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1. Global, regional, and national burden of suicide mortality 1990 to 2016: Systematic analysis for the Global Burden of Disease Study 2016

Author

Orpana, H.M. Marczak, L.B. Arora, M. Abbasi, N. Abdulkader, R.S. Abebe, Z. Abraha, H.N. Afarideh, M. Afshari, M. Ahmadi, A. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akseer, N. Al‐raddadi, R.M. Alahdab, F. Alkerwi, A. Allebeck, P. Alvis‐guzman, N. Anber, N.H. Anjomshoa, M. Antonio, C.A.T. Arora, A. Aryal, K.K. Asgedom, S.W. Awasthi, A. Quintanilla, B.P.A. Badali, H. Barker‐collo, S.L. Bärnighausen, T.W. Bazargan‐hejazi, S. Benjet, C. Bensenor, I.M. Berfeld, N. Beuran, M. Bhutta, Z.A. Biadgo, B. Bililign, N. Borges, G. Borschmann, R. Brazinova, A. Breitborde, N.J.K. Brugha, T. Butt, Z.A. Carrero, J.J. Carvalho, F. Malta, D.C. Castañeda‐orjuela, C.A. Catalá‐lópez, F. Ciobanu, L.G. Dachew, B.A. Dandona, L. Dandona, R. Dargan, P.I. Daryani, A. Davitoiu, D.V. Davletov, K. Degenhardt, L. Demoz, G.T. Jarlais, D.C.D. Dharmaratne, S.D. Djalalinia, S. Doan, L. Doku, D.T. Dubey, M. El‐khatib, Z. Eskandarieh, S. Esteghamati, A. Esteghamati, S. Faro, A. Farzadfar, F. Fekadu, W. Fernandes, E. Ferrari, A.J. Filip, I. Fischer, F. Foreman, K.J. Fukumoto, T. Gebre, A.K. Grosso, G. Gupta, R. Haagsma, J.A. Bidgoli, H.H. Haj‐mirzaian, A. Hamidi, S. Hankey, G.J. Haro, J.M. Hassen, H.Y. Hay, S.I. Heidari, B. Hendrie, D. Rad, E.H. Hosseini, S.M. Hostiuc, S. Irvani, S.S.N. Islam, S.M.S. Jakovljevic, M. James, S. Jayatilleke, A.U. Jha, R.P. Jonas, J.B. Jozwiak, J.J. Kadel, R. Kahsay, A. Kasaeian, A. Kassa, G.M. Kawakami, N. Kefale, A.T. Kemp, G.R. Khader, Y.S. Khafaie, M.A. Khalil, I.A. Khan, E.A. Khan, M.A. Khan, M.S. Khang, Y.-H. Khubchandani, J. Kiadaliri, A.A. Kieling, C. Kim, Y.-E. Kisa, A. Knudsen, A.K.S. Kokubo, Y. Koyanagi, A. Krish, V.S. Defo, B.K. Kumar, G.A. Kumar, M. Lamichhane, P. Lang, J.J. Latifi, A. Lee, P.H. Leung, J. Lim, L.-L. Lopez, A.D. Lorkowski, S. Lotufo, P.A. Lozano, R. Lunevicius, R. Mahesh, P.A. Majdan, M. Majdzadeh, R. Malekzadeh, R. Manda, A.-L. Mansournia, M.A. Mantovani, L.G. Maravilla, J.C. Martinez‐raga, J. Mathur, M.R. Maulik, P.K. McGrath, J.J. Mehrotra, R. Mekonen, T. Mendoza, W. Meretoja, T.J. Mestrovic, T. Miller, T.R. Mini, G.K. Mirrakhimov, E.M. Mitchell, P.B. Moazen, B. Mohammad, K.A. Mohammadi, M. Mohammed, S. Mokdad, A.H. Monasta, L. Moosazadeh, M. Moradi, G. Moradi‐lakeh, M. Moradinazar, M. Velásquez, I.M. Morisaki, N. Morrison, S.D. Moschos, M.M. Mousavi, S.M. Mustafa, G. Nagel, G. Naheed, A. Naik, G. Najafi, F. Negoi, I. Negoi, R.I. Nguyen, H.L.T. Nguyen, L.H. Nixon, M.R. Ofori‐asenso, R. Ogbo, F.A. Oh, I.-H. Olagunju, A.T. Olagunju, T.O. Øverland, S. Owolabi, M.O. Panda‐jonas, S. Parry, C.D.H. Pati, S. Patten, S.B. Patton, G.C. Petzold, M. Phillips, M.R. Plana‐ripoll, O. Postma, M.J. Pourshams, A. Poustchi, H. Qorbani, M. Radfar, A. Rafay, A. Rafiei, A. Rahim, F. Rahimi‐movaghar, A. Rahimi‐movaghar, V. Rahman, M.A. Rai, R.K. Rezaeian, S. Roever, L. Ronfani, L. Roshandel, G. Rostami, A. Sachdev, P.S. Safari, H. Safiri, S. Salamati, P. Salimi, Y. Salomon, J.A. Samy, A.M. Santos, I.S. Santric‐milicevic, M.M. Sartorius, B. Sarvi, S. Satpathy, M. Sawhney, M. Schwebel, D.C. Sepanlou, S.G. Shaikh, M.A. Sharif, M. Shibuya, K. Shigematsu, M. Shiri, R. Shiue, I. Siabani, S. Siddiqi, T.J. Sigfusdottir, I.D. Silva, J.P. Singh, J.A. Filho, A.M.S. Sobhani, S. Stein, D.J. Stein, M.B. Sufiyan, M.B. Sunguya, B.F. Tabarés‐seisdedos, R. Tabb, K.M. Tavakkoli, M. Tehrani‐banihashemi, A. Temsah, M.-H. Topor‐madry, R. Tran, B.X. Tran, K.B. Ullah, I. Unutzer, J. Usman, M.S. Uthman, O.A. Valdez, P.R. Vasankari, T.J. Vasconcelos, C. Vlassov, V. Vos, T. Vujcic, I.S. Waheed, Y. Wang, Y.-P. Weiderpass, E. Werdecker, A. Westerman, R. Whiteford, H.A. Wyper, G.M.A. Yaseri, M. Yimer, E.M. Yisma, E. Yonemoto, N. Yoon, S.-J. Yotebieng, M. Yousefifard, M. Yu, C. Zaidi, Z. Zamani, M. Murray, C.J.L. Naghavi, M.

Abstract

Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. Design Systematic analysis. Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education). Results The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%). Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates. © Published by the BMJ Publishing Group Limited.

Published
2019

2. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Author

Lozano, R. Fullman, N. Abate, D. Abay, S.M. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdel-Rahman, O. Abdi, A. Abdollahpour, I. Abdulkader, R.S. Abebe, N.D. Abebe, Z. Abejie, A.N. Abera, S.F. Abil, O.Z. Aboyans, V. Abraha, H.N. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M. Abyu, G.Y. Accrombessi, M.M.K. Acharya, D. Acharya, P. Adamu, A.A. Adebayo, O.M. Adedeji, I.A. Adedoyin, R.A. Adekanmbi, V. Adetokunboh, O.O. Adhena, B.M. Adhikari, T.B. Adib, M.G. Adou, A.K. Adsuar, J.C. Afarideh, M. Afshari, M. Afshin, A. Agarwal, G. Aghayan, S.A. Agius, D. Agrawal, A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Ahmed, S. Akalu, T.Y. Akanda, A.S. Akbari, M.E. Akibu, M. Akinyemi, R.O. Akinyemiju, T. Akseer, N. Alahdab, F. Al-Aly, Z. Alam, K. Alam, T. Albujeer, A. Alebel, A. Alene, K.A. Al-Eyadhy, A. Alhabib, S. Ali, R. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Allen, C.A. Almasi, A. Al-Maskari, F. Al-Mekhlafi, H.M. Alonso, J. Al-Raddadi, R.M. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Amenu, K. Amini, E. Ammar, W. Anber, N.H. Anderson, J.A. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Ansari, H. Ansariadi, A. Ansha, M.G. Antonio, C.A.T. Anwari, P. Appiah, L.T. Aremu, O. Areri, H.A. Ärnlöv, J. Arora, M. Aryal, K.K. Asayesh, H. Asfaw, E.T. Asgedom, S.W. Asghar, R.J. Assadi, R. Ataro, Z. Atique, S. Atre, S.R. Atteraya, M.S. Ausloos, M. Avila-Burgos, L. Avokpaho, E.F.G.A. Awasthi, A. Quintanilla, B.P.A. Ayele, H.T. Ayele, Y. Ayer, R. Azarpazhooh, M.R. Azzopardi, P.S. Azzopardi-Muscat, N. Babalola, T.K. Babazadeh, A. Badali, H. Badawi, A. Balakrishnan, K. Bali, A.G. Banach, M. Banerjee, A. Banoub, J.A.M. Banstola, A. Barac, A. Barboza, M.A. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Barthelemy, C.M. Bassat, Q. Basu, A. Basu, S. Battista, R.J. Baune, B.T. Baynes, H.W. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Béjot, Y. Bekele, B.B. Belachew, A.B. Belay, A.G. Belay, S.A. Belay, Y.A. Bell, M.L. Bello, A.K. Bennett, D.A. Bensenor, I.M. Benzian, H. Berhane, A. Berhe, A.K. Berman, A.E. Bernabe, E. Bernstein, R.S. Bertolacci, G.J. Beuran, M. Beyranvand, T. Bhala, N. Bhalla, A. Bhansali, A. Bhattarai, S. Bhaumik, S. Bhutta, Z.A. Biadgo, B. Biehl, M.H. Bijani, A. Bikbov, B. Bililign, N. Sayeed, M.S.B. Birlik, S.M. Birungi, C. Bisanzio, D. Biswas, T. Bitew, H. Bizuneh, H. Bjertness, E. Bobasa, E.M. Boufous, S. Bourne, R. Bozorgmehr, K. Bragazzi, N.L. Brainin, M. Brant, L.C. Brauer, M. Brazinova, A. Breitborde, N.J.K. Briant, P.S. Britton, G. Brugha, T. Bukhman, G. Busse, R. Butt, Z.A. Cahuana-Hurtado, L. Callender, C.S.K.H. Campos-Nonato, I.R. Rincon, J.C.C. Cano, J. Car, J. Car, M. Cárdenas, R. Carrero, J.J. Carter, A. Carvalho, F. Castañeda-Orjuela, C.A. Rivas, J.C. Castro, F. Causey, K. Çavlin, A. Cercy, K.M. Cerin, E. Chaiah, Y. Chalek, J. Chang, H.-Y. Chang, J.-C. Chattopadhyay, A. Chattu, V.K. Chaturvedi, P. Chiang, P.P.-C. Chin, K.L. Chisumpa, V.H. Chitheer, A. Choi, J.-Y.J. Chowdhury, R. Christensen, H. Christopher, D.J. Chung, S.-C. Cicuttini, F.M. Ciobanu, L.G. Cirillo, M. Claro, R.M. Claßen, T.K.D. Cohen, A.J. Collado-Mateo, D. Cooper, C. Cooper, L.T. Cornaby, L. Cortinovis, M. Costa, M. Cousin, E. Cromwell, E.A. Crowe, C.S. Cunningham, M. Daba, A.K. Dadi, A.F. Dandona, L. Dandona, R. Dang, A.K. Dargan, P.I. Daryani, A. Das, S.K. Das Gupta, R. Das Neves, J. Dasa, T.T. Dash, A.P. Davis, A.C. Davitoiu, D.V. Davletov, K. Dayama, A. De Courten, B. De Leo, D. Neve, J.W.D. De Steur, H. Degefa, M.G. Degenhardt, L. Degfie, T.T. Deiparine, S. Dellavalle, R.P. Demoz, G.T. Demtsu, B. Denova-Gutiérrez, E. Deribe, K. Dervenis, N. Dessie, G.A. Dey, S. Dharmaratne, S.D. Dhimal, M. Dicker, D. Dinberu, M.T. Ding, E.L. Djalalinia, S. Do, H.P. Dokova, K. Doku, D.T. Douwes-Schultz, D. Driscoll, T.R. Duan, L. Dubey, M. Dubljanin, E. Duken, E.E. Duncan, B.B. Duraes, A.R. Ebrahimpour, S. Edvardsson, D. El Bcheraoui, C. Eldrenkamp, E. El-Khatib, Z. Elyazar, I.R.F. Enayati, A. Endries, A.Y. Eshrati, B. Eskandarieh, S. Esteghamati, A. Esteghamati, S. Estep, K. Fakhar, M. Fakhim, H. Fanzo, J. Faramarzi, M. Fareed, M. Farhadi, F. Farid, T.A. Farinha, C.S.E.S. Farioli, A. Faro, A. Farvid, M.S. Farzadfar, F. Farzaei, M.H. Farzam, H. Fazaeli, A.A. Fazeli, M.S. Feigin, V.L. Feigl, A.B. Fekadu, W. Feldman, R. Fentahun, N. Fereshtehnejad, S.-M. Fernandes, E. Fernandes, J.C. Feyissa, G.T. Fijabi, D.O. Filip, I. Finegold, S. Finger, J.D. Fischer, F. Fitzmaurice, C. Flor, L.S. Foigt, N.A. Foreman, K.J. Frank, T.D. Franklin, R.C. Fukumoto, T. Fukutaki, K. Fuller, J.E. Fürst, T. Furtado, J.M. Gakidou, E. Gallus, S. Gankpe, F.G. Gansevoort, R.T. Garcia, A.C. Garcia-Basteiro, A.L. Garcia-Gordillo, M.A. Gardner, W.M. Gebre, A.K. Gebre, T. Gebregergs, G.B. Gebrehiwot, T.T. Gebremedhin, A.T. Gebremichael, B. Gebremichael, T.G. Gelano, T.F. Geleijnse, J.M. Geramo, Y.C.D. Getachew, S. Gething, P.W. Gezae, K.E. Ghadami, M.R. Ghadimi, R. Ghadiri, K. Ghasemi-Kasman, M. Ghiasvand, H. Ghimire, M. Ghoshal, A.G. Giampaoli, S. Gill, P.S. Gill, T.K. Giussani, G. Gnedovskaya, E.V. Goldberg, E.M. Goli, S. Gona, P.N. Goodridge, A. Gopalani, S.V. Gorman, T.M. Goto, A. Goulart, A.C. Goulart, B.N.G. Grada, A. Griswold, M.G. Grosso, G. Gugnani, H.C.C. Guillemin, F. Guimaraes, A.L.S. Guo, Y. Gupta, P.C. Gupta, R. Gupta, R. Gupta, T. Ha, G.H. Haagsma, J.A. Hachinski, V. Hafezi-Nejad, N. Bidgoli, H.H. Hagos, T.B. Haile, M.T. Hailegiyorgis, T.T. Hailu, G.B. Haj-Mirzaian, A. Haj-Mirzaian, A. Hamadeh, R.R. Hamidi, S. Hankey, G.J. Harb, H.L. Harikrishnan, S. Haririan, H. Haro, J.M. Hasan, M. Hassankhani, H. Hassen, H.Y. Havmoeller, R. Hawley, C.N. Hay, S.I. He, Y. Hedayatizadeh-Omran, A. Hegazy, M.I. Heibati, B. Heidari, B. Heidari, M. Hendrie, D. Henok, A. Heredia-Pi, I. Herteliu, C. Heydarpour, B. Heydarpour, F. Heydarpour, S. Hibstu, D.T. Híjar, M. Hoek, H.W. Hoffman, D.J. Hole, M.K. Homaie Rad, E. Hoogar, P. Horita, N. Hosgood, H.D. Hosseini, S.M. Hosseinzadeh, M. Hostiuc, M. Hostiuc, S. Hotez, P.J. Hoy, D.G. Hsairi, M. Hsiao, T. Hu, G. Huang, J.J. Hughes, C. Huynh, C.K. Igumbor, E.U. Ikeda, C.T. Ilesanmi, O.S. Iqbal, U. Irvani, S.S.N. Irvine, C.M.S. Islam, S.M.S. Islami, F. Ivers, R.Q. Izadi, N. Jacobsen, K.H. Jahangiry, L. Jahanmehr, N. Jain, S.K. Jakovljevic, M. Jalu, M.T. Jamal, A.A. James, S.L. Jassal, S.K. Javanbakht, M. Jayatilleke, A.U. Jeemon, P. Jha, R.P. Jha, V. Ji, J.S. Johnson, C.O. Johnson, S.C. Jonas, J.B. Jonnagaddala, J. Shushtari, Z.J. Joshi, A. Jozwiak, J.J. Jungari, S.B. Jürisson, M. Madhanraj, K. Kabir, Z. Kadel, R. Kahsay, A. Kahssay, M. Kalani, R. Kapil, U. Karami, M. Matin, B.K. Karanikolos, M. Karimi, N. Karimi, S.M. Karimi-Sari, H. Kasaeian, A. Kassa, D.H. Kassa, G.M. Kassa, T.D. Kassa, Z.Y. Kassebaum, N.J. Katikireddi, S.V. Kaul, A. Kawakami, N. Kazemi, Z. Karyani, A.K. Kazi, D.S. Prakash, K.C. Kebede, S. Keiyoro, P.N. Kemmer, L. Kemp, G.R. Kengne, A.P. Keren, A. Kesavachandran, C.N. Khader, Y.S. Khafaei, B. Khafaie, M.A. Khajavi, A. Khalid, N. Khalil, I.A. Khan, E.A. Khan, M.S. Khan, M.A. Khang, Y.-H. Khanna, T. Khater, M.M. Khatony, A. Khazaeipour, Z. Khazaie, H. Khoja, A.T. Khosravi, A. Khosravi, M.H. Khubchandani, J. Kiadaliri, A.A. Kiarie, H.W. Kibret, G.D. Kiirithio, D.N. Kim, D. Kim, J.Y. Kim, Y.-E. Kim, Y.J. Kimokoti, R.W. Kinfu, Y. Kinra, S. Kisa, A. Kissimova-Skarbek, K. Kissoon, N. Kivimäki, M. Kocarnik, J.M. Kochhar, S. Kokubo, Y. Kolola, T. Kopec, J.A. Kosek, M.N. Kosen, S. Koul, P.A. Koyanagi, A. Kravchenko, M.A. Krishan, K. Krohn, K.J. Defo, B.K. Kucuk Bicer, B. Kudom, A.A. Kulikoff, X.R. Kumar, G.A. Kumar, M. Kumar, P. Kutz, M.J. Kyu, H.H. Lachat, C. Lad, D.P. Lad, S.D. Lafranconi, A. Lagat, A.K. Lal, D.K. Lalloo, R. Lam, H. Lami, F.H. Lamichhane, P. Lan, Q. Lang, J.J. Lansingh, V.C. Lansky, S. Larson, H.J. Larsson, A.O. Laryea, D.O. Lassi, Z.S. Latifi, A. Lau, K.M.-M. Laxmaiah, A. Lazarus, J.V. Leasher, J.L. Lebedev, G. Ledesma, J.R. Lee, J.B. Lee, P.H. Leever, A.T. Leigh, J. Leinsalu, M. Leshargie, C.T. Leung, J. Lewycka, S. Li, S. Li, X. Li, Y. Liang, J. Liang, X. Liben, M.L. Lim, L.-L. Limenih, M.A. Linn, S. Liu, S. Liu, Y. Lodha, R. Logroscino, G. Lopez, A.D. Lorkowski, S. Lotufo, P.A. Lucchesi, L.R. Lyons, R.A. Macarayan, E.R.K. Mackay, M.T. Maddison, E.R. Madotto, F. Maghavani, D.P. Magis-Rodriguez, C. Mahotra, N.B. Majdan, M. Majdzadeh, R. Majeed, A. Malekzadeh, R. Malta, D.C. Mamun, A.A. Manda, A.-L. Mandarano-Filho, L.G. Mangalam, S. Manguerra, H. Mansournia, M.A. Mapoma, C.C. Maravilla, J.C. Marcenes, W. Marks, A. Martin, R.V. Martins, S.C.O. Martins-Melo, F.R. Martopullo, I. Mashamba-Thompson, T.P. Massenburg, B.B. Mathur, M.R. Maulik, P.K. Mazidi, M. McAlinden, C. McGrath, J.J. McKee, M. McMahon, B.J. Mehata, S. Mehndiratta, M.M. Mehrotra, R. Mehta, K.M. Mehta, V. Mejia-Rodriguez, F. Mekonen, T. Mekonnen, T.C.C. Meles, H.G. Melese, A. Melku, M. Memiah, P.T.N. Memish, Z.A. Mendoza, W. Mengistu, D.T. Mengistu, G. Mensah, G.A. Mensink, G.B.M. Mereta, S.T. Meretoja, A. Meretoja, T.J. Mestrovic, T. Mezgebe, H.B. Miazgowski, B. Miazgowski, T. Millear, A.I. Miller, T.R. Miller-Petrie, M.K. Milne, G.J. Mini, G.K. Minnig, S.P. Mirabi, P. Mirarefin, M. Mirrakhimov, E.M. Misganaw, A.T. Mitchell, P.B. Moazen, B. Moghadamnia, A.A. Mohajer, B. Mohammad, K.A. Mohammadi, M. Mohammadifard, N. Mohammadnia-Afrouzi, M. Mohammed, M.A. Mohammed, S. Mohan, M.B.V. Mohan, V. Mohebi, F. Moitra, M. Mokdad, A.H. Molokhia, M. Monasta, L. Montañez, J.C. Moosazadeh, M. Moradi, G. Moradi, M. Moradi-Lakeh, M. Moradinazar, M. Moraga, P. Morawska, L. Morgado-da-Costa, J. Morisaki, N. Morrison, S.D. Mosapour, A. Moschos, M.M. Mountjoy-Venning, W.C. Mouodi, S. Mousavi, S.M. Muche, A.A. Muchie, K.F. Mueller, U.O. Muhammed, O.S.S. Mukhopadhyay, S. Mullany, E.C. Muller, K. Mumford, J.E. Murhekar, M. Murthy, G.V.S. Murthy, S. Musa, J. Musa, K.I. Mustafa, G. 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Vujcic, I.S. Wagner, G.R. Wagnew, F.S. Waheed, Y. Walson, J.L. Wang, Y. Wang, Y.-P. Wassie, M.M. Weiderpass, E. Weintraub, R.G. Weiss, J. Weldegebreal, F. Weldegwergs, K.G. Werdecker, A. Werkneh, A.A. West, T.E. Westerman, R. Whisnant, J.L. Whiteford, H.A. Widecka, J. Widecka, K. Wijeratne, T. Wilner, L.B. Winkler, A.S. Wiyeh, A.B. Wiysonge, C.S. Wolde, H.F. Wolfe, C.D.A. Wu, S. Xavier, D. Xu, G. Xu, R. Yadollahpour, A. Jabbari, S.H.Y. Yakob, B. Yamada, T. Yan, L.L. Yano, Y. Yaseri, M. Yasin, Y.J. Ye, P. Yearwood, J.A. Yeshaneh, A. Yimer, E.M. Yip, P. Yirsaw, B.D. Yisma, E. Yonemoto, N. Yonga, G. Yoon, S.-J. Yotebieng, M. Younis, M.Z. Yousefifard, M. Yu, C. Zaman, S.B. Zamani, M. Zare, Z. Zavala-Arciniega, L. Zegeye, D.T. Zegeye, E.A. Zeleke, A.J. Zendehdel, K. Zerfu, T.A. Zhang, A.L. Zhang, X. Zhou, M. Zhu, J. Zimsen, S.R.M. Zodpey, S. Zoeckler, L. Zucker, I. Zuhlke, L.J.J. Lim, S.S. Murray, C.J.L. GBD 2017 SDG Collaborators

Abstract

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Published
2018

3. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017

Author

Kyu, H.H. Abate, D. Abate, K.H. Abay, S.M. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdollahpour, I. Abdulkader, R.S. Abebe, M. Abebe, Z. Abil, O.Z. Aboyans, V. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M.E. Accrombessi, M.M.K. Acharya, D. Acharya, P. Ackerman, I.N. Adamu, A.A. Adebayo, O.M. Adekanmbi, V. Ademi, Z. Adetokunboh, O.O. Adib, M.G. Adsuar, J.C. Afanvi, K.A. Afarideh, M. Afshin, A. Agarwal, G. Agesa, K.M. Aggarwal, R. Aghayan, S.A. Agrawal, A. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Ahmed, S. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akinyemiju, T. Akseer, N. Al-Aly, Z. Al-Eyadhy, A. Al-Mekhlafi, H.M. Al-Raddadi, R.M. Alahdab, F. Alam, K. Alam, T. Alashi, A. Alavian, S.M. Alene, K.A. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Alonso, J. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Aminde, L.N. Amini, E. Amiresmaili, M. Ammar, W. Amoako, Y.A. Anber, N.H. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Ansha, M.G. Antonio, C.A.T. Anwari, P. Arabloo, J. Aremu, O. Ärnlöv, J. Arora, A. Arora, M. Artaman, A. Aryal, K.K. Asayesh, H. Ataro, Z. Ausloos, M. Avila-Burgos, L. Avokpaho, E.F.G.A. Awasthi, A. Ayala Quintanilla, B.P. Ayer, R. Azzopardi, P.S. Babazadeh, A. Badali, H. Balakrishnan, K. Bali, A.G. Banach, M. Banoub, J.A.M. Barac, A. Barboza, M.A. Barker-Collo, S.L. Bärnighausen, T.W. Barquera, S. Barrero, L.H. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Bekele, B.B. Bekru, E.T. Belachew, A.B. Belay, Y.A. Bell, M.L. Bello, A.K. Bennett, D.A. Bensenor, I.M. Berhane, A. Bernabe, E. Bernstein, R.S. Beuran, M. Beyranvand, T. Bhala, N. Bhatt, S. Bhaumik, S. Bhutta, Z.A. Biadgo, B. Biehl, M.H. Bijani, A. Bikbov, B. Bilano, V. Bililign, N. Bin Sayeed, M.S. Bisanzio, D. Bjorge, T. Bleyer, A. Bobasa, E.M. Bou-Orm, I.R. Boufous, S. Bourne, R. Brady, O.J. Brant, L.C. Brayne, C. Brazinova, A. Breitborde, N.J.K. Brenner, H. Briant, P.S. 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Abstract

Background: How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted lifeyears (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severityof ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-speci?c mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the ?ve leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Published
2018

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