RP, Jha V, Ji JS, Jonas JB, Joukar F, Jozwiak JJ, Jürisson M, Kabir Z, Kalani H, Kalankesh LR, Kamiab Z, Kanchan T, Kapoor N, Karch A, Karimi SE, Karimi SA, Kassebaum NJ, Katikireddi SV, Kawakami N, Kayode GA, Keiyoro PN, Keller C, Khader YS, Khalid N, Khan EA, Khan M, Khang YH, Khater AM, Khater MM, Khazaei S, Khazaie H, Khodayari MT, Khubchandani J, Kianipour N, Kim CI, Kim YE, Kim YJ, Kinfu Y, Kisa A, Kisa S, Kissimova-Skarbek K, Kivimäki M, Komaki H, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kumar GA, Kumar M, Kumar P, Kumar V, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lami FH, Lansky S, Larson SL, Larsson AO, Lasrado S, Lassi ZS, Lazarus JV, Lee PH, Lee SWH, Leever AT, LeGrand KE, Leonardi M, Li S, Lim LL, Lim SS, Linn S, Lodha R, Logroscino G, Lopez AD, Lopukhov PD, Lotufo PA, Lozano R, Lu A, Lunevicius R, Madadin M, Maddison ER, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahasha PW, Mahdavi MM, Malekzadeh R, Mamun AA, Manafi N, Mansour-Ghanaei F, Mansouri B, Mansournia MA, Mapoma CC, Martini S, Martins-Melo FR, Masaka A, Mastrogiacomo CI, Mathur MR, May EA, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehri F, Mehta KM, Meitei WB, Memiah PTN, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Meretoja A, Meretoja TJ, Mestrovic T, Michalek IM, Mihretie KM, Miller TR, Mills EJ, Milne GJ, Mirrakhimov EM, Mirzaei H, Mirzaei M, Mirzaei-Alavijeh M, Misganaw AT, Moazen B, Moghadaszadeh M, Mohamadi E, Mohammad DK, Mohammad Y, Mohammad Gholi Mezerji N, Mohammadbeigi A, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed H, Mohammed S, Mohebi F, Mohseni Bandpei MA, Mokari A, Mokdad AH, Momen NC, Monasta L, Mooney MD, Moradi G, Moradi M, Moradi-Joo M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Mosser JF, Mouodi S, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Musa KI, Muthupandian S, Nabavizadeh B, Naderi M, Nagarajan AJ, Naghavi M, Naghshtabrizi B, Naik G, Najafi F, Nangia V, Nansseu JR, Ndwandwe DE, Negoi I, Negoi RI, Ngunjiri JW, Nguyen HLT, Nguyen TH, Nigatu YT, Nikbakhsh R, Nikpoor AR, Nixon MR, Nnaji CA, Nomura S, Noubiap JJ, Nouraei Motlagh S, Nowak C, Oţoiu A, Odell CM, Oh IH, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Omar Bali A, Ong KL, Onwujekwe OE, Ortiz A, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakshir K, Palladino R, Pana A, Panda-Jonas S, Park J, Pasupula DK, Patel JR, Patel SK, Patton GC, Paulson KR, Pazoki Toroudi H, Pease SA, Peden AE, Pepito VCF, Peprah EK, Pereira A, Pereira DM, Perico N, Pigott DM, Pilgrim T, Pilz TM, Piradov MA, Pirsaheb M, Pokhrel KN, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Poznańska A, Prada SI, Prakash S, Preotescu L, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiei A, Raggi A, Rahman MA, Rajabpour-Sanati A, Ram P, Ranabhat CL, Rao SJ, Rasella D, Rashedi V, Rastogi P, Rathi P, Rawal L, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezai MS, Rezapour A, Rickard J, Roever L, Ronfani L, Roshandel G, Rostamian M, Rubagotti E, Rwegerera GM, Sabour S, Saddik B, Sadeghi E, Sadeghi M, Saeedi Moghaddam S, Safari Y, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salahshoor MR, Salama JS, Salamati P, Salem MRR, Salimi Y, Salomon JA, Salz I, Samad Z, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Saylan M, Schaeffer LE, Schiavolin S, Schwebel DC, Schwendicke F, Sekerija M, Senbeta AM, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Shabani M, Shahabi S, Shahbaz M, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharafi Z, Sharara F, Sharma R, Shaw DH, Sheikh A, Shin JI, Shiri R, Shrime MG, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Simonetti B, Simpson KE, Singh JA, Skiadaresi E, Skryabin VY, Soheili A, Sokhan A, Sorensen RJD, Soriano JB, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Stockfelt L, Stokes MA, Stubbs JL, Sudaryanto A, Sufiyan MB, Suliankatchi Abdulkader R, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Tadakamadla SK, Taherkhani A, Tang M, Taveira N, Taylor HJ, Teagle WL, Tehrani-Banihashemi A, Teklehaimanot BF, Tessema ZT, Thankappan KR, Thomas N, Thrift AG, Titova MV, Tohidinik HR, Tonelli M, Topor-Madry R, Topouzis F, Tovani-Palone MRR, Traini E, Tran BX, Travillian R, Trias-Llimós S, Truelsen TC, Tudor Car L, Unnikrishnan B, Upadhyay E, Vacante M, Vakilian A, Valdez PR, Valli A, Vardavas C, Vasankari TJ, Vasconcelos AMN, Vasseghian Y, Veisani Y, Venketasubramanian N, Vidale S, Violante FS, Vlassov V, Vollset SE, Vos T, Vujcic IS, Vukovic A, Vukovic R, Waheed Y, Wallin MT, Walters MK, Wang H, Wang YP, Watson S, Wei J, Weiss J, Weldesamuel GT, Werdecker A, Westerman R, Whiteford HA, Wiangkham T, Wiens KE, Wijeratne T, Wiysonge CS, Wojtyniak B, Wolfe CDA, Wondmieneh AB, Wool EE, Wu AM, Wu J, Xu G, Yamada T, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeheyis TY, Yilgwan CS, Yip P, Yonemoto N, Yoon SJ, Yoosefi Lebni J, York HW, Younis MZ, Younker TP, Yousefi Z, Yousefinezhadi T, Yousuf AY, Yusefzadeh H, Zahirian Moghadam T, Zakzuk J, Zaman SB, Zamani M, Zamanian M, Zandian H, Zhang ZJ, Zheng P, Zhou M, Ziapour A, Murray CJL. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1160-1203. [PMID: 33069325 PMCID: PMC7566045 DOI: 10.1016/s0140-6736(20)30977-6] [Citation(s) in RCA: 1014] [Impact Index Per Article: 202.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/10/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. METHODS 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. FINDINGS The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66-2·79) in 2000 to 2·31 (2·17-2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5-137·8) in 2000 to a peak of 139·6 million (133·0-146·9) in 2016. Global livebirths then declined to 135·3 million (127·2-144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4-27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8-67·6) in 2000 to 73·5 years (72·8-74·3) in 2019. The total number of deaths increased from 50·7 million (49·5-51·9) in 2000 to 56·5 million (53·7-59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1-10·3) in 2000 to 5·0 million (4·3-6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0-6·3) in 2000 to 7·7 billion (7·5-8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1-60·8) in 2000 to 63·5 years (60·8-66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. INTERPRETATION Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. FUNDING Bill & Melinda Gates Foundation.
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Murray CJL, Abbafati C, Abbas KM, Abbasi M, Abbasi-Kangevari M, Abd-Allah F, Abdollahi M, Abedi P, Abedi A, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abu-Gharbieh E, Abu Haimed AK, Abushouk AI, Acebedo A, Ackerman IN, Adabi M, Adamu AA, Adebayo OM, Adelson JD, Adetokunboh OO, Afarideh M, Afshin A, Agarwal G, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmed MB, Aji B, Akinyemiju T, Akombi B, Alahdab F, Alam K, Alanezi FM, Alanzi TM, Albertson SB, Alemu BW, Alemu YM, Alhabib KF, Ali M, Ali S, Alicandro G, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almadi MAH, Almasi-Hashiani A, Al-Mekhlafi HM, Almulhim AM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Amare B, Amare AT, Amini S, Amit AML, Amugsi DA, Anbesu EW, Ancuceanu R, Anderlini D, Anderson JA, Andrei T, Andrei CL, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antony CM, Anvari D, Appiah SCY, Arabloo J, Arab-Zozani M, Aravkin AY, Arba AAK, Aripov T, Ärnlöv J, Arowosegbe OO, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atout MMW, Ausloos M, Ausloos F, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azene ZN, B DB, Babaee E, Badawi A, Badiye AD, Bagherzadeh M, Bairwa M, Bakhtiari A, Bakkannavar SM, Balachandran A, Banach M, Banerjee SK, Banik PC, Baraki AG, Barker-Collo SL, Basaleem H, Basu S, Baune BT, Bayati M, Baye BA, Bedi N, Beghi E, Bell ML, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhala N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Biondi A, Bisignano C, Biswas RK, Bjørge T, Bohlouli S, Bohluli M, Bolla SRR, Boloor A, Bose D, Boufous S, Brady OJ, Braithwaite D, Brauer M, Breitborde NJK, Brenner H, Breusov AV, Briant PS, Briggs AM, Britton GB, Brugha T, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cámera LLAA, Campos-Nonato IR, Campuzano Rincon JC, Car J, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castelpietra G, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang JC, Charan J, Charlson FJ, Chattu VK, Chaturvedi S, Cherbuin N, Chin KL, Chirinos-Caceres JL, Cho DY, Choi JYJ, Chu DT, Chung SC, Chung MT, Cicuttini FM, Cirillo M, Cislaghi B, Cohen AJ, Compton K, Corso B, Cortesi PA, Costa VM, Cousin E, Cowden RG, Cross M, Crowe CS, Cummins S, Dai H, Dai H, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darwesh AM, Das JK, Das Gupta R, das Neves J, Davey G, Dávila-Cervantes CA, Davis AC, De Leo D, Denova-Gutiérrez E, Deribe K, Dervenis N, Desai R, Deuba K, Dhungana GP, Dianatinasab M, Diaz D, Dichgans M, Didarloo A, Dippenaar IN, Dokova K, Dolecek C, Dorostkar F, Doshi PP, Doshi CP, Doshmangir L, Doxey MC, Driscoll TR, Duncan BB, Eagan AW, Ebrahimi H, Ebrahimi Kalan M, Edvardsson D, Ehrlich JR, Elbarazi I, Elgendy IY, El-Jaafary SI, El Sayed Zaki M, Elsharkawy A, El Tantawi M, Elyazar IRF, Emamian MH, Eshrati B, Eskandarieh S, Esteghamati A, Esteghamati S, Fanzo J, Faro A, Farzadfar F, Fattahi N, Feigin VL, Fereshtehnejad SM, Fernandes E, Ferrara P, Ferrari AJ, Filip I, Fischer F, Fisher JL, Fitzgerald R, Foigt NA, Folayan MO, Fomenkov AA, Foroutan M, Franklin RC, Freitas M, Fukumoto T, Furtado JM, Gad MM, Gaidhane AM, Gakidou E, Gallus S, Gardner WM, Geberemariyam BS, Gebremedhin KB, Gebremeskel LG, Gebresillassie BM, Geramo YCD, Gesesew HA, Gething PW, Gezae KE, Ghadiri K, Ghaffarifar F, Ghafourifard M, Ghamari F, Ghashghaee A, Gholamian A, Giampaoli S, Gill PS, Gillum RF, Ginawi IA, Giussani G, Gnedovskaya EV, Godinho MA, Golechha M, Gona PN, Gopalani SV, Gorini G, Goulart BNG, Goulart AC, Grada A, Greaves F, Gudi N, Guimarães RA, Guo Y, Gupta SS, Gupta R, Gupta R, Haagsma JA, Hachinski V, Hafezi-Nejad N, Haile LM, Haj-Mirzaian A, Hall BJ, Hamadeh RR, Hamidi S, Han C, Hankey GJ, Haro JM, Hasaballah AI, Hashi A, Hassan A, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay SI, Hayat K, Henok A, Henry NJ, Herteliu C, Heydarpour F, Ho HC, Hole MK, Holla R, Hoogar P, Hopf KP, Hosgood HD, Hossain N, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hu G, Huda TM, Hugo FN, Humayun A, Hussain R, Hwang BF, Iavicoli I, Ibeneme CU, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Iqbal U, Irvani SSN, Islam MM, Islam SMS, Iso H, Iwu CCD, Jaafari J, Jahagirdar D, Jahani MA, Jakovljevic M, Jalali A, Jalilian F, Janodia MD, Javaheri T, Jenabi E, Jha RP, Jha V, Ji JS, Johnson CO, Jonas JB, Jürisson M, Kabir A, Kabir Z, Kalani R, Kalankesh LR, Kalhor R, Kanchan T, Kapoor N, Karami Matin B, Karch A, Karim MA, Karimi SE, Kasa AS, Kassebaum NJ, Kayode GA, Kazemi Karyani A, Keiyoro P, Khalid N, Khammarnia M, Khan M, Khan EA, Khan G, Khatab K, Khater MM, Khatib MN, Khazaie H, Khoja AT, Khubchandani J, Kianipour N, Kieling C, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa S, Kisa A, Kissoon N, Kivimäki M, Kneib CJ, Knight M, Koh DSQ, Komaki H, Kopec JA, Kosen S, Kotlo A, Koul PA, Koyanagi A, Krishan K, Krohn KJ, KS S, Kumar GA, Kumar N, Kumar M, Kurmi OP, Kusuma D, Kyu HH, Lacey B, Lal DK, Lalloo R, Lallukka T, Lan Q, Landires I, Larson HJ, Lasrado S, Lau KMM, Lauriola P, La Vecchia C, Leal LF, Leasher JL, Ledesma JR, Lee PH, Lee SWH, Leonardi M, Leung J, Li B, Li S, Lim LL, Lin RT, Listl S, Liu X, Liu Y, Logroscino G, Lopez JCF, Lorkowski S, Lozano R, Lu A, Lugo A, Lunevicius R, Lyons RA, Ma J, Machado DB, Maddison ER, Mahasha PW, Mahmoudi M, Majeed A, Maled V, Maleki S, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Manguerra H, Mansouri B, Mansournia MA, Mantilla Herrera AM, Martini S, Martins-Melo FR, Martopullo I, Masoumi SZ, Massenburg BB, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehri F, Mehta KM, Melese A, Memish ZA, Mendoza W, Menezes RG, Mengesha EW, Meretoja TJ, Meretoja A, Mestrovic T, Miazgowski B, Michalek IM, Milne GJ, Miri M, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Mirzaei-Alavijeh M, Misganaw AT, Moazen B, Moghadaszadeh M, Mohajer B, Mohamad O, Mohammad Y, Mohammad DK, Mohammad Gholi Mezerji N, Mohammadian-Hafshejani A, Mohammed S, Mohebi F, Mokdad AH, Molokhia M, Monasta L, Mooney MD, Moradi M, Moradi G, Moradi-Lakeh M, Moradzadeh R, Moraga P, Morawska L, Morgado-da-Costa J, Morrison SD, Mosapour A, Mosser JF, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Mullany EC, Musa KI, Naderi M, Nagarajan AJ, Naghavi M, Naghshtabrizi B, Naimzada MD, Najafi F, Naldi L, Nayak VC, Nazari J, Ndejjo R, Negoi I, Negoi RI, Netsere HBN, Nguefack-Tsague G, Ngunjiri JW, Nguyen DN, Nguyen HLT, Nichols E, Nigatu YT, Nikbakhsh R, Nixon MR, Nnaji CA, Nomura S, Noubiap JJ, Nowak C, Nsoesie EO, Nunez-Samudio V, Ogbo FA, Oghenetega OB, Okunga EW, Oladnabi M, Olagunju AT, Olusanya JO, Olusanya BO, Omar Bali A, Omer MO, Ong S, Ong KL, Onwujekwe OE, Oren E, Ortiz A, Ostroff SM, Oţoiu A, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakhale S, Pakshir K, Palladino R, Pana A, Panda-Jonas S, Parmar PGK, Pathak M, Patton GC, Pazoki Toroudi H, Peden AE, Pepito VCF, Peprah EK, Pereira DM, Pereira A, Pereira J, Perico N, Pescarini JM, Pham HQ, Phillips MR, Piccinelli C, Pilz TM, Pinheiro M, Piradov MA, Pirsaheb M, Pishgar F, Pond CD, Postma MJ, Pottoo FH, Pourjafar H, Pourmalek F, Prada SI, Prasad N, Pribadi DRA, Pupillo E, Quazi Syed Z, Rabiee N, Rabiee M, Radfar A, Rafiee A, Raggi A, Rahman MHU, Rahman MA, Ramezanzadeh K, Ranabhat CL, Ranta A, Rao SJ, Rao PC, Rasella D, Rashedi V, Rastogi P, Rawaf S, Rawaf DL, Rawal L, Rawassizadeh R, Rawat R, Razo C, Regassa LD, Reitsma MB, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezaei N, Rezai MS, Rezapour A, Rhinehart PA, Riahi SM, Ribeiro ALP, Ribeiro DC, Rickard J, Roever L, Romoli M, Ronfani L, Roshandel G, Rubagotti E, Rumisha SF, Rwegerera GM, Saadatagah S, Sabour S, Sachdev PS, Saddik B, Sadeghi M, Sadeghi E, Saeedi Moghaddam S, Sahebkar A, Sahraian MA, Sajadi SM, Salem MRR, Salem H, Salimzadeh H, Salomon JA, Salz I, Samad Z, Samadi Kafil H, Samy AM, Sanabria J, Santomauro DF, 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Thakur B, Thankappan KR, Thapar R, Thomas N, Titova MV, Tlou B, Tonelli M, Topor-Madry R, Torre AE, Touvier M, Tovani-Palone MRR, Tran BX, Travillian R, Uddin R, Ullah I, Unnikrishnan B, Upadhyay E, Vacante M, Vaicekonyte R, Valdez PR, Valli A, Vasankari TJ, Vasseghian Y, Venketasubramanian N, Vidale S, Violante FS, Vlassov V, Vollset SE, Vongpradith A, Vu GT, W/hawariat FG, Waheed Y, Wamai RG, Wang F, Wang H, Wang J, Wang Y, Wang YP, Watson A, Wei J, Weintraub RG, Weiss J, Welay FT, Werdecker A, Westerman R, Whiteford HA, Wiangkham T, Wickramasinghe ND, Wilner LB, Wojtyniak B, Wolfe CDA, Wondmeneh TG, Wu AM, Wu C, Wulf Hanson S, Wunrow HY, Xie Y, Yahyazadeh Jabbari SH, Yamagishi K, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeheyis TY, Yeshitila YG, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Younker TP, Yousefinezhadi T, Yu C, Yu Y, Yuce D, Yusefzadeh H, Zaidi SS, Zaman SB, Zamanian M, Zangeneh A, Zarafshan H, Zastrozhin MS, Zewdie KA, Zhang ZJ, Zhang J, Zhang Y, Zhao XJG, Zhao Y, Zheleva B, Zheng P, Zhu C, Ziapour A, Zimsen SRM, Lopez AD, Vos T, Lim SS. Five insights from the Global Burden of Disease Study 2019. Lancet 2020; 396:1135-1159. [PMID: 33069324 PMCID: PMC7116361 DOI: 10.1016/s0140-6736(20)31404-5] [Citation(s) in RCA: 327] [Impact Index Per Article: 65.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023]
Abstract
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.
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Y, Xu R, Yahyazadeh Jabbari SH, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeshitila YG, Yip P, Yonemoto N, Younis MZ, Yousefi Z, Yousefinezhadi T, Yusefzadeh H, Zadey S, Zahirian Moghadam T, Zaidi SS, Zaki L, Zaman SB, Zamani M, Zamanian M, Zandian H, Zastrozhin MS, Zewdie KA, Zhang Y, Zhao XJG, Zhao Y, Zheng P, Zhu C, Ziapour A, Zlavog BS, Zodpey S, Murray CJL. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1250-1284. [PMID: 32861314 PMCID: PMC7562819 DOI: 10.1016/s0140-6736(20)30750-9] [Citation(s) in RCA: 281] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/05/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. METHODS Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. FINDINGS Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2-47·5) in 1990 to 60·3 (58·7-61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9-3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6-421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0-3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5-1040·3]) residing in south Asia. INTERPRETATION The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC. FUNDING Bill & Melinda Gates Foundation.
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Roshandel G, Khoshnia M, Poustchi H, Hemming K, Kamangar F, Gharavi A, Ostovaneh MR, Nateghi A, Majed M, Navabakhsh B, Merat S, Pourshams A, Nalini M, Malekzadeh F, Sadeghi M, Mohammadifard N, Sarrafzadegan N, Naemi-Tabiei M, Fazel A, Brennan P, Etemadi A, Boffetta P, Thomas N, Marshall T, Cheng KK, Malekzadeh R. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. Lancet 2019; 394:672-683. [PMID: 31448738 DOI: 10.1016/s0140-6736(19)31791-x] [Citation(s) in RCA: 206] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND A fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income and middle-income countries (LMICs). The PolyIran study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease. METHODS The PolyIran study was a two-group, pragmatic, cluster-randomised trial nested within the Golestan Cohort Study (GCS), a cohort study with 50 045 participants aged 40-75 years from the Golestan province in Iran. Clusters (villages) were randomly allocated (1:1) to either a package of non-pharmacological preventive interventions alone (minimal care group) or together with a once-daily polypill tablet (polypill group). Randomisation was stratified by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the unit of randomisation. We used a balanced randomisation algorithm, considering block sizes of 20 and balancing for cluster size or natural log of the cluster size (depending on the skewness within strata). Randomisation was done at a fixed point in time (Jan 18, 2011) by statisticians at the University of Birmingham (Birmingham, UK), independent of the local study team. The non-pharmacological preventive interventions (including educational training about healthy lifestyle-eg, healthy diet with low salt, sugar, and fat content, exercise, weight control, and abstinence from smoking and opium) were delivered by the PolyIran field visit team at months 3 and 6, and then every 6 months thereafter. Two formulations of polypill tablet were used in this study. Participants were first prescribed polypill one (hydrochlorothiazide 12·5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants who developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome-occurrence of major cardiovascular events (including hospitalisation for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)-was centrally assessed by the GCS follow-up team, who were masked to allocation status. We did intention-to-treat analyses by including all participants who met eligibility criteria in the two study groups. The trial was registered with ClinicalTrials.gov, number NCT01271985. FINDINGS Between Feb 22, 2011, and April 15, 2013, we enrolled 6838 individuals into the study-3417 (in 116 clusters) in the minimal care group and 3421 (in 120 clusters) in the polypill group. 1761 (51·5%) of 3421 participants in the polypill group were women, as were 1679 (49·1%) of 3417 participants in the minimal care group. Median adherence to polypill tablets was 80·5% (IQR 48·5-92·2). During follow-up, 301 (8·8%) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9%) of 3421 participants in the polypill group (adjusted hazard ratio [HR] 0·66, 95% CI 0·55-0·80). We found no statistically significant interaction with the presence (HR 0·61, 95% CI 0·49-0·75) or absence of pre-existing cardiovascular disease (0·80; 0·51-1·12; pinteraction=0·19). When restricted to participants in the polypill group with high adherence, the reduction in the risk of major cardiovascular events was even greater compared with the minimal care group (adjusted HR 0·43, 95% CI 0·33-0·55). The frequency of adverse events was similar between the two study groups. 21 intracranial haemorrhages were reported during the 5 years of follow-up-ten participants in the polypill group and 11 participants in the minimal care group. There were 13 physician-confirmed diagnoses of upper gastrointestinal bleeding in the polypill group and nine in the minimal care group. INTERPRETATION Use of polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs. FUNDING Tehran University of Medical Sciences, Barakat Foundation, and Alborz Darou.
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Sadeghi M, Liu W, Zhang TG, Stavropoulos P, Levy B. Role of Photoinduced Charge Carrier Separation Distance in Heterogeneous Photocatalysis: Oxidative Degradation of CH3OH Vapor in Contact with Pt/TiO2 and Cofumed TiO2−Fe2O3. ACTA ACUST UNITED AC 1996. [DOI: 10.1021/jp961335z] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bhatnagar RS, Qian JJ, Wedrychowska A, Sadeghi M, Wu YM, Smith N. Design of biomimetic habitats for tissue engineering with P-15, a synthetic peptide analogue of collagen. TISSUE ENGINEERING 1999; 5:53-65. [PMID: 10207189 DOI: 10.1089/ten.1999.5.53] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In tissues, collagen forms the scaffold for cell attachment and migration, and it modulates cell differentiation and morphogenesis by mediating the flux of chemical and mechanical stimuli. We are constructing biomimetic environments by immobilizing a collagen-derived high-affinity cell-binding peptide P-15 in three-dimensional (3-D) templates. The cell-binding peptide can be expected to transduce mechanical forces. In their physiological environment, periodontal ligament fibroblasts (PDLF) are subject to significant mechanical forces. We have examined the behavior of human PDLF in culture on particulate bovine anorganic bone mineral (ABM) coated with P-15 (ABM-P-15). Greater numbers of cells associated with ABM-P-15 compared to ABM alone. Higher levels of incorporation of radiolabeled precursors in DNA and protein were consistent with the presence of larger numbers of cells on ABM-P-15 compared to ABM cultures. Scanning electron microscopic examination showed that cultures on ABM-P-15 generated highly oriented 3-D colonies of elongated cells and formed copious amounts of fibrous as well as membranous matrix reminiscent of ligamentous structures. PDLF cultured on ABM formed sparse monolayers with little order and a meager matrix. Alizarin Red stained the matrix of particle associated cells and inter-particle cellular bridges in P-15-associated cultures, indicating mineralization. 3-D colony formation and ordering of cells along with increased mineralization suggests that the coupling of cells to the ABM matrix through P-15 may provide a biomimetic environment permissive for cell differentiation and morphogenesis. Our studies suggest that ABM-P-15 templates may be effective as endosseous grafts, and, when seeded with PDLF, these matrices may serve as tissue engineered substitutes for autologous bone grafts.
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Momtazmanesh S, Moghaddam SS, Ghamari SH, Rad EM, Rezaei N, Shobeiri P, Aali A, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abdelmasseh M, Abdoun M, Abdulah DM, Md Abdullah AY, Abedi A, Abolhassani H, Abrehdari-Tafreshi Z, Achappa B, Adane Adane DE, Adane TD, Addo IY, Adnan M, Sakilah Adnani QE, Ahmad S, Ahmadi A, Ahmadi K, Ahmed A, Ahmed A, Rashid TA, Al Hamad H, Alahdab F, Alemayehu A, Alif SM, Aljunid SM, Almustanyir S, Altirkawi KA, Alvis-Guzman N, Dehkordi JA, Amir-Behghadami M, Ancuceanu R, Andrei CL, Andrei T, Antony CM, Anyasodor AE, Arabloo J, Arulappan J, Ashraf T, Athari SS, Attia EF, Ayele MT, Azadnajafabad S, Babu AS, Bagherieh S, Baltatu OC, Banach M, Bardhan M, Barone-Adesi F, Barrow A, Basu S, Bayileyegn NS, Bensenor IM, Bhardwaj N, Bhardwaj P, Bhat AN, Bhattacharyya K, Bouaoud S, Braithwaite D, Brauer M, Butt MH, Butt ZA, Calina D, Cámera LA, Chanie GS, Charalampous P, Chattu VK, Chimed-Ochir O, Chu DT, Cohen AJ, Cruz-Martins N, Dadras O, Darwesh AM, Das S, Debela SA, Delgado-Ortiz L, Dereje D, Dianatinasab M, Diao N, Diaz D, Digesa LE, Dirirsa G, Doku PN, Dongarwar D, Douiri A, Dsouza HL, Eini E, Ekholuenetale M, Ekundayo TC, Mustafa Elagali AE, Elhadi M, Enyew DB, Erkhembayar R, Etaee F, Fagbamigbe AF, Faro A, Fatehizadeh A, Fekadu G, Filip I, Fischer F, Foroutan M, Franklin RC, Gaal PA, Gaihre S, Gaipov A, Gebrehiwot M, Gerema U, Getachew ME, Getachew T, Ghafourifard M, Ghanbari R, Ghashghaee A, Gholami A, Gil AU, Golechha M, Goleij P, Golinelli D, Guadie HA, Gupta B, Gupta S, Gupta VB, Gupta VK, Hadei M, Halwani R, Hanif A, Hargono A, Harorani M, Hartono RK, Hasani H, Hashi A, Hay SI, Heidari M, Hellemons ME, Herteliu C, Holla R, Horita N, Hoseini M, Hosseinzadeh M, Huang J, Hussain S, Hwang BF, Iavicoli I, Ibitoye SE, Ibrahim S, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Ismail NE, Merin J L, Jakovljevic M, Jamshidi E, Janodia MD, Javaheri T, Jayapal SK, Jayaram S, Jha RP, Johnson O, Joo T, Joseph N, Jozwiak JJ, K V, Kaambwa B, Kabir Z, Kalankesh LR, Kalhor R, Kandel H, Karanth SD, Karaye IM, Kassa BG, Kassie GM, Keikavoosi-Arani L, Keykhaei M, Khajuria H, Khan IA, Khan MA, Khan YH, Khreis H, Kim MS, Kisa A, Kisa S, Knibbs LD, Kolkhir P, Komaki S, Kompani F, Koohestani HR, Koolivand A, Korzh O, Koyanagi A, Krishan K, Krohn KJ, Kumar N, Kumar N, Kurmi OP, Kuttikkattu A, La Vecchia C, Lám J, Lan Q, Lasrado S, Latief K, Lauriola P, Lee SW, Lee YH, Legesse SM, Lenzi J, Li MC, Lin RT, Liu G, Liu W, Lo CH, Lorenzovici L, Lu Y, Mahalingam S, Mahmoudi E, Mahotra NB, Malekpour MR, Malik AA, Mallhi TH, Malta DC, Mansouri B, Mathews E, Maulud SQ, Mechili EA, Nasab EM, Menezes RG, Mengistu DA, Mentis AF, Meshkat M, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Mirrakhimov EM, Misganaw A, Mithra P, Moghadasi J, Mohammadi E, Mohammadi M, Mohammadshahi M, Mohammed S, Mohan S, Moka N, Monasta L, Moni MA, Moniruzzaman M, Montazeri F, Moradi M, Mostafavi E, Mpundu-Kaambwa C, Murillo-Zamora E, Murray CJ, Nair TS, Nangia V, Swamy SN, Narayana AI, Natto ZS, Nayak BP, Negash WW, Nena E, Kandel SN, Niazi RK, Nogueira de Sá AT, Nowroozi A, Nzoputam CI, Nzoputam OJ, Oancea B, Obaidur RM, Odukoya OO, Okati-Aliabad H, Okekunle AP, Okonji OC, Olagunju AT, Bali AO, Ostojic SM, A MP, Padron-Monedero A, Padubidri JR, Pahlevan Fallahy MT, Palicz T, Pana A, Park EK, Patel J, Paudel R, Paudel U, Pedersini P, Pereira M, Pereira RB, Petcu IR, Pirestani M, Postma MJ, Prashant A, Rabiee M, Radfar A, Rafiei S, Rahim F, Ur Rahman MH, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmanian V, Rajput P, Rana J, Rao CR, Rao SJ, Rashedi S, Rashidi MM, Ratan ZA, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Razeghinia MS, Mohamed Redwan EM, Rezaei M, Rezaei N, Rezaei N, Rezaeian M, Rodrigues M, Buendia Rodriguez JA, Roever L, Rojas-Rueda D, Rudd KE, Saad AM, Sabour S, Saddik B, Sadeghi E, Sadeghi M, Saeed U, Sahebazzamani M, Sahebkar A, Sahoo H, Sajid MR, Sakhamuri S, Salehi S, Samy AM, Santric-Milicevic MM, Sao Jose BP, Sathian B, Satpathy M, Saya GK, Senthilkumaran S, Seylani A, Shahabi S, Shaikh MA, Shanawaz M, Shannawaz M, Sheikhi RA, Shekhar S, Sibhat MM, Simpson CR, Singh JA, Singh P, Singh S, Skryabin VY, Skryabina AA, Soltani-Zangbar MS, Song S, Soyiri IN, Steiropoulos P, Stockfelt L, Sun J, Takahashi K, Talaat IM, Tan KK, Tat NY, Tat VY, Taye BT, Thangaraju P, Thapar R, Thienemann F, Tiyuri A, Ngoc Tran MT, Tripathy JP, Car LT, Tusa BS, Ullah I, Ullah S, Vacante M, Valdez PR, Valizadeh R, van Boven JF, Vasankari TJ, Vaziri S, Violante FS, Vo B, Wang N, Wei MY, Westerman R, Wickramasinghe ND, Xu S, Xu X, Yadav L, Yismaw Y, Yon DK, Yonemoto N, Yu C, Yu Y, Yunusa I, Zahir M, Zangiabadian M, Zareshahrabadi Z, Zarrintan A, Zastrozhin MS, Zegeye ZB, Zhang Y, Naghavi M, Larijani B, Farzadfar F. Global burden of chronic respiratory diseases and risk factors, 1990-2019: an update from the Global Burden of Disease Study 2019. EClinicalMedicine 2023; 59:101936. [PMID: 37229504 PMCID: PMC7614570 DOI: 10.1016/j.eclinm.2023.101936] [Citation(s) in RCA: 142] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. METHODS Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. FINDINGS In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6-4.3) with a prevalence of 454.6 million cases (417.4-499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4-225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9-3.6) deaths. With 262.4 million (224.1-309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. INTERPRETATION Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries.
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Mehrabi A, Fonouni H, Wente M, Sadeghi M, Eisenbach C, Encke J, Schmied BM, Libicher M, Zeier M, Weitz J, Büchler MW, Schmidt J. Wound complications following kidney and liver transplantation. Clin Transplant 2007; 20 Suppl 17:97-110. [PMID: 17100709 DOI: 10.1111/j.1399-0012.2006.00608.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.
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Sarraf-Zadegan N, Sadri G, Malek Afzali H, Baghaei M, Mohammadi Fard N, Shahrokhi S, Tolooie H, Poormoghaddas M, Sadeghi M, Tavassoli A, Rafiei M, Kelishadi R, Rabiei K, Bashardoost N, Boshtam M, Asgary S, Naderi G, Changiz T, Yousefie A. Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58:309-20. [PMID: 12948036 DOI: 10.2143/ac.58.4.2005288] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Isfahan Healthy Heart Programme (IHHP) is a five to six year comprehensive integrated community-based programme for cardiovascular diseases (CVD) prevention and control via reducing CVD risk factors and improvement of cardiovascular healthy behaviour in a target population. IHHP started late in 1999 and will be finished in 2005-2006. A primary survey was done to collect baseline data from interventional (Isfahan and Najaf-Abad) and reference (Arak) communities. In a two-stage sampling method, we randomly selected 5 to 10 percent of households from randomly selected clusters. Then individuals aged > or = 19 years were selected for the survey. This way, data from 12,600 individuals (6300 in interventional counties and 6300 in the reference county) was collected and stratified according to living area (urban vs. rural) and different age and sex groups. The samples underwent a 30-minute interview to complete validated questionnaires containing questions on demography, socioeconomic status, smoking behaviour, physical activity, nutritional habits and other behaviour regarding CVD. Blood pressure and body mass index (BMI) measurements were done and fasting blood samples were taken for two hours post load plasma glucose (2 hpp), serum (total, HDL and LDL) cholesterol and triglyceride levels. A twelve-lead electrocardiogram was recorded in all persons above 35 years of age. Community-wide surveillance of deaths, hospital discharges, myocardial infarction and stroke registry was carried out in the intervention and control areas. Four to five years of interventions based on different categories such as mass media, community partnerships, health system involvement and policy and legislation have started in the intervention area while Arak will be followed without intervention. Considering the results of the baseline surveys, (assessments needed, the objectives, existing resources and the possibility of national implementation) the interventions were planned. They were set based on specific target groups like school children, women, work-site, health personnel, high-risk persons, and community leaders were actively engaged as decision makers. A series of teams was arranged for planning and implementation of the intervention strategies. Monitoring will be done on small samples to assess the effect of different interventions in the intervention area. While four periodic surveys will be conducted on independent samples to assess health behaviours related to CVD risk factors in the intervention and reference areas, the original pre-intervention subjects aged more than 35 years will be followed in both areas to assess the individual effect of interventions and outcomes like sudden death, fatal and nonfatal MI and stroke. The whole baseline survey will be repeated on the original and an independent sample in both communities at the end of the study.
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Turk-Adawi K, Supervia M, Lopez-Jimenez F, Pesah E, Ding R, Britto RR, Bjarnason-Wehrens B, Derman W, Abreu A, Babu AS, Santos CA, Jong SK, Cuenza L, Yeo TJ, Scantlebury D, Andersen K, Gonzalez G, Giga V, Vulic D, Vataman E, Cliff J, Kouidi E, Yagci I, Kim C, Benaim B, Estany ER, Fernandez R, Radi B, Gaita D, Simon A, Chen SY, Roxburgh B, Martin JC, Maskhulia L, Burdiat G, Salmon R, Lomelí H, Sadeghi M, Sovova E, Hautala A, Tamuleviciute-Prasciene E, Ambrosetti M, Neubeck L, Asher E, Kemps H, Eysymontt Z, Farsky S, Hayward J, Prescott E, Dawkes S, Santibanez C, Zeballos C, Pavy B, Kiessling A, Sarrafzadegan N, Baer C, Thomas R, Hu D, Grace SL. Cardiac Rehabilitation Availability and Density around the Globe. EClinicalMedicine 2019; 13:31-45. [PMID: 31517261 PMCID: PMC6737209 DOI: 10.1016/j.eclinm.2019.06.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. METHODS A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. FINDINGS CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35-1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04-1.06), and significantly lower with private (OR = .92, 95%CI = .91-.93) or public (OR = .83, 95%CI = .82-84) funding compared to hybrid sources.Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150-390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. INTERPRETATION CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.
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Sadeghi M, Naderi-Manesh H, Zarrabi M, Ranjbar B. Effective factors in thermostability of thermophilic proteins. Biophys Chem 2005; 119:256-70. [PMID: 16253416 DOI: 10.1016/j.bpc.2005.09.018] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 09/13/2005] [Accepted: 09/14/2005] [Indexed: 11/26/2022]
Abstract
Thermostability of proteins in general and especially thermophilic proteins has been subject of a wide variety of studies based on theoretical and experimental investigation. Thermostability seems to be a property obtained through many minor structural modifications rather than certain amino acids substitution. In comparison with its mesophile homologue in a thermostable protein, usually a number of amino acids are exchanged. A wide variety of theoretical studies are based on comparative investigation of thermophilic proteins characteristics with their mesophilic counterparts in order to reveal their sequences, structural differences and consequently, to relate these observed differences to the thermostability properties. In this work we have compared a dataset of thermophilic proteins with their mesophilic homologues and furthermore, a mesophilic proteins dataset was also compared with its mesophilic homologue. This strategy enabled us first, to eliminate noise or background differences from signals and moreover, the important factors which were related to the thermostability were recognized too. Our results reveal that thermophilic and mesophilic proteins have both similar polar and nonpolar contribution to the surface area and compactness. On the other hand, salt bridges and main chain hydrogen bonds show an increase in the majority of thermophilic proteins in comparison to their mesophilic homologues. In addition, in thermophilic proteins hydrophobic residues are significantly more frequent, while polar residues are less. These findings indicate that thermostable proteins through evolution adopt several different strategies to withstand high temperature environments.
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Research Support, Non-U.S. Gov't |
20 |
116 |
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Supervia M, Turk-Adawi K, Lopez-Jimenez F, Pesah E, Ding R, Britto RR, Bjarnason-Wehrens B, Derman W, Abreu A, Babu AS, Santos CA, Jong SK, Cuenza L, Yeo TJ, Scantlebury D, Andersen K, Gonzalez G, Giga V, Vulic D, Vataman E, Cliff J, Kouidi E, Yagci I, Kim C, Benaim B, Estany ER, Fernandez R, Radi B, Gaita D, Simon A, Chen SY, Roxburgh B, Martin JC, Maskhulia L, Burdiat G, Salmon R, Lomelí H, Sadeghi M, Sovova E, Hautala A, Tamuleviciute-Prasciene E, Ambrosetti M, Neubeck L, Asher E, Kemps H, Eysymontt Z, Farsky S, Hayward J, Prescott E, Dawkes S, Santibanez C, Zeballos C, Pavy B, Kiessling A, Sarrafzadegan N, Baer C, Thomas R, Hu D, Grace SL. Nature of Cardiac Rehabilitation Around the Globe. EClinicalMedicine 2019; 13:46-56. [PMID: 31517262 PMCID: PMC6733999 DOI: 10.1016/j.eclinm.2019.06.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region. METHODS In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models. FINDINGS 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05). INTERPRETATION This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.
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Pourjavadi A, Sadeghi M, Hosseinzadeh H. Modified carrageenan. 5. Preparation, swelling behavior, salt- and pH-sensitivity of partially hydrolyzed crosslinked carrageenan-graft-polymethacrylamide superabsorbent hydrogel. POLYM ADVAN TECHNOL 2004. [DOI: 10.1002/pat.524] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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101 |
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Sefidgar M, Soltani M, Raahemifar K, Sadeghi M, Bazmara H, Bazargan M, Mousavi Naeenian M. Numerical modeling of drug delivery in a dynamic solid tumor microvasculature. Microvasc Res 2015; 99:43-56. [PMID: 25724978 DOI: 10.1016/j.mvr.2015.02.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/24/2014] [Accepted: 02/11/2015] [Indexed: 01/01/2023]
Abstract
The complicated capillary network induced by angiogenesis is one of the main reasons of unsuccessful cancer therapy. A multi-scale mathematical method which simulates drug transport to a solid tumor is used in this study to investigate how capillary network structure affects drug delivery. The mathematical method involves processes such as blood flow through vessels, solute and fluid diffusion, convective transport in extracellular matrix, and extravasation from blood vessels. The effect of heterogeneous dynamic network on interstitial fluid flow and drug delivery is investigated by this multi-scale method. The sprouting angiogenesis model is used for generating capillary network and then fluid flow governing equations are implemented to calculate blood flow through the tumor-induced capillary network and fluid flow in normal and tumor tissues. Finally, convection-diffusion equation is used to simulate drug delivery. Three approaches are used to simulate drug transport based on the developed mathematical method: without a vascular network, using a static vascular network, and a dynamic vascular network. The avascular approach predicts more uniform and higher drug concentration than vascular approaches since the simplified assumptions are implemented in this method. The dynamic network which uses more realistic assumptions predicts more irregular blood vessels, high interstitial pressure, and more heterogeneity in drug distribution than other two approaches.
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Journal Article |
10 |
95 |
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Sarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N, Sajjadieh AR, Kabiri P, Marshall T, Thomas GN, Tavasoli A. The Isfahan cohort study: rationale, methods and main findings. J Hum Hypertens 2010; 25:545-53. [PMID: 21107436 DOI: 10.1038/jhh.2010.99] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 10-year longitudinal population-based study, entitled the Isfahan Cohort Study (ICS) is being conducted. The ICS commenced in 2001, recruiting individuals aged 35+ living in urban and rural areas of three counties in central Iran, to determine the individual and combined impact of various risk factors on the incidence of cardiovascular events. After 24379 person-years of follow-up with a median follow-up of 4.8 years, we documented 219 incident cases of ischemic heart disease (IHD) (125 in men and 94 in women) and 57 incident cases of stroke (28 in men and 29 in women). The absolute risk of IHD was 8.9 (7.8-10.2) per 1000 person-years for all participants, 10.6 (8.8-12.5) per 1000 person-years for men and 7.4 (6.0-9.0) per 1000 person-years for women. The respective risk of ischemic stroke was 2.3 (1.7-3.0), 2.3 (1.6-3.3) and 2.3 (1.5-3.2) per 1000 person-years. The risk of IHD was approximately 3.5-fold higher in the presence of hypertension, followed by diabetes mellitus and hypercholesterolemia with near 2.5- and twofold higher risk, respectively. This cohort provides confirmatory evidence of the ethnic differences in the magnitude of the impact of various risk factors on cardiovascular events. The differences may be due to varying absolute risk levels among populations and the existing ethnic disparities for using western risk equations to local requirements.
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Journal Article |
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Javaherian K, Sadeghi M, Liu LF. Nonhistone proteins HMG1 and HMG2 unwind DNA double helix. Nucleic Acids Res 1979; 6:3569-80. [PMID: 226939 PMCID: PMC327957 DOI: 10.1093/nar/6.11.3569] [Citation(s) in RCA: 89] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In a previous communication we have shown that both HMG1 and HMG2 nonhistone proteins change the DNA helical structure and the binding of HMG1 and HMG2 to DNA induces a net unwinding equivalent of DNA double helix (Javaherian, K., Liu, L. F. and Wang, J. C. (1978) Science, 199, 1345-1346). Employing melting absorption technique, we now show that in the presence of salt HMG1 and HMG2 destabilize DNA whereas in the absence of salt, they both stabilize DNA molecules. Consequently the folded structure of HMG must play an important role in melting DNA. Furthermore, by measuring topological winding number using competition unwinding experiments, we conclude that HMG1 has a higher affinity for a single-stranded DNA relative to double-stranded DNA. These results together suggest that HMG1 and HMG2 unwind DNA double helix by local denaturation of the DNA base pairs. The net unwinding angles have been measured to be 22 degrees and 26 degrees per molecule of HMG1 and HMG2 respectively.
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Abstract
A new, simple method based on information theory is introduced to predict the solvent accessibility of amino acid residues in various states defined by their different thresholds. Prediction is achieved by the application of information obtained from a single amino acid position or pair-information for a window of seventeen amino acids around the desired residue. Results obtained by pairwise information values are better than results from single amino acids. This reinforces the effect of the local environment on the accessibility of amino acid residues. The prediction accuracy of this method in a jackknife test system for two and three states is better than 70 and 60 %, respectively. A comparison of the results with those reported by others involving the same data set also testifies to a better prediction accuracy in our case.
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Comparative Study |
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Turk-Adawi K, Sarrafzadegan N, Fadhil I, Taubert K, Sadeghi M, Wenger NK, Tan NS, Grace SL. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden. Nat Rev Cardiol 2017; 15:106-119. [PMID: 28933782 DOI: 10.1038/nrcardio.2017.138] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa. The most prominent CVD risk factors in this region include tobacco consumption, physical inactivity, depression, obesity, hypertension, and diabetes mellitus. Many individuals living in the EMR are unaware of their risk factor status, and even if treated, these risk factors are often poorly controlled. Furthermore, infrequent use of emergency medical services, delays in access to care, and lack of access to cardiac catheterization affects the timely diagnosis of CVD. Treatment of CVD is also suboptimal in this region, consisting primarily of thrombolysis, with insufficient provision of timely revascularization. In this Review, we summarize what is known about CVD burden, risk factors, and treatment strategies for individuals living in the EMR. This information will hopefully aid decision-makers when devising strategies on how to improve CVD prevention and management in this region.
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Review |
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Afshar H, Roohafza H, Mousavi G, Golchin S, Toghianifar N, Sadeghi M, Talaei M. Topiramate add-on treatment in schizophrenia: a randomised, double-blind, placebo-controlled clinical trial. J Psychopharmacol 2009; 23:157-62. [PMID: 18515465 DOI: 10.1177/0269881108089816] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Glutamate antagonists such as topiramate have been proposed based on the glutamate hypothesis of schizophrenia because its properties encourage its exploration and possible development as a medication for the treatment of schizophrenia. A randomised, double-blind, placebo-controlled clinical trial was performed on 18- to 45-year-old patients with schizophrenia. Baseline information including vital signs, height, weight, smoking status, demographic characteristics, (past) psychiatric history, medication history and medication-related adverse effects were collected. Patients were randomly assigned to a topiramate or placebo group. Efficacy of medication was measured by administering Positive and Negative Syndrome Scale (PANSS), and tolerability of treatment was recorded on day 0 (baseline), day 28 and day 56. PANSS values (95% confidence interval) at baseline, day 28 and day 56 in the topiramate group were 96.87 (85.37-108.37), 85.68 (74.67-96.70) and 76.87 (66.06-87.69), respectively; compared with 101.87 (90.37-113.37), 100.31 (89.29-111.32) and 100.56 (89.74-111.37) in the placebo group. General linear model for repeated measures analysis showed that topiramate has lowered PANSS values significantly compared with the placebo group. Similar significant decline patterns were found in all three subscales (negative, positive and psychopathology sign). Clinical response (more than 20% reduction in PANSS) was significantly higher in topiramate-treated subjects than controls (50% vs 12.5%). Topiramate can be an effective medication in controlling schizophrenic symptoms, considering its effect on negative symptoms and controlling antipsychotic-associated weight gain.
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Randomized Controlled Trial |
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Pesah E, Turk-Adawi K, Supervia M, Lopez-Jimenez F, Britto R, Ding R, Babu A, Sadeghi M, Sarrafzadegan N, Cuenza L, Anchique Santos C, Heine M, Derman W, Oh P, Grace SL. Cardiac rehabilitation delivery in low/middle-income countries. Heart 2019; 105:1806-1812. [PMID: 31253695 DOI: 10.1136/heartjnl-2018-314486] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 01/26/2023] Open
Abstract
ObjectiveCardiac rehabilitation (CR) availability, programme characteristics and barriers are not well-known in low/middle-income countries (LMICs). In this study, they were compared with high-income countries (HICs) and by CR funding source.MethodsA cross-sectional online survey was administered to CR programmes globally. Need for CR was computed using incident ischaemic heart disease (IHD) estimates from the Global Burden of Disease study. General linear mixed models were performed.ResultsCR was identified in 55/138 (39.9%) LMICs; 47/55 (85.5% country response rate) countries participated and 335 (53.5% programme response) surveys were initiated. There was one CR spot for every 66 IHD patients in LMICs (vs 3.4 in HICs). CR was most often paid by patients in LMICs (n=212, 65.0%) versus government in HICs (n=444, 60.2%; p<0.001). Over 85% of programmes accepted guideline-indicated patients. Cardiologists (n=266, 89.3%), nurses (n=234, 79.6%; vs 544, 91.7% in HICs, p=0.001) and physiotherapists (n=233, 78.7%) were the most common providers on CR teams (mean=5.8±2.8/programme). Programmes offered 7.3±1.8/10 core components (vs 7.9±1.7 in HICs, p<0.01) over 33.7±30.7 sessions (significantly greater in publicly funded programmes; p<0.001). Publicly funded programmes were more likely to have social workers and psychologists on staff, and to offer tobacco cessation and psychosocial counselling.ConclusionCR is only available in 40% of LMICs, but where offered is fairly consistent with guidelines. Governments should enact policies to reimburse CR so patients do not pay out-of-pocket.
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Sarrafzadegan N, Kelishadi R, Baghaei A, Hussein Sadri G, Malekafzali H, Mohammadifard N, Rabiei K, Bahonar A, Sadeghi M, O'Laughlin J. Metabolic syndrome: an emerging public health problem in Iranian women: Isfahan Healthy Heart Program. Int J Cardiol 2008; 131:90-6. [PMID: 18190978 DOI: 10.1016/j.ijcard.2007.10.049] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2006] [Revised: 06/16/2007] [Accepted: 10/20/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine the gender-specific prevalence of the metabolic syndrome (Met S) in a representative sample of Iranian adults, and to identify some possible related lifestyle factors. METHODS As the baseline survey of a community-based interventional program entitled Isfahan Healthy Heart Program, we performed this cross-sectional study on 12,514 adults (> or =19 years) living in urban and rural areas of 3 cities in Iran. We assessed the prevalence of the Met S (according to the ATP III criteria) as well as dietary intake (based on food frequency questionnaire) and physical activity habits of all of the participants. We also evaluated dietary intake at the micronutrient level by using a one-day food record in a sub-sample of 2000 participants. RESULTS The age-adjusted prevalence of Met S was 23.3%, with a higher prevalence in women compared to men (35.1% vs. 10.7%, P<0.05) and in urban residents compared to rural residents (24.2% vs. 19.5%, P<0.05). In all age groups and in both urban and rural areas, the Met S affected a significantly larger number of women than men. Among women, abdominal obesity (71.7%) was more prevalent followed by low HDL-C (60.9%) and hypertriglyceridemia (56.6%), whereas among men, the most frequent components were hypertriglyceridemia (49.1%) and low HDL-C (35.1%), respectively. Abdominal obesity was nearly six times as prevalent in women as in men (71.7% vs. 12%, P<0.05) and had a significant association with metabolic disorders even after adjustment for age, sex and the living area. In general, dietary intake had no effect on the prevalence of Met S. The prevalence of Met S in subjects with a sedentary lifestyle was significantly higher than in active subjects of both genders (25.6% vs. 14.4%, respectively, P<0.05). CONCLUSION The Met S is highly prevalent in the Iranian population, notably in women living in urban areas. Abdominal obesity and dyslipidemia characterize this syndrome. Implementing community-based strategies for lifestyle change is of great significance.
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Research Support, Non-U.S. Gov't |
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Asgari-Taee F, Zerafati-Shoae N, Dehghani M, Sadeghi M, Baradaran HR, Jazayeri S. Association of sugar sweetened beverages consumption with non-alcoholic fatty liver disease: a systematic review and meta-analysis. Eur J Nutr 2018; 58:1759-1769. [PMID: 29761318 DOI: 10.1007/s00394-018-1711-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The relationship between consumption of sugar sweetened beverages (SSB) and NAFLD has been reported in several epidemiological studies, but the results are inconsistent. The present systematic review and meta-analysis of observational studies was carried out to assess the relationship between sugar sweetened beverages consumption and NAFLD. METHODS Online databases were searched systematically through December, 2016 for studies investigating association between SSB consumption and NAFLD but limited to observational studies in human. Pooled odds ratio (OR) and 95% confidence intervals were calculated using Der-Simonian and Laird method while random effects meta-analysis was used, taking into account conceptual heterogeneity. Heterogeneity was assessed with the Cochran Q statistic and quantified with the I2 statistic. RESULTS Of the 1015 identified articles, 42 were reviewed in depth and six studies (four cross-sectional, one case-control, and one cohort) met the criteria for inclusion in our systematic review with 6326 participants and 1361 cases of NAFLD in both men and women. Finally, four cross-sectional studies were included in the meta-analysis. Higher intake of SSBs (highest compared to lowest categories) was significantly associated with NAFLD, with a 40% increased Odds of NAFLD after adjusting for important potential confounders (pooled odds ratio 1.40; 95% CI 1.07, 1.82). There was no evidence for significant heterogeneity across studies [P = 0.226 (Q statistics), I2 = 31.0%]. A significant positive association between SSB consumption and NAFLD was observed consistently in a sensitivity analysis [range of summary ORs 1.39-1.49]. There was no evidence of publication bias for the association between SSB and NAFLD. CONCLUSIONS This meta-analysis supports a positive significant association between higher consumption of SSB and NAFLD in both men and women. These findings strengthen the evidence that intake of SSBs should be limited to reduce fatty liver disease.
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Systematic Review |
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53 |