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1. Utilizing the National Early Warning Score 2 (NEWS2) to confirm the impact of emergency department management in sepsis patients: a cohort study from taiwan 1998–2020

Author: Ming-Shun Hsieh, Kuan-Chih Chiu, Amrita Chattopadhyay, Tzu-Pin Lu, Shu-Hui Liao, Chia-Ming Chang, Yi-Chen Lee, Wei-En Lo, Vivian Chia-Rong Hsieh, Sung-Yuan Hu, and Chorng-Kuang How
Subjects: Hospital mortality, National early warning score 2 (NEWS2), Prediction score, Sepsis, Sequential organ failure assessment score (SOFA score), Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Most sepsis patients could potentially experience advantageous outcomes from targeted medical intervention, such as fluid resuscitation, antibiotic administration, respiratory support, and nursing care, promptly upon arrival at the emergency department (ED). Several scoring systems have been devised to predict hospital outcomes in sepsis patients, including the Sequential Organ Failure Assessment (SOFA) score. In contrast to prior research, our study introduces the novel approach of utilizing the National Early Warning Score 2 (NEWS2) as a means of assessing treatment efficacy and disease progression during an ED stay for sepsis. Objectives To evaluate the sepsis prognosis and effectiveness of treatment administered during ED admission in reducing overall hospital mortality rates resulting from sepsis, as measured by the NEWS2. Methods The present investigation was conducted at a medical center from 1997 to 2020. The NEWS2 was calculated for patients with sepsis who were admitted to the ED in a consecutive manner. The computation was based on the initial and final parameters that were obtained during their stay in the ED. The alteration in the NEWS2 from the initial to the final measurements was utilized to evaluate the benefit of ED management to the hospital outcome of sepsis. Univariate and multivariate Cox regression analyses were performed, encompassing all clinically significant variables, to evaluate the adjusted hazard ratio (HR) for total hospital mortality in sepsis patients with reduced severity, measured by NEWS2 score difference, with a 95% confidence interval (adjusted HR with 95% CI). The study employed Kaplan-Meier analysis with a Log-rank test to assess variations in overall hospital mortality rates between two groups: the “improvement (reduced NEWS2)” and “non-improvement (no change or increased NEWS2)” groups. Results The present investigation recruited a cohort of 11,011 individuals who experienced the first occurrence of sepsis as the primary diagnosis while hospitalized. The mean age of the improvement and non-improvement groups were 69.57 (± 16.19) and 68.82 (± 16.63) years, respectively. The mean SOFA score of the improvement and non-improvement groups were of no remarkable difference, 9.7 (± 3.39) and 9.8 (± 3.38) years, respectively. The total hospital mortality for sepsis was 42.92% (4,727/11,011). Following treatment by the prevailing guidelines at that time, a total of 5,598 out of 11,011 patients (50.88%) demonstrated improvement in the NEWS2, while the remaining 5,403 patients (49.12%) did not. The improvement group had a total hospital mortality rate of 38.51%, while the non-improvement group had a higher rate of 47.58%. The non-improvement group exhibited a lower prevalence of comorbidities such as congestive heart failure, cerebral vascular disease, and renal disease. The non-improvement group exhibited a lower Charlson comorbidity index score [4.73 (± 3.34)] compared to the improvement group [4.82 (± 3.38)] The group that underwent improvement exhibited a comparatively lower incidence of septic shock development in contrast to the non-improvement group (51.13% versus 54.34%, P
Published: 2024
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2. Bridging geographical disparities across 368 townships with healthcare system and socioeconomic factors in Taiwan

Author: Chia-Ling Hsieh, Chia-Yu Chung, Hsin-Yu Chen, Shwn-Huey Shieh, Ming-Shun Hsieh, and Vivian Chia-Rong Hsieh
Subjects: Medicine, Science
Abstract: Abstract A universal health insurance program such as the National Health Insurance in Taiwan offers a wide coverage and increased access to healthcare services. Despite its ongoing efforts to enhance healthcare accessibility, differences in health for people living in urban and resource-deprived areas remain substantial. To investigate the longitudinal impact of the healthcare system and other potential structural drivers such as education and economic development on geographical disparities in health, we designed a panel study with longitudinal open secondary data, covering all 368 townships in Taiwan between 2013 and 2017. Our findings indicated higher mortality rates in the mountainous and rural areas near the east and south regions of the island in both years. Multivariate analyses showed an increase in the density of primary care physicians (PCP) was associated with lower all-cause mortality (β = − 0.72, p
Published: 2023
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3. Effect of end-stage kidney disease on the return of spontaneous circulation in Taiwanese adults with out-of-hospital cardiac arrest

Author: Ming-Shun Hsieh, Amrita Chattopadhyay, Tzu-Pin Lu, Shu-Hui Liao, Chia-Ming Chang, Yi-Chen Lee, Wei-En Lo, Jia-Jun Wu, Vivian Chia-Rong Hsieh, Sung-Yuan Hu, and Chorng-Kuang How
Subjects: Medicine, Science
Abstract: Abstract Rescuing patients with out-of-hospital cardiac arrest (OHCA), especially those with end-stage kidney disease (ESKD), is challenging. This study hypothesizes that OHCA patients with ESKD undergoing maintenance hemodialysis have (1) higher rates of return of spontaneous circulation (ROSC) during cardio-pulmonary resuscitation (CPR) and (2) lower rates of hyperkalemia and less severe acidosis than those without ESKD. OHCA patients who received CPR between 2011 and 2020 were dichotomized into ESKD and non-ESKD groups. The association of ESKD with “any” and “sustained” ROSC were examined using logistic regression analysis. Furthermore, the effect of ESKD on hospital outcomes for OHCA patients who survived to admission was evaluated using Kaplan–Meier analysis. ESKD patients without “any” ROSC displayed lower potassium and higher pH levels than non-ESKD patients. ESKD was positively associated with “any” ROSC (adjusted-OR: 4.82, 95% CI 2.70–5.16, P
Published: 2023
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4. Association between medication adherence and disease outcomes in patients with hepatitis B-related cirrhosis: a population-based case–control study

Author: Vivian Chia-Rong Hsieh, Kuo-Yu Fu, Meng-Lun Hsieh, and Jou-An Chen
Subjects: Medicine
Abstract: Objective To evaluate medication adherence among patients with hepatitis B-related cirrhosis who developed decompensation and mortality, and to examine the association between medication adherence and patients’ disease outcomes.Design In this retrospective case–control study, patients aged over 20 years old and diagnosed with both chronic hepatitis B and cirrhosis from 2007 to 2016 are identified using a population-based medical claims database. Two prognosis endpoints (decompensation and mortality) are used, respectively, to classify subjects into two different case–control sets. Study groups are propensity-score matched. Medication possession ratio (MPR) is used as a measure of treatment adherence for oral antiviral drugs, and conditional logistic regression models are used to estimate the odds of decompensation and mortality after accounting for MPR and other covariates.Results Between decompensated and compensated patients, longer term treatment adherence is seen higher in the compensated group versus the decompensated group: 1-year MPR (0.65±0.43 vs 0.57±0.53) and 6-month MPR (0.79±0.52 vs 0.76±0.79). On the contrary, 3-month adherence is higher in the decompensated group (1.00±1.15 vs 0.96±0.79). For patients with and without mortality, drug adherence is ubiquitously higher in the alive group regardless of follow-up length: 1-year MPR (0.62±0.44 vs 0.50±0.51), 6-month MPR (0.78±0.62 vs 0.69±0.72) and 3-month MPR (0.97±0.91 vs 0.96±1.12). After accounting for confounding variables, we find that the likelihood of complicated cirrhosis is significantly lower in more adherent patients and the benefit increases with more persistent adherence (log 1-year MPR OR: 0.75, 95% CI: 0.73 to 0.77). Similar results are observed for the adjusted likelihood of mortality (log 1-year MPR OR: 0.70, 95% CI: 0.68 to 0.72).Conclusions Long-term patient adherence to oral antiviral therapy remains inadequate in patients with hepatitis B virus-related cirrhosis. Their adherence to oral antiviral therapy appears to be inversely associated with decompensation and mortality.
Published: 2022
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5. Unmet supportive care needs of survival patients with breast cancer in different cancer stages and treatment phases

Author: Ying-Hsiang Chou, Vivian Chia-Rong Hsieh, XianXiu Chen, Ting-Yi Huang, and Shwn-Huey Shieh
Subjects: Gynecology and obstetrics, RG1-991
Abstract: Objective: This study aimed to examine the differences between patients with breast cancer (BC) at different cancer stages and treatment phases in terms of unmet supportive care needs as well as to predict the critical factors that influence the unmet needs of such patients. Materials and methods: A retrospective study was conducted by collecting data from the case consultation and service records of a cancer center in central Taiwan. Information extracted from the case consultation and service records included patients' age, treatment phase, cancer stage, and unmet need domains. Results and conclusion: Overall, 1129 BC patients were recruited. In the prediction of critical factors influential to the health information needs of patients with BC, in-treatment patients, and those undergoing a follow-up were found to have significantly lower health information needs than patients newly diagnosed with BC. In-treatment and follow-up patients had significantly lower patient care needs than those newly diagnosed with BC. Stage II, III, and IV BC patients had significantly lower nutritional needs than stage I patients. In-treatment patients and those receiving follow-ups had significantly lower nutritional needs than patients newly diagnosed with BC. Relapse and terminal care patients had significantly higher psychosocial needs than patients newly diagnosed with BC. Thus, unmet needs of patients with cancer differ according to their age, cancer stage, and treatment phase. Appropriate and punctual tailored support provided by medical care personnel to address the unmet needs of patients can reduce the unmet supportive care needs in such patients and improve the quality of medical care services they are provided with. Ultimately, the overall quality of life of patients can be improved. Keywords: Breast cancer, Unmet supportive care needs, Quality of life
Published: 2020
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6. Long-Term Exposures to Air Pollutants and Risk of Peripheral Arterial Occlusive Disease: A Nationwide Cohort Study in Taiwan

Author: Shu-Hui Liao, Chien-Shan Chiu, Li-Ho Jang, Sung-Yuan Hu, Chorng-Kuang How, Vivian Chia-Rong Hsieh, and Ming-Shun Hsieh
Subjects: peripheral arterial occlusive disease (PAOD), PM2.5, carbon monoxide (CO), nitrogen dioxide (NO2), air pollutants, prolonged exposure, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Air pollution is one of the most alarming environmental issues which causes multiple health hazards. An association between air pollution and cardiovascular diseases has been established through many prior studies. In this study, we aimed to evaluate the risk of long-term exposure to air pollution (PM2.5, CO, and NO2) and its association with the risk of developing peripheral arterial occlusive disease (PAOD). PAOD is a condition involving impairment of perfusion of blood in the distal parts of the aorta due to narrowing of the arteries (arterial stenosis) and has been reported as a risk factor for developing cardiovascular diseases. Furthermore, the risk of PAOD increases with age, and hence is a serious public health issue and a cause for concern, especially for an aging society such as Taiwan. Two national-scale databases from Taiwan, the national health insurance database (NHIRD) and the Taiwan air quality-monitoring database (TAQMD), were linked to conduct this cohort study between 2003 and 2013. Cox proportional hazards regression with time-dependent modeling was used to evaluate the hazard ratio (HR) for PAOD with respect to daily exposure to air pollutants. The concentrations of each of the pollutants of interest (PM2.5, NO2, and CO) were categorized into four categories according to the daily average concentration of air pollutants for every quarter of the year, Q1 to Q4 (Q4 = highest). The cumulative incidence of PAOD was examined by Kaplan–Meier analysis with two-tailed log-rank test. A total of 1,598 PAOD cases were identified during the 10-year follow-up period, along with 98,540 non-PAOD controls. In the multivariate analysis, after adjusting for age, gender, urbanization level, residential area, baseline comorbidities, and medications, the adjusted HRs were PM2.5 = 1.14 (95% CI 1.13–1.16), NO2 = 1.03 (95% CI 1.02–1.04), and CO = 2.35 (95% CI 1.95–2.84). Kaplan–Meier analysis showed that CO (P < 0.0001) and PM2.5 (P < 0.0001) concentrations were strongly and positively associated with the cumulative incidence of PAOD during the follow-up period. Findings from this study established that prolonged exposure to air pollutants CO and PM2.5 are significant factors that, among other well-known causes, may also play a potential role in PAOD pathogenesis.
Published: 2022
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7. Risk for hypoglycemic emergency with levofloxacin use, a population-based propensity score matched nested case-control study.

Author: Shu-Hui Liao, Sung-Yuan Hu, Chorng-Kuang How, Vivian Chia-Rong Hsieh, Chia-Ming Chan, Chien-Shan Chiu, and Ming-Shun Hsieh
Subjects: Medicine, Science
Abstract: Potential association between oral levofloxacin use and hypoglycemic emergency (HE) have been established. However, a large epidemiological study is required to verify this observation. This study aimed to determine if use of oral levofloxacin increased the risk of HE. The nationwide database between 1999 and 2013, including 1.6 million patients with type 2 diabetes (T2D), was used to conduct a nested case-control study. Cases and controls comprised of patients with and without HE, respectively. To avoid indication bias the control subjects were chosen through propensity score matching with cases in a 10-fold ratio. T2D severity was classified based on the adjusted diabetic complication severity index score. 26,695 and 266,950 matched patients with T2D, were finally used as cases and controls, respectively, for the analysis. Multivariate logistic regression analysis showed that antibiotic use was associated with an increased risk for HE (adjusted odds ratio (aOR) = 6.08, 95% confidence interval (95% CI): 5.79-6.38). When compared with antibiotic non-users, those who used fluoroquinolones and sulfonamides displayed the highest (aOR = 12.05, 95% CI: 10.66-13.61) and second highest (aOR = 7.20, 95% CI: 6.29-8.24) risks of HE, respectively. The associated risk for HE was significantly higher with levofloxacin than that with cephalosporins (aOR = 5.13, 95% CI: 2.28-11.52) and penicillin (aOR = 9.40, 95% CI: 2.25-39.24). In the joint effect analyses, the risk for HE increased with the combination of levofloxacin with insulin (aOR = 8.42, 95% CI: 1.91-37.00) or sulfonylurea (aOR = 3.56, 95% CI: 1.12-11.33). Use of oral levofloxacin, compared to that of other antibiotics, was found to be significantly associated with HE in T2D patients. Clinicians should exercise caution while prescribing levofloxacin, especially when combined with insulin or sulfonylurea.
Published: 2022
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8. Type 2 Diabetic Sepsis Patients Have a Lower Mortality Rate in Pioglitazone Use: A Nationwide 15-Year Propensity Score Matching Observational Study in Taiwan

Author: Ming-Shun Hsieh, Sung-Yuan Hu, Shu-Hui Liao, Chia-Ming Chang, Vivian Chia-Rong Hsieh, and Chorng-Kuang How
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Background. Pioglitazone use via the PPARγ agonist in sepsis patients is inconclusive. It was based on a great number of animal studies. However, except for information from animal studies, there are merely any data of human studies for reference. Methods. This study was conducted by a unique database including 1.6 million diabetic patients. From 1999 to 2013, a total of 145,327 type 2 diabetic patients, first admitted for sepsis, were enrolled. Propensity score matching was conducted in a 1 : 5 ratio between pioglitazone users and nonusers. Multivariate logistic regression was conducted to evaluate the adjusted odds ratios (aORs) of hospital mortality in pioglitazone users. Further stratification analysis was done and Kaplan–Meier plot was used. Results. A total of 9,310 sepsis pioglitazone users (defined as “ever” use of pioglitazone in any dose within 3 months prior to the first admission for sepsis) and 46,550 matched nonusers were retrieved, respectively. In the multivariate logistic regression model, the cohort of pioglitazone users (9,310) had a decreased aOR of 0.95 (95% CI, 0.89–1.02) of sepsis mortality. Further stratification analysis demonstrated that “chronic pioglitazone users” (defined as “at least” 4-week drug use within 3 months) (3,399) were more associated with significant aOR of 0.80 (95% CI, 0.72–0.89) in reducing sepsis mortality. Conclusions. This first human cohort study demonstrated the potential protective effect of chronic pioglitazone use in type 2 diabetic sepsis patients.
Published: 2021
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9. Putting resiliency of a health system to the test: COVID-19 in Taiwan

Author: Vivian Chia-Rong Hsieh
Subjects: Medicine (General), R5-920
Published: 2020
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10. Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study

Author: Ming-Shun Hsieh, Shu-Hui Liao, Vivian Chia-Rong Hsieh, and Chorng-Kuang How
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Objective. Sepsis patients are at risk of gastrointestinal bleeding (GIB) and major adverse cardiovascular events (MACEs), but few data are available on the occurrence of GIB and MACEs and their impact on sepsis outcomes. Methods. The medical claims records of 220,082 patients admitted for sepsis between 1999 and 2013 were retrieved from the nationwide database. The adjusted odds ratios (aORs) of composite outcomes including the hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation (MV) in patients with a MACE or GIB were estimated by multivariate logistic regression and joint effect analyses. Results. The enrollees were 70.15 ± 15.17 years of age with a hospital mortality rate of 38.91%. GIB developed in 3.80% of the patients; MACEs included ischemic stroke in 1.54%, intracranial hemorrhage (ICH) in 0.92%, and acute myocardial infarction (AMI) in 1.59%. Both ICH and AMI significantly increased the risk of (1) ICU admission (aOR = 8.02, 95% confidence interval (CI): 6.84–9.42 for ICH and aOR = 4.78, 95% CI: 4.21–5.42 for AMI, respectively), (2) receiving MV (aOR = 3.92, 95% CI: 3.52–4.40 and aOR = 1.99, 95% CI: 1.84–2.16, respectively), and (3) the hospital mortality (aOR = 1.08, 95% CI: 0.98–1.19 and aOR = 1.11, 95% CI: 1.03–1.19, respectively). However, sepsis with GIB or ischemic stroke increased only the risk of ICU admission and MV but not the hospital mortality (aOR = 0.98, 95% CI: 0.93–1.03 for GIB and aOR = 0.84, 95% CI: 0.78–0.91 for ischemic stroke, respectively). Conclusions. GIB and MACEs significantly increased the risk of ICU admission and receiving MV but not the hospital mortality, which was independently associated with both AMI and ICH. Early prevention can at least reduce the complexity of clinical course and even the hospital mortality.
Published: 2020
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11. Hospital outcomes and cumulative burden from complications in type 2 diabetic sepsis patients: a cohort study using administrative and hospital-based databases

Author: Ming-Shun Hsieh, Sung-Yuan Hu, Chorng-Kuang How, Chen-June Seak, Vivian Chia-Rong Hsieh, Jin-Wei Lin, and Pau-Chung Chen
Subjects: Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract: Background: The association between type 2 diabetes and hospital outcomes of sepsis remains controversial when severity of diabetes is not taken into consideration. We examined this association using nationwide and hospital-based databases. Methods: The first part of this study was mainly conducted using a nationwide database, which included 1.6 million type 2 diabetic patients. The diabetic complication burden was evaluated using the adapted Diabetes Complications Severity Index score (aDCSI score). In the second part, we used laboratory data from a distinct hospital-based database to make comparisons using regression analyses. Results: The nationwide study included 19,719 type 2 diabetic sepsis patients and an equal number of nondiabetic sepsis patients. The diabetic sepsis patients had an increased odds ratio (OR) of 1.14 (95% confidence interval 1.1–1.19) for hospital mortality. The OR for mortality increased as the complication burden increased [aDCSI scores of 0, 1, 2, 3, 4, and ⩾5 with ORs of 0.91, 0.87, 1.14, 1.25, 1.56, and 1.77 for mortality, respectively (all p
Published: 2019
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12. Increased low back pain risk in nurses with high workload for patient care: A questionnaire survey

Author: Shwn-Huey Shieh, Fung-Chang Sung, Chia-Hsien Su, Yafang Tsai, and Vivian Chia-Rong Hsieh
Subjects: job stress, low back pain, nurses, occupational health, prolonged work shift, Gynecology and obstetrics, RG1-991
Abstract: Objective: To examine whether the prevalence of low back pain (LBP) increased in hospital nurses with high patient care workload. Materials and Methods: A structured, self-administered questionnaire was used to collect information on the prevalence of LBP and its associated factors from 788 registered nurses from a medical center in Taiwan. Results: Among all nurses with eligible questionnaires, 567 (72.0%) had LBP. Mean daily hours of working, standing, and walking were persistently longer in the LBP group. Results from multivariate logistic regression analysis showed that daily working for 1 hour longer is linked to a 35% (95% confidence interval (CI) = 2–78%) greater risk of LBP. Compared with
Published: 2016
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13. A population-based cohort study examining the association of documented bladder diverticulum and bladder cancer risk in urology patients.

Author: Chu-Wen Fang, Vivian Chia-Rong Hsieh, Steven Kuan-Hua Huang, I-Ju Tsai, Chih-Hsin Muo, and Shih-Chi Wu
Subjects: Medicine, Science
Abstract: OBJECTIVES:Studies have shown a high risk of tumor development within a bladder diverticulum (BD). We were interested in the relationship between BD and the development of bladder cancer. Herein, we attempted to investigate whether there exists an association between documented BD and subsequent risk of bladder cancer. METHODS:We identified 10,662 hospitalized urology patients, including 2,134 documented BD patients (study cohort) and 8,528 non-BD subjects (comparison cohort) from Taiwan's National Health Insurance database. Only urology patients were enrolled in the study to minimize selection bias. The two cohorts were frequency-matched 1:4 by age, sex and index-year. Patients with less than one year of follow-up were excluded to avoid inverting cause and effect. Risks of developing bladder cancer were estimated using the Cox proportional hazard regression model. RESULTS:There was an increased bladder cancer risk in the documented BD patients. The incidence of bladder cancer in documented BD patients was 2.60-fold higher than that in the comparison group, and the overall risk-factor-adjusted hazard ratio was 2.63 (95% CI, 1.74-3.97). Moreover, stratified analysis by sex also showed that documented BD patients were at higher risk of subsequent bladder cancer than the comparison cohort. The effect of BD on the risk of bladder cancer was higher in males than in females and was more profound in patients without comorbidities than in those with comorbidities. CONCLUSION:In this population-based longitudinal study, urology patients with documented BD might have an elevated risk of subsequent bladder cancer. Based on the limitations of the retrospective study design, further studies are required.
Published: 2019
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14. Delayed time from first medical visit to diagnosis for breast cancer patients in Taiwan

Author: Shwn-Huey Shieh, Vivian Chia-Rong Hsieh, Shu-Hui Liu, Chun-Ru Chien, Cheng-Chieh Lin, and Trong-Neng Wu
Subjects: breast cancer, delayed diagnosis, hospital level, number of hospitals visited, Medicine (General), R5-920
Abstract: Delay in diagnosis may affect the survival of breast cancer patients. The purpose of this study was to investigate delayed diagnosis for breast cancer patients in Taiwan. Methods: This study was conducted via one-to-one interviews with structured questionnaires in hospital outpatient visit. Included were 600 breast cancer patients seeking medical care in two medical centers in central Taiwan. Results: Average delay in breast cancer diagnosis was 27.8 days. Service level of the patients' first visit and number of hospitals patients visited before obtaining a correct diagnosis were significantly associated with delay in diagnosis. Logistic regression analysis found that patients who had visited two, and three or more hospitals before getting a correct diagnosis had longer delays in diagnosis than patients who had visited one hospital (odds ratio = 2.23 and 9.26, 95% confidence interval 1.37–3.63 and 95% CI:3.87–22.15, respectively). Conclusion: Results of this study are anticipated to serve as a reference for the government and medical institutions to develop policies to reduce the number of hospitals visited before diagnosis for breast cancer patients, and ultimately to achieve the goal of early detection and treatment.
Published: 2014
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15. Migraine and risk of narcolepsy in children: A nationwide longitudinal study.

Author: Chun-Pai Yang, Meng-Lun Hsieh, Jen-Huai Chiang, Hsing-Yi Chang, and Vivian Chia-Rong Hsieh
Subjects: Medicine, Science
Abstract: The association between migraine and narcolepsy remains controversial. We aim to investigate whether migraine is associated with an increased risk of developing narcolepsy in children.In this longitudinal study, nationwide medical-claims data of pediatric patients (0-17y) with migraine are identified using the National Health Insurance Research Database (NHIRD) between 1997 and 2010 in Taiwan. Two cohorts are selected: migraine cases (n = 8,923) and propensity score-matched non-migraine controls (n = 35,692). Children with previous history of narcolepsy or headache before the index date are excluded. Cohorts are followed until the end of 2012, their withdrawal from the NHI program, or incidence of narcolepsy (ICD-9-CM: 347). Cox proportional hazards regression models are used to estimate hazard ratios (HRs) and 95% confidence intervals of developing narcolepsy in children with migraine compared to their non-migraine controls.A total of 13 incident cases with narcolepsy are observed during follow-up, with incidence rates of 0.1915 and 0.0278 per 1,000 person-years in migraine and non-migraine children, respectively. After a mean follow-up period of 4.68 and 5.04 years in the case and control cohort, respectively, the former exhibited a greater risk of developing narcolepsy compared to the latter (adjusted hazard ratio (aHR) = 5.30, 95% confidence interval (CI): 1.61, 17.4; p = 0.006). This finding persisted after controlling for potential confounders like baseline comorbidities and concurrent medication uptake, and in our analyses with migraine subtypes.Migraine is an independent risk factor for narcolepsy development in children. Further studies are needed to validate our findings and to explore the exact pathophysiological mechanisms linking migraine and narcolepsy.
Published: 2017
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16. Risk of Allergic Rhinitis, Allergic Conjunctivitis, and Eczema in Children Born to Mothers with Gum Inflammation during Pregnancy.

Author: Vivian Chia-Rong Hsieh, Chin-Chen Liu, Yu-Chen Hsiao, and Trong-Neng Wu
Subjects: Medicine, Science
Abstract: PURPOSE:Despite links between maternal and child health status, evidence on the association between gum infection in pregnant mothers and childhood allergies is scarce. We aim to evaluate the risk of developing allergy in children born to periodontal mothers in a nationwide study. METHODS:We conducted a 9-year population-based, retrospective cohort study using Taiwan's National Health Insurance database. A study cohort of 42,217 newborns born to mothers with periodontal disease during pregnancy was identified in 2001 and matched with 42,334 babies born to mothers without any infection (control) by mother's age at delivery and baby sex. With a follow-up period from 2001 to 2010, we observed the incidence of allergic rhinitis (AR), allergic conjunctivitis (AC), and eczema in these children. Cox proportional hazards regression models were performed with premature deaths as competing risk for the estimation of allergic disease risks. RESULTS:Nine-year cumulative incidences were the highest among children born to periodontal mothers; they reached 46.8%, 24.2%, and 40.4% (vs. 39.5%, 18.3% and 34.8% in control) for AR, AC, and eczema, respectively. Our results showed moderately increased risks for the allergies in children born to periodontal mothers relative to their matched non-inflammatory control (adjusted HRs: 1.17, 95% CI: 1.15-1.20; 1.27, 1.24-1.31; 1.14, 1.12-1.17, respectively). Because the impact of food consumption and living environment cannot be considered using insurance data, we attempted to control it by adjusting for parental income and mother's residential area. CONCLUSIONS:Overall cumulative incidence and risks of children born to periodontal mothers for AR, AC, and eczema are significantly higher than those born to non-inflammatory mothers. Gum infection in women during pregnancy is an independent risk factor for allergic diseases in children, thus its intergenerational consequences should be considered in gestational care.
Published: 2016
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17. Unmet supportive care needs of survival patients with breast cancer in different cancer stages and treatment phases

Author: Shwn-Huey Shieh, Ting-Yi Huang, XianXiu Chen, Ying-Hsiang Chou, and Vivian Chia-Rong Hsieh
Subjects: Adult, medicine.medical_specialty, Taiwan, Breast Neoplasms, lcsh:Gynecology and obstetrics, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Quality of life (healthcare), Cancer Survivors, medicine, Terminal care, Humans, lcsh:RG1-991, Aged, Neoplasm Staging, Retrospective Studies, Health Services Needs and Demand, 030219 obstetrics & reproductive medicine, business.industry, Palliative Care, Treatment phases, Obstetrics and Gynecology, Cancer, Retrospective cohort study, Middle Aged, medicine.disease, Family medicine, Quality of Life, Female, Health information, business, Psychosocial, Needs Assessment
Abstract: Objective: This study aimed to examine the differences between patients with breast cancer (BC) at different cancer stages and treatment phases in terms of unmet supportive care needs as well as to predict the critical factors that influence the unmet needs of such patients. Materials and methods: A retrospective study was conducted by collecting data from the case consultation and service records of a cancer center in central Taiwan. Information extracted from the case consultation and service records included patients' age, treatment phase, cancer stage, and unmet need domains. Results and conclusion: Overall, 1129 BC patients were recruited. In the prediction of critical factors influential to the health information needs of patients with BC, in-treatment patients, and those undergoing a follow-up were found to have significantly lower health information needs than patients newly diagnosed with BC. In-treatment and follow-up patients had significantly lower patient care needs than those newly diagnosed with BC. Stage II, III, and IV BC patients had significantly lower nutritional needs than stage I patients. In-treatment patients and those receiving follow-ups had significantly lower nutritional needs than patients newly diagnosed with BC. Relapse and terminal care patients had significantly higher psychosocial needs than patients newly diagnosed with BC. Thus, unmet needs of patients with cancer differ according to their age, cancer stage, and treatment phase. Appropriate and punctual tailored support provided by medical care personnel to address the unmet needs of patients can reduce the unmet supportive care needs in such patients and improve the quality of medical care services they are provided with. Ultimately, the overall quality of life of patients can be improved. Keywords: Breast cancer, Unmet supportive care needs, Quality of life
Published: 2020

18. Mortality Risk and Decompensation in Hospitalized Patients with Non-Alcoholic Liver Cirrhosis: Implications for Disease Management

Author: Ming-Shun Hsieh, Vivian Chia-Rong Hsieh, Jen-Huai Chiang, Kung-Chuan Cheng, and Meng-Lun Hsieh
Subjects: Adult, medicine.medical_specialty, Cirrhosis, Carcinoma, Hepatocellular, complications, Health, Toxicology and Mutagenesis, liver cirrhosis, Population, hepatic encephalopathy, Taiwan, lcsh:Medicine, Esophageal and Gastric Varices, Article, 03 medical and health sciences, ascites, cause of death, 0302 clinical medicine, Spontaneous bacterial peritonitis, Hepatorenal syndrome, Internal medicine, medicine, Humans, chronic hepatitis C, Decompensation, chronic hepatitis B, 030212 general & internal medicine, education, Hepatic encephalopathy, Cause of death, Aged, Aged, 80 and over, education.field_of_study, business.industry, Mortality rate, Liver Neoplasms, lcsh:R, Public Health, Environmental and Occupational Health, Disease Management, nonalcoholic, varices, Middle Aged, medicine.disease, mortality, 030211 gastroenterology & hepatology, business, Gastrointestinal Hemorrhage
Abstract: Here we aimed to assess the mortality risk and distribution of deaths from different complications and etiologies for non-alcoholic liver cirrhosis (NALC) adult inpatients and compare them with that of the general hospitalized adult population. Hospitalized patients with a primary diagnosis of NALC and aged between 30 and 80 years of age from 1999 to 2010 were identified using a population-based administrative claims database in Taiwan. They were matched with a general, non-NALC population of hospitalized patients. Causes of death considered were variceal hemorrhage, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatocellular carcinoma, jaundice, and hepatorenal syndrome. A total of 109,128 NALC inpatients were included and then matched with 109,128 inpatients without NALC. Overall mortality rates were 21.2 (95% CI: 21.0&ndash, 21.4) and 6.27 (95% CI: 6.17&ndash, 6.37) per 100 person-years, respectively. Among complications that caused death in NALC patients, variceal hemorrhage was the most common (23.7%, 11.9 per 100 person-years), followed by ascites (20.9%, 10.4 per 100 person-years) and encephalopathy (18.4%, 9.21 per 100 person-years). Among all etiologies, mortality rates were highest for NALC patients with HBV infection (43.7%, 21.8 per 100 person-years), followed by HBV-HCV coinfection (41.8%, 20.9 per 100 person-years), HCV infection (41.2%, 20.6 per 100 person-years), and NAFLD (35.9%, 17.9 per 100 person-years). In this study, we demonstrated that mortality risks in NALC patients may differ with their etiology and their subsequent complications. Patients&rsquo, care plans, thus, should be formulated accordingly.
Published: 2021

19. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. 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Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Mahesh P A, Pallab K. Maulik, Ali H. Mokdad, Andre M. N. Renzaho, Milena Santric-Milicevic, Parvaiz A Koul, Foad Abd-Allah, Mihaela Hostiuc, Richard G. Cowden, Ronny Westerman, Meghdad Pirsaheb, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Tampere University, Tays Research Services, Health Sciences, Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., Adekanmbi, V., Adeoye, A. M., Adetokunboh, O. O., Adham, D., Advani, S. M., Agarwal, G., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Ahmadi, K., Ahmadi, M., Ahmadieh, H., Ahmed, M. B., Akalu, T. Y., Akinyemi, R. O., Akinyemiju, T., Akombi, B., Akunna, C. J., Alahdab, F., Al-Aly, Z., Alam, K., Alam, S., Alam, T., Alanezi, F. M., Alanzi, T. M., Alemu, B. W., Alhabib, K. F., Ali, M., Ali, S., Alicandro, G., Alinia, C., Alipour, V., Alizade, H., Aljunid, S. M., Alla, F., Allebeck, P., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Alonso, J., Altirkawi, K. A., Amini-Rarani, M., Amiri, F., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Anderson, J. A., Andrei, C. L., Andrei, T., Angus, C., Anjomshoa, M., Ansari, F., Ansari-Moghaddam, A., Antonazzo, I. C., Antonio, C. A. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Appiah, S. C. Y., Arabloo, J., Arab-Zozani, M., Ariani, F., Armoon, B., Arnlov, J., Arzani, A., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Ashbaugh, C., Assmus, M., Atafar, Z., Atnafu, D. D., Atout, M. M. W., Ausloos, F., Ausloos, M., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Azari, S., Azarian, G., Azene, Z. N., Badawi, A., Badiye, A. D., Bahrami, M. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Bante, A. B., Baraki, A. G., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Barthelemy, C. M., Barua, L., Basu, S., Baune, B. T., Bayati, M., Becker, J. S., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bennitt, F. B., Bensenor, I. M., Berhe, K., Berman, A. E., Bhagavathula, A. S., Bhageerathy, R., Bhala, N., Bhandari, D., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Bikbov, B., Bin Sayeed, M. S., Biondi, A., Birihane, B. M., Bisignano, C., Biswas, R. K., Bitew, H., Bohlouli, S., Bohluli, M., Boon-Dooley, A. S., Borges, G., Borzi, A. M., Borzouei, S., Bosetti, C., Boufous, S., Braithwaite, D., Breitborde, N. J. K., Breitner, S., Brenner, H., Briant, P. S., Briko, A. N., Briko, N. I., Britton, G. B., Bryazka, D., Bumgarner, B. R., Burkart, K., Burnett, R. T., Burugina Nagaraja, S., Butt, Z. A., Caetano dos Santos, F. L., Cahill, L. E., Camera, L. L. A., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J. S., Chang, K. -L., Charlson, F. J., Chattu, V. K., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Chung, S. -C., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Classen, T. K. D., Cohen, A. J., Compton, K., Cooper, O. R., Costa, V. M., Cousin, E., Cowden, R. G., Cross, D. H., Cruz, J. A., Dahlawi, S. M. A., Damasceno, A. A. M., Damiani, G., Dandona, L., Dandona, R., Dangel, W. J., Danielsson, A. -K., Dargan, P. I., Darwesh, A. M., Daryani, A., Das, J. K., Das Gupta, R., das Neves, J., Davila-Cervantes, C. A., Davitoiu, D. V., De Leo, D., Degenhardt, L., Delang, M., Dellavalle, R. P., Demeke, F. M., Demoz, G. T., Demsie, D. G., Denova-Gutierrez, E., Dervenis, N., Dhungana, G. P., Dianatinasab, M., Dias da Silva, D., Diaz, D., Dibaji Forooshani, Z. S., Djalalinia, S., Do, H. T., Dokova, K., Dorostkar, F., Doshmangir, L., Driscoll, T. R., Duncan, B. B., Duraes, A. R., Eagan, A. W., Edvardsson, D., El Nahas, N., El Sayed, I., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., El-Jaafary, S. I., Elyazar, I. R., Emmons-Bell, S., Erskine, H. E., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Estep, K., Etemadi, A., Etisso, A. E., Fanzo, J., Farahmand, M., Fareed, M., Faridnia, R., Farioli, A., Faro, A., Faruque, M., Farzadfar, F., Fattahi, N., Fazlzadeh, M., Feigin, V. L., Feldman, R., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, G., Ferrari, A. J., Ferreira, M. L., Filip, I., Fischer, F., Fisher, J. L., Flor, L. S., Foigt, N. A., Folayan, M. O., Fomenkov, A. A., Force, L. M., Foroutan, M., Franklin, R. C., Freitas, M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gakidou, E., Gallus, S., Garcia-Basteiro, A. L., Gardner, W. M., Geberemariyam, B. S., Gebreslassie, A. A. A. A., Geremew, A., Gershberg Hayoon, A., Gething, P. W., Ghadimi, M., Ghadiri, K., Ghaffarifar, F., Ghafourifard, M., Ghamari, F., Ghashghaee, A., Ghiasvand, H., Ghith, N., Gholamian, A., Ghosh, R., Gill, P. S., Ginindza, T. G. G., Giussani, G., Gnedovskaya, E. V., Goharinezhad, S., Gopalani, S. V., Gorini, G., Goudarzi, H., Goulart, A. C., Greaves, F., Grivna, M., Grosso, G., Gubari, M. I. M., Gugnani, H. C., Guimaraes, R. A., Guled, R. A., Guo, G., Guo, Y., Gupta, R., Gupta, T., Haddock, B., Hafezi-Nejad, N., Hafiz, A., Haj-Mirzaian, A., Hall, B. J., Halvaei, I., Hamadeh, R. R., Hamidi, S., Hammer, M. S., Hankey, G. J., Haririan, H., Haro, J. M., Hasaballah, A. I., Hasan, M. M., Hasanpoor, E., Hashi, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Henrikson, H. J., Herbert, M. E., Herteliu, C., Heydarpour, F., Hird, T. R., Hoek, H. W., Holla, R., Hoogar, P., Hosgood, H. D., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsairi, M., Hsieh, V. C. -R., Hu, G., Hu, K., Huda, T. M., Humayun, A., Huynh, C. K., Hwang, B. -F., Iannucci, V. C., Ibitoye, S. E., Ikeda, N., Ikuta, K. S., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Inbaraj, L. R., Ippolito, H., Iqbal, U., Irvani, S. S. N., Irvine, C. M. S., Islam, M. M., Islam, S. M. S., Iso, H., Ivers, R. Q., Iwu, C. C. D., Iwu, C. J., Iyamu, I. O., Jaafari, J., Jacobsen, K. H., Jafari, H., Jafarinia, M., Jahani, M. A., Jakovljevic, M., Jalilian, F., James, S. L., Janjani, H., Javaheri, T., Javidnia, J., Jeemon, P., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Johansson, L., John, O., John-Akinola, Y. O., Johnson, C. O., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, A., Kabir, Z., Kalani, H., Kalani, R., Kalankesh, L. R., Kalhor, R., Kanchan, T., Kapoor, N., Karami Matin, B., Karch, A., Karim, M. A., Kassa, G. M., Katikireddi, S. V., Kayode, G. A., Kazemi Karyani, A., Keiyoro, P. N., Keller, C., Kemmer, L., Kendrick, P. J., Khalid, N., Khammarnia, M., Khan, E. A., Khan, M., Khatab, K., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khazaei, S., Kieling, C., Kim, Y. J., Kimokoti, R. W., Kisa, A., Kisa, S., Kivimaki, M., Knibbs, L. D., Knudsen, A. K. S., Kocarnik, J. M., Kochhar, S., Kopec, J. A., Korshunov, V. A., Koul, P. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Krohn, K. J., Kromhout, H., Kuate Defo, B., Kumar, G. A., Kumar, V., Kurmi, O. P., Kusuma, D., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Lallukka, T., Lami, F. H., Landires, I., Lang, J. J., Langan, S. M., Larsson, A. O., Lasrado, S., Lauriola, P., Lazarus, J. V., Lee, P. H., Lee, S. W. H., Legrand, K. E., Leigh, J., Leonardi, M., Lescinsky, H., Leung, J., Levi, M., Li, S., Lim, L. -L., Linn, S., Liu, S., Liu, Y., Lo, J., Lopez, A. D., Lopez, J. C. F., Lopukhov, P. D., Lorkowski, S., Lotufo, P. A., Lu, A., Lugo, A., Maddison, E. R., Mahasha, P. W., Mahdavi, M. M., Mahmoudi, M., Majeed, A., Maleki, A., Maleki, S., Malekzadeh, R., Malta, D. C., Mamun, A. A., Manda, A. L., Manguerra, H., Mansour-Ghanaei, F., Mansouri, B., Mansournia, M. A., Mantilla Herrera, A. M., Maravilla, J. C., Marks, A., Martin, R. V., Martini, S., Martins-Melo, F. R., Masaka, A., Masoumi, S. Z., Mathur, M. R., Matsushita, K., Maulik, P. K., Mcalinden, C., Mcgrath, J. J., Mckee, M., Mehndiratta, M. M., Mehri, F., Mehta, K. M., Memish, Z. A., Mendoza, W., Menezes, R. G., Mengesha, E. W., Mereke, A., Mereta, S. T., Meretoja, A., Meretoja, T. J., Mestrovic, T., Miazgowski, B., Miazgowski, T., Michalek, I. M., Miller, T. R., Mills, E. J., Mini, G. K., Miri, M., Mirica, A., Mirrakhimov, E. M., Mirzaei, H., Mirzaei, M., Mirzaei, R., Mirzaei-Alavijeh, M., Misganaw, A. T., Mithra, P., Moazen, B., Mohammad, D. K., Mohammad, Y., Mohammad Gholi Mezerji, N., Mohammadian-Hafshejani, A., Mohammadifard, N., Mohammadpourhodki, R., Mohammed, A. S., Mohammed, H., Mohammed, J. A., Mohammed, S., Mokdad, A. H., Molokhia, M., Monasta, L., Mooney, M. D., Moradi, G., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morawska, L., Morgado-da-Costa, J., Morrison, S. D., Mosapour, A., Mosser, J. F., Mouodi, S., Mousavi, S. M., Mousavi Khaneghah, A., Mueller, U. O., Mukhopadhyay, S., Mullany, E. C., Musa, K. I., Muthupandian, S., Nabhan, A. F., Naderi, M., Nagarajan, A. J., Nagel, G., Naghavi, M., Naghshtabrizi, B., Naimzada, M. D., Najafi, F., Nangia, V., Nansseu, J. R., Naserbakht, M., Nayak, V. C., Negoi, I., Ngunjiri, J. W., Nguyen, C. T., Nguyen, H. L. T., Nguyen, M., Nigatu, Y. T., Nikbakhsh, R., Nixon, M. R., Nnaji, C. A., Nomura, S., Norrving, B., Noubiap, J. 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A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Ram, P., Ramezanzadeh, K., Ranabhat, C. L., Rao, P. C., Rao, S. J., Rashedi, V., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Rawat, R., Razo, C., Redford, S. B., Reiner, R. C., Reitsma, M. B., Remuzzi, G., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Rezaei, N., Rezapour, A., Rhinehart, P. -A., Riahi, S. M., Ribeiro, D. C., Ribeiro, D., Rickard, J., Rivera, J. A., Roberts, N. L. S., Rodriguez-Ramirez, S., Roever, L., Ronfani, L., Room, R., Roshandel, G., Roth, G. A., Rothenbacher, D., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Saeedi, R., Saeedi Moghaddam, S., Safari, Y., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sajadi, S. M., Salam, N., Salamati, P., Salem, H., Salem, M. R. R., Salimzadeh, H., Salman, O. M., Salomon, J. A., Samad, Z., Samadi Kafil, H., Sambala, E. Z., Samy, A. M., Sanabria, J., Sanchez-Pimienta, T. G., Santomauro, D. F., Santos, I. 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N., Spotin, A., Sreeramareddy, C. T., Srinivasan, V., Stanaway, J. D., Stein, C., Stein, D. J., Steiner, C., Stockfelt, L., Stokes, M. A., Straif, K., Stubbs, J. L., Sufiyan, M. B., Suleria, H. A. R., Suliankatchi Abdulkader, R., Sulo, G., Sultan, I., Szumowski, Tabares-Seisdedos, R., Tabb, K. M., Tabuchi, T., Taherkhani, A., Tajdini, M., Takahashi, K., Takala, J. S., Tamiru, A. T., Taveira, N., Tehrani-Banihashemi, A., Temsah, M. -H., Tesema, G. A., Tessema, Z. T., Thurston, G. D., Titova, M. V., Tohidinik, H. R., Tonelli, M., Topor-Madry, R., Topouzis, F., Torre, A. E., Touvier, M., Tovani-Palone, M. R. R., Tran, B. X., Travillian, R., Tsatsakis, A., Tudor Car, L., Tyrovolas, S., Uddin, R., Umeokonkwo, C. D., Unnikrishnan, B., Upadhyay, E., Vacante, M., Valdez, P. R., van Donkelaar, A., Vasankari, T. J., Vasseghian, Y., Veisani, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S. E., Vos, T., Vukovic, R., Waheed, Y., Wallin, M. 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S., Lacey, B, Sartorius, B, Abbafati, C, Abbas, K, Abbasi-Kangevari, M, Abd-Allah, F, Abdelalim, A, Abdollahi, M, Abdollahpour, I, Abegaz, K, Abolhassani, H, Aboyans, V, Abreu, L, Abrigo, M, Abualhasan, A, Abu-Raddad, L, Abushouk, A, Adabi, M, Adekanmbi, V, Adeoye, A, Adetokunboh, O, Adham, D, Advani, S, Afshin, A, Agarwal, G, Aghamir, S, Agrawal, A, Ahmad, T, Ahmadi, K, Ahmadi, M, Ahmadieh, H, Ahmed, M, Akalu, T, Akinyemi, R, Akinyemiju, T, Akombi, B, Akunna, C, Alahdab, F, Al-Aly, Z, Alam, K, Alam, S, Alam, T, Alanezi, F, Alanzi, T, Alemu, B, Alhabib, K, Ali, M, Ali, S, Alicandro, G, Alinia, C, Alipour, V, Alizade, H, Aljunid, S, Alla, F, Allebeck, P, Almasi-Hashiani, A, Al-Mekhlafi, H, Alonso, J, Altirkawi, K, Amini-Rarani, M, Amiri, F, Amugsi, D, Ancuceanu, R, Anderlini, D, Anderson, J, Andrei, C, Andrei, T, Angus, C, Anjomshoa, M, Ansari, F, Ansari-Moghaddam, A, Antonazzo, I, Antonio, C, Antony, C, Antriyandarti, E, Anvari, D, Anwer, R, Appiah, S, Arabloo, J, Arab-Zozani, M, Aravkin, A, Ariani, F, Armoon, B, Arnlov, J, Arzani, A, Asadi-Aliabadi, M, Asadi-Pooya, A, Ashbaugh, C, Assmus, M, Atafar, Z, Atnafu, D, Atout, M, Ausloos, F, Ausloos, M, Ayala Quintanilla, B, Ayano, G, Ayanore, M, Azari, S, Azarian, G, Azene, Z, Badawi, A, Badiye, A, Bahrami, M, Bakhshaei, M, Bakhtiari, A, Bakkannavar, S, Baldasseroni, A, Ball, K, Ballew, S, Balzi, D, Banach, M, Banerjee, S, Bante, A, Baraki, A, Barker-Collo, S, Barnighausen, T, Barrero, L, Barthelemy, C, Barua, L, Basu, S, Baune, B, Bayati, M, Becker, J, Bedi, N, Beghi, E, Bejot, Y, Bell, M, Bennitt, F, Bensenor, I, Berhe, K, Berman, A, Bhagavathula, A, Bhageerathy, R, Bhala, N, Bhandari, D, Bhattacharyya, K, Bhutta, Z, Bijani, A, Bikbov, B, Bin Sayeed, M, Biondi, A, Birihane, B, Bisignano, C, Biswas, R, Bitew, H, Bohlouli, S, Bohluli, M, Boon-Dooley, A, Borges, G, Borzi, A, Borzouei, S, Bosetti, C, Boufous, S, Braithwaite, D, Brauer, M, Breitborde, N, Breitner, S, Brenner, H, Briant, P, Briko, A, Briko, N, Britton, G, Bryazka, D, Bumgarner, B, Burkart, K, Burnett, R, Burugina Nagaraja, S, Butt, Z, Caetano Dos Santos, F, Cahill, L, Camera, L, Campos-Nonato, I, Cardenas, R, Carreras, G, Carrero, J, Carvalho, F, Castaldelli-Maia, J, Castaneda-Orjuela, C, Castelpietra, G, Castro, F, Causey, K, Cederroth, C, Cercy, K, Cerin, E, Chandan, J, Chang, K, Charlson, F, Chattu, V, Chaturvedi, S, Cherbuin, N, Chimed-Ochir, O, Cho, D, Choi, J, Christensen, H, Chu, D, Chung, M, Chung, S, Cicuttini, F, Ciobanu, L, Cirillo, M, Classen, T, Cohen, A, Compton, K, Cooper, O, Costa, V, Cousin, E, Cowden, R, Cross, D, Cruz, J, Dahlawi, S, Damasceno, A, Damiani, G, Dandona, L, Dandona, R, Dangel, W, Danielsson, A, Dargan, P, Darwesh, A, Daryani, A, Das, J, Das Gupta, R, das Neves, J, Davila-Cervantes, C, Davitoiu, D, De Leo, D, Degenhardt, L, Delang, M, Dellavalle, R, Demeke, F, Demoz, G, Demsie, D, Denova-Gutierrez, E, Dervenis, N, Dhungana, G, Dianatinasab, M, Dias da Silva, D, Diaz, D, Dibaji Forooshani, Z, 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M, Jahani, M, Jakovljevic, M, Jalilian, F, James, S, Janjani, H, Javaheri, T, Javidnia, J, Jeemon, P, Jenabi, E, Jha, R, Jha, V, Ji, J, Johansson, L, John, O, John-Akinola, Y, Johnson, C, Jonas, J, Joukar, F, Jozwiak, J, Jurisson, M, Kabir, A, Kabir, Z, Kalani, H, Kalani, R, Kalankesh, L, Kalhor, R, Kanchan, T, Kapoor, N, Matin, B, Karch, A, Karim, M, Kassa, G, Katikireddi, S, Kayode, G, Kazemi Karyani, A, Keiyoro, P, Keller, C, Kemmer, L, Kendrick, P, Khalid, N, Khammarnia, M, Khan, E, Khan, M, Khatab, K, Khater, M, Khatib, M, Khayamzadeh, M, Khazaei, S, Kieling, C, Kim, Y, Kimokoti, R, Kisa, A, Kisa, S, Kivimaki, M, Knibbs, L, Knudsen, A, Kocarnik, J, Kochhar, S, Kopec, J, Korshunov, V, Koul, P, Koyanagi, A, Kraemer, M, Krishan, K, Krohn, K, Kromhout, H, Kuate Defo, B, Kumar, G, Kumar, V, Kurmi, O, Kusuma, D, La Vecchia, C, Lal, D, Lalloo, R, Lallukka, T, Lami, F, Landires, I, Lang, J, Langan, S, Larsson, A, Lasrado, S, Lauriola, P, Lazarus, J, Lee, P, Lee, S, Legrand, K, Leigh, J, Leonardi, M, Lescinsky, H, Leung, J, Levi, M, Li, S, Lim, L, Linn, S, Liu, S, Liu, Y, Lo, J, Lopez, A, Lopez, J, Lopukhov, P, Lorkowski, S, Lotufo, P, Lu, A, Lugo, A, Maddison, E, Mahasha, P, Mahdavi, M, Mahmoudi, M, Majeed, A, Maleki, A, Maleki, S, Malekzadeh, R, Malta, D, Mamun, A, Manda, A, Manguerra, H, Mansour-Ghanaei, F, Mansouri, B, Mansournia, M, Mantilla Herrera, A, Maravilla, J, Marks, A, Martin, R, Martini, S, Martins-Melo, F, Masaka, A, Masoumi, S, Mathur, M, Matsushita, K, Maulik, P, Mcalinden, C, Mcgrath, J, Mckee, M, Mehndiratta, M, Mehri, F, Mehta, K, Memish, Z, Mendoza, W, Menezes, R, Mengesha, E, Mereke, A, Mereta, S, Meretoja, A, Meretoja, T, Mestrovic, T, Miazgowski, B, Miazgowski, T, Michalek, I, Miller, T, Mills, E, Mini, G, Miri, M, Mirica, A, Mirrakhimov, E, Mirzaei, H, Mirzaei, M, Mirzaei, R, Mirzaei-Alavijeh, M, Misganaw, A, Mithra, P, Moazen, B, Mohammad, D, Mohammad, Y, Mohammad Gholi Mezerji, N, Mohammadian-Hafshejani, A, Mohammadifard, N, Mohammadpourhodki, R, Mohammed, A, Mohammed, H, Mohammed, J, Mohammed, S, Mokdad, A, Molokhia, M, Monasta, L, Mooney, M, Moradi, G, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morawska, L, Morgado-Da-Costa, J, Morrison, S, Mosapour, A, Mosser, J, Mouodi, S, Mousavi, S, Khaneghah, A, Mueller, U, Mukhopadhyay, S, Mullany, E, Musa, K, Muthupandian, S, Nabhan, A, Naderi, M, Nagarajan, A, Nagel, G, Naghavi, M, Naghshtabrizi, B, Naimzada, M, Najafi, F, Nangia, V, Nansseu, J, Naserbakht, M, Nayak, V, Negoi, I, Ngunjiri, J, Nguyen, C, Nguyen, H, Nguyen, M, Nigatu, Y, Nikbakhsh, R, Nixon, M, Nnaji, C, Nomura, S, Norrving, B, Noubiap, J, Nowak, C, Nunez-Samudio, V, Oancea, B, Odell, C, Ogbo, F, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, B, Olusanya, J, Omer, M, Ong, K, Onwujekwe, O, Orpana, H, Ortiz, A, Osarenotor, O, Osei, F, Ostroff, S, Otoiu, A, Otstavnov, N, Otstavnov, S, Overland, S, Owolabi, M, Mahesh, P, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Parry, C, Pasovic, M, Pasupula, D, Patel, S, Pathak, M, Patten, S, Patton, G, Toroudi, H, Peden, A, Pennini, A, Pepito, V, Peprah, E, Pereira, D, Pesudovs, K, Pham, H, Phillips, M, Piccinelli, C, Pilz, T, Piradov, M, Pirsaheb, M, Plass, D, Polinder, S, Polkinghorne, K, Pond, C, Postma, M, Pourjafar, H, Pourmalek, F, Poznanska, A, Prada, S, Prakash, V, Pribadi, D, Pupillo, E, Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiee, A, Raggi, A, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Rakovac, I, Ram, P, Ramezanzadeh, K, Ranabhat, C, Rao, P, Rao, S, Rashedi, V, Rathi, P, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Rawat, R, Razo, C, Redford, S, Reiner, R, Reitsma, M, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezapour, A, Rhinehart, P, Riahi, S, Ribeiro, D, Rickard, J, Rivera, J, Roberts, N, Rodriguez-Ramirez, S, Roever, L, Ronfani, L, Room, R, Roshandel, G, Roth, G, Rothenbacher, D, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, E, Sadeghi, M, Saeedi, R, Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.
Subjects: Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
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. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
Published: 2020
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20. Forgone Health and Economic Benefits Associated with Socioeconomic Differences in Organized Cervical Cancer Screening

Author: Chin-Chen Liu, Shwn-Huey Shieh, Zih-Jhen Chen, Ming-Shun Hsieh, Vivian Chia-Rong Hsieh, and Jen-Huai Chiang
Subjects: 0301 basic medicine, Adult, Inequality, cervical cancer, media_common.quotation_subject, Population, Taiwan, Uterine Cervical Neoplasms, Capital good, 03 medical and health sciences, 0302 clinical medicine, inequalities, Environmental health, Health care, Cancer screening, Medicine, Humans, Healthcare Disparities, education, Early Detection of Cancer, media_common, Consumption (economics), Cervical cancer, Vaginal Smears, education.field_of_study, business.industry, health, General Medicine, economics, Patient Acceptance of Health Care, medicine.disease, Prognosis, 030104 developmental biology, Years of potential life lost, Socioeconomic Factors, cancer screening, 030220 oncology & carcinogenesis, Pap smear, Female, business, Research Article, Follow-Up Studies, Papanicolaou Test
Abstract: Objective To describe cervical cancer screening participation among women in Taiwan under its population-based screening policy and to estimate the economic burden of disease attributable to avoidable disparities in cervical cancer (CC) screening. Methods We identified a nationally-representative sample of females aged 30 years or above who were eligible for Pap smear testing in Taiwan from 1 January to 31 December 2013. An administrative database with detailed claims of health care utilization under the universal coverage health care system was used. Socioeconomic position of the female subjects was defined using the occupation classification, and two groups were specifically identified: general (O1) and low-income (O5) groups. Differences in screening rate, CC prevalence, and CC-attributable deaths were assessed between the two groups. Economic consequences as a result of screening inequalities were estimated using actual total health care spending (health care expenditure), monetary value per life-year and years of life lost for ill health and screening disparities (health as consumption good), and productivity losses alongside costs of social benefits (health as capital good). Result A total of 301,057 enrolled females aged 30 years and older eligible for screening were identified. Overall, 3-year and 1-year screening rates among all subjects were 0.601 and 0.372, respectively. Impact of observed differences in screening translated to US$59,568 of health care spending in one year, 90.4% of which was specific to hospital admissions. When we viewed health as a consumption good and capital good, the impact of screening disparity on health losses through CC would be equivalent to US$78,095 and US$190,868, respectively. Conclusion Forgone health and economic benefits associated with inequalities in CC screening uptake can be considerable in productive women.
Published: 2019

21. 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

Author: Sorin Hostiuc, Shaun Wen Huey Lee, Jorge R. Ledesma, Carsten Flohr, Masoumeh Sadeghi, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Mehdi Bohluli, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Seyyed Meysam Mousavi, Bernhard T. Baune, Ehsan Ahmadpour, Dinh-Toi Chu, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Mohammad Taghi Khodayari, Gianna Gayle Herrera Amul, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Michael K. Hole, Azeem Majeed, Iman Halvaei, Saqib Ali, Arianna Maever L. Amit, Tomas Y. Yeheyis, John S. Ji, Martin McKee, Jamileh Shadid, Leonardo Roever, Peng Jia, Ettore Beghi, Pablo M. Lavados, Young Eun Kim, Vahid Alipour, Sowmya J. Rao, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nicole K. DeCleene, Ebrahim Babaee, Saman Esmaeilnejad, Boris Bikbov, William M. Gardner, Lydia M. Haile, Luca Ronfani, Azalea M. Thomson, Irena Ilic, Ruth W. Kimokoti, Yingxi Zhao, Guoqing Hu, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Nathaniel J. Henry, Brijesh Sathian, Daniel Kim, Peter Memiah, Mohammad Hadi Abbasi, Andrea Farioli, Zahra Kamiab, Bolajoko O. Olusanya, Matthew C. Doxey, Tommi Vasankari, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Shanshan Li, Tanvir M. Huda, Dillon O Sylte, Rosario Cárdenas, Agegnehu Bante, Helen Ippolito, Alyssa Acebedo, Jeffrey D. Stanaway, Anwar Faraj, João Pedro Silva, Amin Mousavi Khaneghah, Pushpendra Kumar, Sangram Kishor Patel, Josephine W. Ngunjiri, Holly E. Erskine, Eugene Sobngwi, Filippo Ariani, Shane D. Morrison, Mohammad Aghaali, Meghan D. Mooney, Vera Marisa Costa, Palash Chandra Banik, Rupak Desai, Ken Takahashi, Maigeng Zhou, Morteza Oladnabi, Bogdan Oancea, Daniela Ribeiro, Mohammad Farahmand, Irmina Maria Michalek, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Emilie R Maddison, Syed Mohamed Aljunid, Damian G. Hoy, Hosni Salem, V. Prakash, Shuhei Nomura, Inga Dora Sigfusdottir, Anders Larsson, Sharareh Eskandarieh, Abdollah Mohammadian-Hafshejani, Somayeh Bohlouli, Joana Morgado-da-Costa, Siamak Sabour, Theo Vos, Han Yong Wunrow, Khaled Khatab, Alireza Zangeneh, Ann Kristin Knudsen, Marissa B Reitsma, Hannah J. Henrikson, Randah R. Hamadeh, Tuomo J. Meretoja, Ireneous N. Soyiri, Giuseppe Grosso, Ziyad Al-Aly, Taraneh Yousefinezhadi, Joseph L Ward, Roba Khundkar, Ricardo Santiago Gomez, Reza Malekzadeh, John J. McGrath, Sandra B. Munro, Shahin Soltani, Amy E. Peden, Rufus Akinyemi, Marcel Ausloos, Naohiro Yonemoto, Bogdan Wojtyniak, Ahmad Ghashghaee, Guilherme Borges, Sadia Bibi, Farhad Islami, Hamed Mirzaei, Mohammad Ali Sahraian, M. Ashworth Dirac, Hosna Janjani, Kairat Davletov, Hermann Brenner, Yuichiro Yano, Elissa M. Abrams, Ana Vukovic, Bartosz Miazgowski, Jobert Richie Nansseu, Jennifer O Lam, Mona Pathak, Leeberk Raja Inbaraj, Thirunavukkarasu Sathish, Asadollah Gholamian, Carlos A Castañeda-Orjuela, Babak Eshrati, Edgar Denova-Gutiérrez, Atte Meretoja, Lorenzo Monasta, Ronan A. Lyons, Neda Kianipour, Desalegn Getnet Demsie, Yasir Waheed, Desta Debalkie Atnafu, Davide Sattin, Kevin S Ikuta, Ghobad Moradi, Srinivas Goli, Krittika Bhattacharyya, Mika Kivimäki, Christopher Troeger, Jordi Alonso, Alireza Ahmadi, Navid Manafi, Caroline Stein, Songhomitra Panda-Jonas, Jason Nguyen, Moses K. Muriithi, Aziz Rezapour, Ismael R. Campos-Nonato, Adrian Pana, H. Dean Hosgood, Noore Alam, James L. Fisher, Mariam Molokhia, Susan F. Rumisha, Ernoiz Antriyandarti, Ayman Grada, Emma Nichols, Babak Asghari, André Luiz Sena Guimarães, Ferrán Catalá-López, Aletta E. Schutte, Fiona B. Bennitt, Maciej Banach, Antonio Biondi, Donal Bisanzio, Josip Car, Ronny Westerman, Shafiu Mohammed, Biniyam Sahiledengle Geberemariyam, Kenji Shibuya, Meghdad Pirsaheb, Milena Santric-Milicevic, Karen M. Tabb, Paula Moraga, Soheil Hassanipour, Hasan Yusefzadeh, Avina Vongpradith, Dara K. Mohammad, Ralph Maddison, Babak Moazen, Getachew Mullu Kassa, Rahman Shiri, Fernando Neves Hugo, Hmwe H Kyu, Zachary V Dingels, Florian Fischer, Valentin Yurievich Skryabin, Rafael Tabarés-Seisdedos, Massimo Cirillo, Nikita Otstavnov, Robert C. Reiner, Van C. Lansingh, Rodrigo Sarmiento-Suarez, Ashkan Afshin, Benjamin A Stark, Mohsen Abbasi-Kangevari, Natalie C. Galles, Behnam Heidari, Eun-Kee Park, Mohammad Ali Jahani, Suzanne Polinder, Mahalaqua Nazli Khatib, Farhad Jadidi-Niaragh, Amir Radfar, Mowafa Househ, Derrick A Bennett, Gaorui Guo, Hesam Ghiasvand, Taweewat Wiangkham, Tamás Joó, Cristiana Abbafati, Kathryn Mei Ming Lau, Anita K. Nandi, Miklós Szócska, Manasi Kumar, Eduardo A. Undurraga, Oladimeji M. Adebayo, Simon Yadgir, Victor Aboyans, Justin J. Lang, Catherine O. Johnson, Soewarta Kosen, Carla Sofia e.Sá Farinha, Marcos Roberto Tovani-Palone, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Heather Orpana, Samuel B. Albertson, Mahdi Afshari, Nicholas J K Breitborde, Nelson J. Alvis-Zakzuk, Adrian Oţoiu, Iván Landires, Robert G. Weintraub, Kidanemaryam Berhe, André Faro, Sophia Emmons-Bell, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Yordanos Gizachew Yeshitila, Mehdi Hosseinzadeh, Arash Etemadi, Oleguer Plana-Ripoll, Theodore Patrick Younker, Joemer C. Maravilla, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayanaswamy Venketasubramanian, Seyed Mohammad Kazem Aghamir, Linda Morales, Amanda Deen, Noushin Mohammadifard, Obinna Onwujekwe, Ai Koyanagi, Michele Nguyen, Chieh Han, Kiana Ramezanzadeh, Mika Shigematsu, Mohammed Shannawaz, Khurshid Alam, Javad Nazari, Bryan L. 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Jonas, Dian Kusuma, Benjamin B. Massenburg, Santosh Varughese, Yousef Mohammad, Beatriz Paulina Ayala Quintanilla, Mihaela Hostiuc, Richard G. Cowden, Morteza Shamsizadeh, Thomas Pilgrim, Alessandra C. Goulart, Leila Doshmangir, Gabriele Nagel, Saravanan Muthupandian, Zahra Sadat Dibaji Forooshani, Maryam Mirzaei, Zabihollah Yousefi, Shadrach Wilson, Iman El Sayed, Juanita A. Haagsma, Segun Emmanuel Ibitoye, Eirini Skiadaresi, Reza Shirkoohi, Tim Driscoll, Morteza Jafarinia, Maha El Tantawi, Telma Zahirian Moghadam, Katarzyna Kissimova-Skarbek, Abdilahi Yousuf Yousuf, Dickson A. Amugsi, Awoke Misganaw, Maseer Khan, Norito Kawakami, Jingkai Wei, Jai K Das, Vishnu Renjith, Tessa M. Pilz, Sameer Vali Gopalani, Roghiyeh Faridnia, Islam Y. Elgendy, Prateek Rastogi, Lauren B. Wilner, Josep Maria Haro, Zahiruddin Quazi Syed, Ben Lacey, Ketema Bizuwork Gebremedhin, Sam Rolfe, Iffat Elbarazi, Yannick Béjot, Raimundas Lunevicius, Sezer Kisa, Harish Chander Gugnani, Basema Saddik, Manu Raj Mathur, Mansour Ghafourifard, Riaz Uddin, Anna Poznańska, Faris Lami, Niguse Meles Alema, Michael T. Chung, Arya Aminorroaya, Arash Sarveazad, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, João M. Furtado, Hamid Ahmadieh, Sara Conti, Yunquan Zhang, Manthan D Janodia, Aislyn U. Orji, S. Mohammad Sajadi, Jalal Arabloo, Gabrielle B. Britton, Colm McAlinden, Francisco Rogerlândio Martins-Melo, Simona Cătălina Ştefan, Ester Cerin, Nuno Taveira, Lars Jacob Stovner, Amir Taherkhani, Masoud Foroutan, Tomasz Miazgowski, Amir Manafi, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Man Mohan Mehndiratta, Graeme J. 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L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL
Subjects: Male, Life expectancy, Disability-Adjusted Life Year, Diseases, Disease, communicable disease, systematic analysis, Global Burden of Disease, 0302 clinical medicine, 80 and over, Medicine, 10. No inequality, Child, 11 Medical and Health Sciences, injuries, Aged, 80 and over, education.field_of_study, Sjúkdómar, DEMENTIA, FALLS, General Medicine, Forvarnir, 3. Good health, Child, Preschool, Human, GBD, Population health, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Humans, Global Burden of Disease Study, education, Aged, Spatial Analysis, Global burden, Disability, Prevention, DISABILITY, Infant, Spatial Analysi, Mortality rate, Global Burden of Disease, Diseases, Injuries, Systematic analysis, PREVENTION, Years of potential life lost, Risk factors, Disease study, ITC-ISI-JOURNAL-ARTICLE, RISK-FACTORS, Clinical Medicine, RA, Demography, Fötlun, Dánartíðni, Áhættuþættir, 030204 cardiovascular system & hematology, Risk Factors, Cause of Death, Global health, 030212 general & internal medicine, 1. No poverty, Disability-Adjusted Life Years, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, Adolescent, Adult, Age Distribution, Female, Infant, Newborn, Young Adult, Lýðheilsa, CLINICAL-TRIALS, Population, Settore MED/01 - Statistica Medica, diseases, ITC-HYBRID, Heilbrigðisvísindi, General & Internal Medicine, Mortality, Preschool, Disease burden, business.industry, Risk Factor, Klinisk medicin, Newborn, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Áverkar, Systematic analysis, NA, business
Abstract: Publisher's version (útgefin grein), 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. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"
Published: 2020
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22. 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

Author: William M. Gardner, Rawlance Ndejjo, Govinda Prasad Dhungana, Fereshteh Ansari, Kathleen Pillsbury Hopf, João Pedro Silva, M. Mofizul Islam, Cong Zhu, Abdul Hafiz, Irmina Maria Michalek, Syed Mohamed Aljunid, Leonardo Roever, Mustefa Glagn, Davood Anvari, Tessa M. Pilz, Sameer Vali Gopalani, Joel M. Francis, Man Mohan Mehndiratta, Rakhi Dandona, Abbas Sheikhtaheri, Mansour Ghafourifard, Simon Øverland, David Laith Rawaf, Jaykaran Charan, Akram Pourshams, Mostafa Dianatinasab, Morteza Mahmoudi, Alton Lu, Alyssa N. Sbarra, Lorainne Tudor Car, Franz Castro, Hafiz Ansar Rasul Suleria, Luca Ronfani, Marina Pinheiro, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Hoa Thi Do, Whitney L. Teagle, Sofia Androudi, Carl Abelardo T. Antonio, Myron Anthony Godinho, Bhaskaran Unnikrishnan, Oluchi Ezekannagha, Getinet Ayano, Seyyed Shamsadin Athari, Dimas Ria Angga Pribadi, Kyle E. Simpson, Muluken Bekele Sorrie, Vivekanand Jha, Chukwuma David Umeokonkwo, Akshaya Srikanth Bhagavathula, Cuong Tat Nguyen, Amr Hassan, Akine Eshete Abosetugn, Hailay Abrha Gesesew, Anna V. Korotkova, Brijesh Sathian, Marcello Tonelli, Olatunde Aremu, Mohammad Reza Salahshoor, Juan Jesus Carrero, Cameron J. Kneib, Ravi Prakash Jha, David H. Shaw, Hossein Samadi Kafil, Tanuj Kanchan, Khezar Hayat, Hamid Sharifi, Morteza Shamsizadeh, Muktar Omer Omer, Fatemeh Amiri, Hamidreza Pazoki Toroudi, David Edvardsson, Xiu Ju George Zhao, Hannah Han, Leticia Avila-Burgos, Adam E. Berman, Jemal Abdu Mohammed, Thomas Pilgrim, Leila Doshmangir, Mu'awiyyah Babale Sufiyan, David M. Pigott, Hadi Hassankhani, Beatriz Paulina Ayala Quintanilla, Teklemariam Gultie, Arash Ziapour, Seyed Sina Naghibi Irvani, Ilse N. Dippenaar, Jean Jacques Noubiap, Emmanuela Gakidou, Abiyu Mekonnen Gebrehiwot, Maha El Tantawi, Xuefeng Liu, Zulfiqar A. Bhutta, Keyghobad Ghadiri, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Yunquan Zhang, Vera Marisa Costa, Iyad Sultan, Mostafa Hosseini, Abdulaziz Khalid Abu Haimed, Haidong Wang, Kaleab Alemayehu Zewdie, Celine M. Barthelemy, Hosna Janjani, Bartosz Miazgowski, Jobert Richie Nansseu, Arianna Maever L. Amit, John S. Ji, Ata Rafiee, Maria Inês Schmidt, Alireza Rafiei, Somayeh Bohlouli, Joana Morgado-da-Costa, Huong Lan Thi Nguyen, Pradyumna Agasthi, Tiffany K. Gill, Martin McKee, Khaled Khatab, Jae Il Shin, Animut Tagele Tamiru, Giancarlo Logroscino, Hassan Abolhassani, Syed Saoud Zaidi, Sivan Yegnanarayana Iyer Saraswathy, Garumma Tolu Feyissa, Ahmad Daryani, Ziyad Al-Aly, Gebreamlak Gebremedhn Gebremeskel, Michael T. Chung, Amirhossein Sahebkar, Mehedi Hasan, Saeed Shahabi, Diep Ngoc Nguyen, Yohannes Kinfu, Nicholas L S Roberts, Jagadish Rao Padubidri, Mika Shigematsu, Lucero Cahuana-Hurtado, Deepa Jahagirdar, Islam Y. Elgendy, Erkin M. Mirrakhimov, Tanvir M. Huda, Fakher Rahim, Dara K. Mohammad, Yingxi Zhao, Ruxandra Irina Negoi, Vinod C. Nayak, Reinhard Busse, Andrew T. Leever, Muhammad Aziz Rahman, Kathryn Mei Ming Lau, Stefania Mondello, Vivian Chia-Rong Hsieh, Kris J. Krohn, Reza Rawassizadeh, Vishnu Renjith, Jianing Ma, Moses K. Muriithi, Mark G. Shrime, Mayowa O. Owolabi, Nobuyuki Horita, Seyed Hossein Yahyazadeh Jabbari, Daniel Y. Cho, Miloje Savic, Moslem Soofi, Iqbal R. F. Elyazar, Freweini Gebrearegay G. Tela, Jonathan F. Mosser, Palash Chandra Banik, Andre Rodrigues Duraes, Yuan-Pang Wang, Natalie C. Galles, Rashid Abdi Guled, Abdallah M. Samy, Hadi Pourjafar, Roman Topor-Madry, Ayesha Humayun, Leila Zaki, Nuworza Kugbey, Maryam Khayamzadeh, Naznin Hossain, Jiregna Darega Gela, Jordi Alonso, Ruth W Kimokoti, A. A. Fomenkov, Jalal Arabloo, Aletta E. Schutte, Biruk Wogayehu Taddele, Teklehaimanot Gereziher Haile, Diego Augusto Santos Silva, Seyed Mohammad Kazem Aghamir, Maciej Banach, Deanna Anderlini, Moses J. Bockarie, Saleem Muhammad Rana, Randah R. Hamadeh, Farhad Islami, Olalekan A. Uthman, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Kairat Davletov, Soraya Seedat, Alan D. Lopez, Masoud Behzadifar, Benjamin B. Massenburg, Santosh Varughese, Ingan Ukur Tarigan, Amin Soheili, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Caleb Mackay Salpeter Irvine, Mojgan Gitimoghaddam, G Anil Kumar, Rasmus J. Havmoeller, Hiroyasu Iso, Atte Meretoja, Yasir Waheed, João M. Furtado, Christian Razo, Neeti Kapoor, Mowafa Househ, Rajaa Al-Raddadi, Mohammad Khammarnia, Santi Martini, Feng Sha, Marco Vacante, Jacek A. Kopec, Hunduma Amensisa Bojia, Jacob Olusegun Olusanya, Kate E. LeGrand, Nikolay Ivanovich Briko, Robert S. Bernstein, Arun Balachandran, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Leake G. Gebremeskel, Smita Pakhale, Ejaz Ahmad Khan, Daniel Cury Ribeiro, Yousef Mohammad, Bernhard T. Baune, Azeem Majeed, Luis Camera, Mohammad Ali Jahani, Hasan Yusefzadeh, Rahman Shiri, Massimo Cirillo, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, Paolo Lauriola, Irfan Ullah, Aruna M Kamath, Maryam Mirzaei, Zabihollah Yousefi, Iman El Sayed, Mohammad Farahmand, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Felix Akpojene Ogbo, Megan Knight, Nelson J. Alvis-Zakzuk, Teferi Mekonnen, Iván Landires, Robert G. Weintraub, Chukwudi A Nnaji, Lauren E. Schaeffer, Paulo A. Lotufo, Mehdi Naderi, Tomislav Mestrovic, André Faro, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Vladimir Andreevich Korshunov, Birhanu Geta Meharie, Mihajlo Jakovljevic, Abdiwahab Hashi, Olatunji O. Adetokunboh, Dejana Braithwaite, Sergio I. Prada, Bárbara Niegia Garcia de Goulart, Reza Pourmirza Kalhori, Jee-Young Jasmine Choi, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Paul S. F. Yip, Mehdi Mirzaei-Alavijeh, Gebremariam Woldu, Rashmi Gupta, Onome Bright Oghenetega, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Mehdi Hosseinzadeh, Marcos Roberto Tovani-Palone, K M Shivakumar, Alireza Ansari-Moghaddam, Archith Boloor, Aidin Abedi, Binyam Minuye Birihane, Mohammad Ali Mansournia, Nihad A. Almasri, Simachew Animen Bante, Carlo Eduardo Medina-Solís, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Antonio Biondi, Valentin Yurievich Skryabin, Srinivasa Vittal Katikireddi, Sarika Chaturvedi, Francesco Saverio Violante, Abhay Gaidhane, George A. Mensah, Naohiro Yonemoto, Ahmad Ghashghaee, Ebrahim Babaee, Saman Esmaeilnejad, Sharath Burugina Nagaraja, Avina Vongpradith, Javad Nazari, Amir Khater, Michael K. Hole, Ben Lacey, Razique Anwer, Łukasz Szumowski, Ai Koyanagi, Rajesh Sagar, Ali Rajabpour-Sanati, Seyed M Karimi, Yordanos Gizachew Yeshitila, Mona Pathak, Nithin Kumar, Masoud Foroutan, Mehdi Fazlzadeh, Anusha Ganapati Bhat, Abbas Mosapour, Kebede Deribe, Nermin Ghith, Vaman Kulkarni, Sanjay Zodpey, Asadollah Gholamian, Mohammed Shannawaz, Nancy Fullman, Benn Sartorius, Giulio Castelpietra, Ghulam Mustafa, Silvia Schiavolin, Nelson Alvis-Guzman, Jeffrey D. Stanaway, Rafael Lozano, Christopher J L Murray, Guoqing Hu, Andrew M. Briggs, Ashish Badiye, Yousef Khader, Masoud Moghadaszadeh, Rahmatollah Moradzadeh, Valery L. Feigin, Claudia I. Mastrogiacomo, Emma Smith, Yasser Vasseghian, Saeed Amini, Asif Hanif, Achala Upendra Jayatilleke, Maryam Adabi, Sarah Wulf Hanson, Bhaskar Thakur, Ravi Mehrotra, Virginia Núñez-Samudio, Lalit Dandona, Segun Emmanuel Ibitoye, Simon I. Hay, Kiirithio N. 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Lee, Mohammad Amin Bahrami, Wondimeneh Shibabaw Shiferaw, Emmanuel Wandera Okunga, Biniyam Sahiledengle Geberemariyam, Samer Hamidi, Young-Ho Khang, Rufus Akinyemi, Farhad Jadidi-Niaragh, Godfrey Mutashambara Rwegerera, Naser Mohammad Gholi Mezerji, Rupak Desai, Eduardo Bernabé, Jamal A. Yearwood, Nima Rezaei, Emerito Jose A. Faraon, Vasily Vlassov, Stanislav S. Otstavnov, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Mukhammad David Naimzada, Tahereh Javaheri, Tamer H. Farag, Paolo Cortesi, Gbenga A. Kayode, Lucas Guimarães Abreu, Manu Raj Mathur, Getie Lake Aynalem, Narayanaswamy Venketasubramanian, Doris V.V. Ortega-Altamirano, Giorgia Giussani, Liliana G Ciobanu, Suraj Bhattarai, Basema Saddik, Mustafa Z. Younis, Ensiyeh Jenabi, Ira Martopullo, Mohamed M. Gad, Kanyin L. Ong, Addisu Melese, Fotis Topouzis, Hanne Christensen, In-Hwan Oh, Arash Sarveazad, Shuhei Nomura, Peter Memiah, Sergej M. 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Subjects: Index (economics), Servicios de Salud, SUSTAINABLE DEVELOPMENT GOALS, 030204 cardiovascular system & hematology, universal health coverage, sustaibale develpment goal, global burden of disease, performance, systematic analysis, Global Burden of Disease, 0302 clinical medicine, Universal Health Insurance, RA0421, 11. Sustainability, Per capita, Medical economics, Disease, 030212 general & internal medicine, 10. No inequality, 11 Medical and Health Sciences, effective coverage of health services, GBD 2019 Universal Health Coverage Collaborators, education.field_of_study, Public health, Medical care, Sjúkdómar, 4. Education, 1. No poverty, Health coverage, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Hälsovetenskaper, 3142 Public health care science, environmental and occupational health, Health services, 3. Good health, Global burden of disease, Health Expenditures, Humans, World Health Organization, Purchasing power parity, Scale (social sciences), Lýðheilsa, universal health coverag, CANCER SURVIVAL, ACCESS, Human, Heilsuhagfræði, medicine.medical_specialty, Health coverage, GBD, GBD, Universal health, GBD 2019, Population, Health expenditures, 3122 Cancers, Population health, 03 medical and health sciences, Health systems, Heilbrigðisvísindi, SDG 3 - Good Health and Well-being, General & Internal Medicine, Development economics, Health Sciences, medicine, Heilbrigðisstefna, Alþjóðaheilbrigðisstofnunin, QUALITY, Global Burden of Disease Study, education, PROGRESS, Disease burden, Health services accessibility, CARE, Heilbrigðisþjónusta, purl.org/pe-repo/ocde/ford#3.02.00 [https], Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, 3121 General medicine, internal medicine and other clinical medicine, Morbility, Administración de los Servicios de Salud, Medical policy, Business, Heilbrigðiskerfi
Abstract: Publisher's version (útgefin grein), 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., Lucas Guimaraes Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (Capes) -Finance Code 001, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDSUEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Barnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (FCT), IP, under the Norma TransitA3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Ivan Landires is a member of the Sistema Nacional de InvestigaciA3n (SNI), which is supported by the Secretaria Nacional de Ciencia Tecnologia e Innovacion (SENACYT), Panama. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 -Norma transitA3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship -Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suarez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Ines Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabares-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada., "Peer Reviewed"
Published: 2020
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23. Migraine and risk of narcolepsy in children: A nationwide longitudinal study

Author: Vivian Chia-Rong Hsieh, Jen-Huai Chiang, Meng-Lun Hsieh, Chun-Pai Yang, and Hsing-Yi Chang
Subjects: Central Nervous System, Male, Longitudinal study, Pediatrics, NSAIDs, lcsh:Medicine, Pathology and Laboratory Medicine, Nervous System, Families, 0302 clinical medicine, Medicine and Health Sciences, Medicine, Antipsychotics, 030212 general & internal medicine, Longitudinal Studies, lcsh:Science, Child, Children, Analgesics, Multidisciplinary, Headaches, Incidence (epidemiology), Hazard ratio, Drugs, Neurology, Child, Preschool, Cohort, Female, Anatomy, Research Article, medicine.medical_specialty, Adolescent, Migraine Disorders, Taiwan, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, Mental Health and Psychiatry, Humans, Risk factor, Migraine, Narcolepsy, Proportional Hazards Models, Pharmacology, business.industry, Proportional hazards model, lcsh:R, Infant, Newborn, Psychoses, Biology and Life Sciences, Infant, medicine.disease, Dyssomnias, Pain management, Age Groups, People and Places, lcsh:Q, Population Groupings, business, Sleep Disorders, 030217 neurology & neurosurgery
Abstract: Background The association between migraine and narcolepsy remains controversial. We aim to investigate whether migraine is associated with an increased risk of developing narcolepsy in children. Methods In this longitudinal study, nationwide medical-claims data of pediatric patients (0-17y) with migraine are identified using the National Health Insurance Research Database (NHIRD) between 1997 and 2010 in Taiwan. Two cohorts are selected: migraine cases (n = 8,923) and propensity score-matched non-migraine controls (n = 35,692). Children with previous history of narcolepsy or headache before the index date are excluded. Cohorts are followed until the end of 2012, their withdrawal from the NHI program, or incidence of narcolepsy (ICD-9-CM: 347). Cox proportional hazards regression models are used to estimate hazard ratios (HRs) and 95% confidence intervals of developing narcolepsy in children with migraine compared to their non-migraine controls. Results A total of 13 incident cases with narcolepsy are observed during follow-up, with incidence rates of 0.1915 and 0.0278 per 1,000 person-years in migraine and non-migraine children, respectively. After a mean follow-up period of 4.68 and 5.04 years in the case and control cohort, respectively, the former exhibited a greater risk of developing narcolepsy compared to the latter (adjusted hazard ratio (aHR) = 5.30, 95% confidence interval (CI): 1.61, 17.4; p = 0.006). This finding persisted after controlling for potential confounders like baseline comorbidities and concurrent medication uptake, and in our analyses with migraine subtypes. Conclusions Migraine is an independent risk factor for narcolepsy development in children. Further studies are needed to validate our findings and to explore the exact pathophysiological mechanisms linking migraine and narcolepsy.
Published: 2017

24. Risk of Allergic Rhinitis, Allergic Conjunctivitis, and Eczema in Children Born to Mothers with Gum Inflammation during Pregnancy

Author: Trong-Neng Wu, Chin-Chen Liu, Yu-Chen Hsiao, and Vivian Chia-Rong Hsieh
Subjects: Male, Pediatrics, Allergy, Eczema, lcsh:Medicine, Pathology and Laboratory Medicine, 0302 clinical medicine, Oral Diseases, Pregnancy, Risk Factors, Allergies, Medicine and Health Sciences, Cumulative incidence, Child, lcsh:Science, Immune Response, Rhinitis, Conjunctivitis, Allergic, Multidisciplinary, Allergic Diseases, Incidence, Incidence (epidemiology), Gingivitis, Allergic conjunctivitis, Infectious Diseases, Prenatal Exposure Delayed Effects, Urinary Tract Infections, Cohort, Regression Analysis, Female, Research Article, Allergic Rhinitis, Adult, medicine.medical_specialty, Infectious Disease Control, Inflammatory Diseases, Urology, Immunology, Oral Medicine, Dermatology, Insurance Claim Review, Young Adult, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, medicine, Humans, Risk factor, Periodontitis, Periodontal Diseases, Retrospective Studies, Inflammation, business.industry, lcsh:R, Infant, Newborn, Biology and Life Sciences, Infant, Retrospective cohort study, 030206 dentistry, Rhinology, medicine.disease, Rhinitis, Allergic, Otorhinolaryngology, 030228 respiratory system, Nasal Diseases, Clinical Immunology, lcsh:Q, Clinical Medicine, business
Abstract: Purpose Despite links between maternal and child health status, evidence on the association between gum infection in pregnant mothers and childhood allergies is scarce. We aim to evaluate the risk of developing allergy in children born to periodontal mothers in a nationwide study. Methods We conducted a 9-year population-based, retrospective cohort study using Taiwan’s National Health Insurance database. A study cohort of 42,217 newborns born to mothers with periodontal disease during pregnancy was identified in 2001 and matched with 42,334 babies born to mothers without any infection (control) by mother’s age at delivery and baby sex. With a follow-up period from 2001 to 2010, we observed the incidence of allergic rhinitis (AR), allergic conjunctivitis (AC), and eczema in these children. Cox proportional hazards regression models were performed with premature deaths as competing risk for the estimation of allergic disease risks. Results Nine-year cumulative incidences were the highest among children born to periodontal mothers; they reached 46.8%, 24.2%, and 40.4% (vs. 39.5%, 18.3% and 34.8% in control) for AR, AC, and eczema, respectively. Our results showed moderately increased risks for the allergies in children born to periodontal mothers relative to their matched non-inflammatory control (adjusted HRs: 1.17, 95% CI: 1.15–1.20; 1.27, 1.24–1.31; 1.14, 1.12–1.17, respectively). Because the impact of food consumption and living environment cannot be considered using insurance data, we attempted to control it by adjusting for parental income and mother’s residential area. Conclusions Overall cumulative incidence and risks of children born to periodontal mothers for AR, AC, and eczema are significantly higher than those born to non-inflammatory mothers. Gum infection in women during pregnancy is an independent risk factor for allergic diseases in children, thus its intergenerational consequences should be considered in gestational care.
Published: 2016

25. Diabetes Shared Care Program (DSCP) and risk of infection mortality: a nationwide cohort study using administrative claims data in Taiwan.

Author: Cheng-Han Chen, Sheng-Hsiang Ma, Sung-Yuan Hu, Chia-Ming Chang, Jen-Huai Chiang, Vivian Chia-Rong Hsieh, David Hung-Tsang Yen, Chorng-Kuang How, and Ming-Shun Hsieh
Abstract: Objective The Diabetes Shared Care Program (DSCP) is an integrated care model in Taiwan that has been proven to improve the care quality of patients with diabetes. We aimed to evaluate the efficacy of DSCP in decreasing the hospital mortality of infectious diseases. Methods From 1 662 929 patients with type 2 diabetes newly diagnosed between 1999 and 2013, we retrieved a total of 919 patients who participated in the DSCP with the first hospitalisation for an infectious disease as the study cohort and 9190 propensity score-matched patients with type 2 diabetes who did not participate as the comparison. The efficacy of DSCP was evaluated via the following comparisons between the DSCP and non-DSCP cohorts: hospital mortality, 1-year medical cost prior to and during the hospitalisation, and complications, such as receiving mechanical ventilation and intensive care unit admission. The ratio (OR) for hospital mortality of the DSCP participants was calculated by logistical regression. Further stratification analyses were conducted to examine which group of patients with type 2 diabetes benefited the most from the DSCP during hospitalisation for infectious diseases. Results The DSCP cohort had a lower hospital mortality rate than the non-DSCP participants (2.18% vs 4.82%, p<0.001). The total medical cost during the hospitalisation was lower in the DSCP cohort than in the non-DSCP cohort (NT$72 454±30 429 vs NT$86 385±29 350) (p=0.006). In the logistical regression model, the DSCP participants exhibited a significantly decreased adjusted OR for hospital mortality (adjusted OR=0.42, 95% CI 0.26 to 0.66, p=0.0002). The efficacy of the DSCP was much more prominent in male patients with type 2 diabetes and in patients with lower incomes. Conclusion Participation in the DSCP was associated with a lower risk of hospital mortality for infectious diseases. [ABSTRACT FROM AUTHOR]
Published: 2018
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26. Contrast Medium Exposure During Computed Tomography and Risk of Development of End-Stage Renal Disease in Patients With Chronic Kidney Disease: A Nationwide Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study.

Author: Ming-Shun Hsieh, Chien-Shan Chiu, Chorng-Kuang How, Jen-Huai Chiang, Meei-Ling Sheu, Wen-Chi Chen, Hsuan-Jen Lin, Vivian Chia-Rong Hsieh, Sung-Yuan Hu, Hsieh, Ming-Shun, Chiu, Chien-Shan, How, Chorng-Kuang, Chiang, Jen-Huai, Sheu, Meei-Ling, Chen, Wen-Chi, Lin, Hsuan-Jen, Hsieh, Vivian Chia-Rong, and Hu, Sung-Yuan
Published: 2016
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26 results on '"Vivian Chia-Rong Hsieh"'

1. Utilizing the National Early Warning Score 2 (NEWS2) to confirm the impact of emergency department management in sepsis patients: a cohort study from taiwan 1998–2020

2. Bridging geographical disparities across 368 townships with healthcare system and socioeconomic factors in Taiwan

3. Effect of end-stage kidney disease on the return of spontaneous circulation in Taiwanese adults with out-of-hospital cardiac arrest

4. Association between medication adherence and disease outcomes in patients with hepatitis B-related cirrhosis: a population-based case–control study

5. Unmet supportive care needs of survival patients with breast cancer in different cancer stages and treatment phases

6. Long-Term Exposures to Air Pollutants and Risk of Peripheral Arterial Occlusive Disease: A Nationwide Cohort Study in Taiwan

7. Risk for hypoglycemic emergency with levofloxacin use, a population-based propensity score matched nested case-control study.

8. Type 2 Diabetic Sepsis Patients Have a Lower Mortality Rate in Pioglitazone Use: A Nationwide 15-Year Propensity Score Matching Observational Study in Taiwan

9. Putting resiliency of a health system to the test: COVID-19 in Taiwan

10. Occurrence and Impact of Gastrointestinal Bleeding and Major Adverse Cardiovascular Events during Sepsis: A 15-Year Observational Study

11. Hospital outcomes and cumulative burden from complications in type 2 diabetic sepsis patients: a cohort study using administrative and hospital-based databases

12. Increased low back pain risk in nurses with high workload for patient care: A questionnaire survey

13. A population-based cohort study examining the association of documented bladder diverticulum and bladder cancer risk in urology patients.

14. Delayed time from first medical visit to diagnosis for breast cancer patients in Taiwan

15. Migraine and risk of narcolepsy in children: A nationwide longitudinal study.

16. Risk of Allergic Rhinitis, Allergic Conjunctivitis, and Eczema in Children Born to Mothers with Gum Inflammation during Pregnancy.

17. Unmet supportive care needs of survival patients with breast cancer in different cancer stages and treatment phases

18. Mortality Risk and Decompensation in Hospitalized Patients with Non-Alcoholic Liver Cirrhosis: Implications for Disease Management

19. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

20. Forgone Health and Economic Benefits Associated with Socioeconomic Differences in Organized Cervical Cancer Screening

21. 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

22. 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

23. Migraine and risk of narcolepsy in children: A nationwide longitudinal study

24. Risk of Allergic Rhinitis, Allergic Conjunctivitis, and Eczema in Children Born to Mothers with Gum Inflammation during Pregnancy

25. Diabetes Shared Care Program (DSCP) and risk of infection mortality: a nationwide cohort study using administrative claims data in Taiwan.

26. Contrast Medium Exposure During Computed Tomography and Risk of Development of End-Stage Renal Disease in Patients With Chronic Kidney Disease: A Nationwide Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study.

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26 results on '"Vivian Chia-Rong Hsieh"'

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