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1. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Author

Fullman, N, Yearwood, J, Abay, SM, Abbafati, C, Abd-Allah, F, Abdela, J, Abdelalim, A, Abebe, Z, Abebo, TA, Aboyans, V, Abraha, HN, Abreu, DMX, Abu-Raddad, LJ, Adane, AA, Adedoyin, RA, Adetokunboh, O, Adhikari, TB, Afarideh, M, Afshin, A, Agarwal, G, Agius, D, Agrawal, A, Agrawal, S, Ahmad Kiadaliri, A, Aichour, MTE, Akibu, M, Akinyemi, RO, Akinyemiju, TF, Akseer, N, Al Lami, FH, Alahdab, F, Al-Aly, Z, Alam, K, Alam, T, Alasfoor, D, Albittar, MI, Alene, KA, Al-Eyadhy, A, Ali, SD, Alijanzadeh, M, Aljunid, SM, Alkerwi, A, Alla, F, Allebeck, P, Allen, C, Alomari, MA, Al-Raddadi, R, Alsharif, U, Altirkawi, KA, Alvis-Guzman, N, Amare, AT, Amenu, K, Ammar, W, Amoako, YA, Anber, N, Andrei, CL, Androudi, S, Antonio, CAT, Araújo, VEM, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Asfaw, ET, Asgedom, SW, Asghar, RJ, Ashebir, MM, Asseffa, NA, Atey, TM, Atre, SR, Atteraya, MS, Avila-Burgos, L, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayalew, AA, Ayele, HT, Ayer, R, Ayuk, TB, Azzopardi, P, Azzopardi-Muscat, N, Babalola, TK, Badali, H, Badawi, A, Banach, M, Banerjee, A, Banstola, A, Barber, RM, Barboza, MA, Barker-Collo, SL, Bärnighausen, T, Barquera, S, Barrero, LH, Bassat, Q, Basu, S, Baune, BT, Bazargan-Hejazi, S, Bedi, N, and Beghi, E

Subjects
General & Internal Medicine, Humans, Wounds and Injuries, Noncommunicable Diseases, Communicable Diseases, Health Services Accessibility, Quality of Health Care, Global Burden of Disease
Abstract

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations.

Published
2018

2. Erratum:Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016 (The Lancet (2017) 390(10100) (1423–1459) (S014067361732336X)(10.1016/S0140-6736(17)32336-X))

Author

Fullman, N, Barber, RM, Abajobir, AA, Abate, KH, Abbafati, C, Abbas, KM, Abd-Allah, F, Abdulkader, RS, Abdulle, AM, Abera, SF, Aboyans, V, Abu-Raddad, LJ, Abu-Rmeileh, NME, Adedeji, IA, Adetokunboh, O, Afshin, A, Agrawal, A, Agrawal, S, Ahmad Kiadaliri, A, Ahmadieh, H, Ahmed, MB, Aichour, MTE, Aichour, AN, Aichour, I, Aiyar, S, Akinyemi, RO, Akseer, N, Al-Aly, Z, Alam, K, Alam, N, Alasfoor, D, Alene, KA, Alizadeh-Navaei, R, Alkerwi, A, Alla, F, Allebeck, P, Allen, C, Al-Raddadi, R, Alsharif, U, Altirkawi, KA, Alvis-Guzman, N, Amare, AT, Amini, E, Ammar, W, Ansari, H, Antonio, CAT, Anwari, P, Arora, M, Artaman, A, Aryal, KK, Asayesh, H, Asgedom, SW, Assadi, R, Atey, TM, Atre, SR, Avila-Burgos, L, Avokpaho, EFGA, Awasthi, A, Azzopardi, P, Bacha, U, Badawi, A, Balakrishnan, K, Bannick, MS, Barac, A, Barker-Collo, SL, Bärnighausen, T, Barrero, LH, Basu, S, Battle, KE, Baune, BT, Beardsley, J, Bedi, N, Beghi, E, Béjot, Y, Bell, ML, Bennett, DA, Bennett, JR, Bensenor, IM, Berhane, A, Berhe, DF, Bernabé, E, Betsu, BD, Beuran, M, Beyene, AS, Bhala, N, Bhansali, A, Bhatt, S, Bhutta, ZA, Bicer, BK, Bidgoli, HH, Bikbov, B, Bilal, AI, Birungi, C, Biryukov, S, Bizuayehu, HM, Blosser, CD, Boneya, DJ, Bose, D, Bou-Orm, IR, and Brauer, M

Subjects
General & Internal Medicine, 11 Medical And Health Sciences
Abstract

GBD 2016 SDG Collaborators. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017; 390: 1423–59—In figure 8B of this Article (published Online First on Sept 12, 2017), the number of indicator targets has been changed from 1 to 9 for Turkmenistan, from 0 to 1 for Afghanistan, and from 1 to 2 for Yemen. Ettore Beghi, Neeraj Bhala, Hélène Carabin, Raimundas Lunevicius, Donald H Silberberg, and Caitlyn Steiner have been added to the list of GBD 2016 SDG Collaborators. Their affiliations, along with the affiliation of Soumya Swaminathan, have been added to the Affiliations section. These corrections have been made to the online version as of Sept 18, 2017, and the printed Article is correct.

Published
2017

3. Erratum: Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016 (The Lancet (2017) 390(10100) (1423–1459) (S014067361732336X) (10.1016/S0140-6736(17)32336-X))

Author

Fullman, N, Barber, RM, Abajobir, AA, Abate, KH, Abbafati, C, Abbas, KM, Abd-Allah, F, Abdulkader, RS, Abdulle, AM, Abera, SF, Aboyans, V, Abu-Raddad, LJ, Abu-Rmeileh, NME, Adedeji, IA, Adetokunboh, O, Afshin, A, Agrawal, A, Agrawal, S, Ahmad Kiadaliri, A, Ahmadieh, H, Ahmed, MB, Aichour, MTE, Aichour, AN, Aichour, I, Aiyar, S, Akinyemi, RO, Akseer, N, Al-Aly, Z, Alam, K, Alam, N, Alasfoor, D, Alene, KA, Alizadeh-Navaei, R, Alkerwi, A, Alla, F, Allebeck, P, Allen, C, Al-Raddadi, R, Alsharif, U, Altirkawi, KA, Alvis-Guzman, N, Amare, AT, Amini, E, Ammar, W, Ansari, H, Antonio, CAT, Anwari, P, Arora, M, Artaman, A, Aryal, KK, Asayesh, H, Asgedom, SW, Assadi, R, Atey, TM, Atre, SR, Avila-Burgos, L, Avokpaho, EFGA, Awasthi, A, Azzopardi, P, Bacha, U, Badawi, A, Balakrishnan, K, Bannick, MS, Barac, A, Barker-Collo, SL, Bärnighausen, T, Barrero, LH, Basu, S, Battle, KE, Baune, BT, Beardsley, J, Bedi, N, Beghi, E, Béjot, Y, Bell, ML, Bennett, DA, Bennett, JR, Bensenor, IM, Berhane, A, Berhe, DF, Bernabé, E, Betsu, BD, Beuran, M, Beyene, AS, Bhala, N, Bhansali, A, Bhatt, S, Bhutta, ZA, Bicer, BK, Bidgoli, HH, Bikbov, B, Bilal, AI, Birungi, C, Biryukov, S, Bizuayehu, HM, Blosser, CD, Boneya, DJ, Bose, D, Bou-Orm, IR, and Brauer, M

Subjects
General & Internal Medicine, 11 Medical And Health Sciences
Abstract

GBD 2016 SDG Collaborators. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017; 390: 1423–59—The full-text version of this Article has been updated so that the list of authors is displayed in the correct order, in line with the pdf version, rather than in alphabetical order. This correction has been made to the online version as of Oct 12, 2017.

Published
2017

11. Clinical and Serologic Patterns in a Large Canadian Paediatric Cohort with Celiac Disease, At Presentation and Follow-Up

Author

Gould, M, Dowhaniuk, J, Arredondo, J, Cheng, J, Azzopardi, P, Hu, T, Mileski, H, Carpenter, A, Pai, N, and Brill, H

Subjects
Pediatrics, Perinatology and Child Health, Abstract
Abstract

BACKGROUND: Celiac Disease (CD) is a chronic illness involving an autoimmune response to gluten, leading to small intestinal inflammation in genetically susceptible individuals. A weakness in the North American pediatric CD literature exists around serologic outcomes after initiation of a gluten free diet (GFD). Only one published North American pediatric study looks at normalization of TTG after initiation of a GFD and only assessed TTG normalization at 6 months post diagnosis. Data is also limited on other clinical patters such as levels of anemia and BMI over the course of treatment of CD. OBJECTIVES: We sought to characterize serologic and clinical patterns in CD over an extended course using one of the largest databases of pediatric CD in North America. DESIGN/METHODS: A retrospective review of all patients diagnosed with CD at our institution from 1996-2014 was completed. Patients required biopsy-proven CD according to the Marsh criteria. Data abstracted included age at diagnosis, gender, reason for referral, comorbidities, family history of CD and autoimmune conditions, BMI, hemoglobin, MVC, fer-ritin, IgA and anti-TTG levels. A Cochran-Armitage trend test was used to trend anti-TTG and hemoglobin normalization over time RESULTS: 227 patients were identified who met study criteria. Visits with associated anti-TTG or hemoglobin analysis were categorized by time since diagnosis. At 6-12 months, 12-17 months, 18-23 months, 24-29 months, 30-35 months and 36-41 months from diagnosis 66.7% (n=144), 75% (n=40), 85.6% (n= 76), 86.9 (n= 23), 93.5 (n=62) and 95% (n= 20) of patients had normalized their anti-TTG levels respectively from a baseline of 100% abnormal TTG and 5.7% (n=140), 7.3% (n=41), 5.1% (n=77), 5.0% (n=20), 1.6% (n=60) and 5.0% (n=20) had anemia versus 18% at presentation. CONCLUSION: The small p-value (p=

Published
2016
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16. OVERSEAS QUALIFICATIONS

Author

Seshadri, R., William (Bill) Runciman, Orell, S., and Azzopardi, P.

Subjects
General Medicine

17. Orotracheal Intubation

Author

Azzopardi, P. G.

Subjects
Correspondence, General Engineering, General Earth and Planetary Sciences, General Medicine, General Environmental Science
Published
1963
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18. Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Author

Uthman, Olalekan A, Valdez, Pascual R, Van Boven, Job F M, Vasankari, Tommi Juhani, Venketasubramanian, Narayanaswamy, Violante, Francesco S, Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vollset, Stein Emil, Vos, Theo, Wagnew, Fasil Wagnew Shiferaw, Waheed, Yasir, Wang, Yuan-Pang, Weiderpass, Elisabete, Weldegebreal, Fitsum, Weldegwergs, Kidu Gidey, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Widecka, Justyna, Wijeratne, Tissa, Wyper, Grant M A, Xu, Gelin, Yamada, Tomohide, Yano, Yuichiro, Ye, Pengpeng, Yimer, Ebrahim M, Yip, Paul, Yirsaw, Biruck Desalegn, Yisma, Engida, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z, Zachariah, Geevar, Zaidi, Zoubida, Zamani, Mohammad, Zhang, Xueying, Zodpey, Sanjay, Mokdad, Ali H, Naghavi, Mohsen, Griswold, Max G, Fullman, Nancy, Hawley, Caitlin, Arian, Nicholas, Zimsen, Stephanie R M, Tymeson, Hayley D, Venkateswaran, Vidhya, Tapp, Austin Douglas, Forouzanfar, Mohammad H, Salama, Joseph S, Abate, Kalkidan Hassen, Abate, Degu, Abay, Solomon M, Abbafati, Cristiana, Abdulkader, Rizwan Suliankatchi, Abebe, Zegeye, Aboyans, Victor, Abrar, Mohammed Mehdi, Acharya, Pawan, Adetokunboh, Olatunji O, Adhikari, Tara Ballav, Adsuar, Jose C, Afarideh, Mohsen, Agardh, Emilie Elisabet, Agarwal, Gina, Aghayan, Sargis Aghasi, Agrawal, Sutapa, Ahmed, Muktar Beshir, Akibu, Mohammed, Akinyemiju, Tomi, Akseer, Nadia, Asfoor, Deena H Al, Al-Aly, Ziyad, Alahdab, Fares, Alam, Khurshid, Albujeer, Ammar, Alene, Kefyalew Addis, Ali, Raghib, Ali, Syed Danish, Alijanzadeh, Mehran, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Allebeck, Peter, Alvis-Guzman, Nelson, Amare, Azmeraw T, Aminde, Leopold N, Ammar, Walid, Amoako, Yaw Ampem, Amul, Gianna Gayle Herrera, Andrei, Catalina Liliana, Angus, Colin, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T, Aremu, Olatunde, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna K, Assadi, Reza, Ausloos, Marcel, Avila-Burgos, Leticia, Avokpaho, Euripide F, Awasthi, Ashish, Ayele, Henok Tadesse, Ayer, Rakesh, Ayuk, Tambe B, Azzopardi, Peter S, Badali, Hamid, Badawi, Alaa, Banach, Maciej, Barker-Collo, Suzanne Lyn, Barrero, Lope H, Basaleem, Huda, Baye, Estifanos, Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Béjot, Yannick, Belachew, Abate Bekele, Belay, Saba Abraham, Bennett, Derrick A, Bensenor, Isabela M, Bernabe, Eduardo, Bernstein, Robert S, Beyene, Addisu Shunu, Beyranvand, Tina, Bhaumik, Soumyadeeep, Bhutta, Zulfiqar A, Biadgo, Belete, Bijani, Ali, Bililign, Nigus, Birlik, Sait Mentes, Birungi, Charles, Bizuneh, Hailemichael, Bjerregaard, Peter, Bjørge, Tone, Borges, Guilherme, Bosetti, Cristina, Boufous, Soufiane, Bragazzi, Nicola Luigi, Brenner, Hermann, Butt, Zahid A, Cahuana-Hurtado, Lucero, Calabria, Bianca, Campos-Nonato, Ismael R, Campuzano, Julio Cesar, Carreras, Giulia, Carrero, Juan J, Carvalho, Félix, Castañeda-Orjuela, Carlos A, Castillo Rivas, Jacqueline, Catalá-López, Ferrán, Chang, Jung-Chen, Charlson, Fiona J, Chattopadhyay, Aparajita, Chaturvedi, Pankaj, Chowdhury, Rajiv, Christopher, Devasahayam J, Chung, Sheng-Chia, Ciobanu, Liliana G, Claro, Rafael M, Conti, Sara, Cousin, Ewerton, Criqui, Michael H, Dachew, Berihun Assefa, Dargan, Paul I, Daryani, Ahmad, Das Neves, José, Davletov, Kairat, De Castro, Filipa, De Courten, Barbora, De Neve, Jan-Walter, Degenhardt, Louisa, Demoz, Gebre Teklemariam, Des Jarlais, Don C, Dey, Subhojit, Dhaliwal, Rupinder Singh, Dharmaratne, Samath Dhamminda, Dhimal, Meghnath, Doku, David Teye, Doyle, Kerrie E, Dubey, Manisha, Dubljanin, Eleonora, Duncan, Bruce B, Ebrahimi, Hedyeh, Edessa, Dumessa, El Sayed Zaki, Maysaa, Ermakov, Sergei Petrovich, Erskine, Holly E, Esteghamati, Alireza, Faramarzi, Mahbobeh, Farioli, Andrea, Faro, Andre, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Felisbino-Mendes, Mariana Santos, Fernandes, Eduarda, Ferrari, Alize J, Ferri, Cleusa P, Fijabi, Daniel Obadare, Filip, Irina, Finger, Jonas David, Fischer, Florian, Flaxman, Abraham D, Franklin, Richard Charles, Futran, Neal D, Gallus, Silvano, Ganji, Morsaleh, Gankpe, Fortune Gbetoho, Gebregergs, Gebremedhin Berhe, Gebrehiwot, Tsegaye Tewelde, Geleijnse, Johanna M, Ghadimi, Reza, Ghandour, Lilian A, Ghimire, Mamata, Gill, Paramjit Singh, Ginawi, Ibrahim Abdelmageed, Giref, Ababi Zergaw Z, Gona, Philimon N, Gopalani, Sameer Vali, Gotay, Carolyn C, Goulart, Alessandra C, Greaves, Felix, Grosso, Giuseppe, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gutiérrez, Reyna Alma, GVS, Murthy, Hafezi-Nejad, Nima, Hagos, Tekleberhan Beyene, Hailu, Gessessew Bugssa, Hamadeh, Randah R, Hankey, Graeme J, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Hassen, Hamid Yimam, Havmoeller, Rasmus, Hay, Simon I, Heibati, Behzad, Henok, Andualem, Heredia-Pi, Ileana, Hernández-Llanes, Norberto Francisco, Herteliu, Claudiu, Hibstu, Desalegn Ts Tsegaw, Hoogar, Praveen, Horita, Nobuyuki, Hosgood, H Dean, Hosseini, Mostafa, Hostiuc, Mihaela, Hu, Guoqing, Huang, Hsiang, Husseini, Abdullatif, Idrisov, Bulat, Ileanu, Bogdan Vasile, Ilesanmi, Olayinka Stephen, Irvani, Seyed Sina Naghibi, Islam, Sheikh Mohammed Shariful, Jackson, Maria D, Jakovljevic, Mihajlo, Jalu, Moti Tolera, Jayatilleke, Achala Upendra, Jha, Ravi Prakash, Jonas, Jost B, Jozwiak, Jacek Jerzy, Kabir, Zubair, Kadel, Rajendra, Kahsay, Amaha, Kapil, Umesh, Kasaeian, Amir, Kassa, Tesfaye D Dessale, Katikireddi, Srinivasa Vittal, Kawakami, Norito, Kebede, Seifu, Kefale, Adane Teshome, Keiyoro, Peter Njenga, Kengne, Andre Pascal, Khader, Yousef, Khafaie, Morteza Abdullatif, Khalil, Ibrahim A, Khan, Md Nuruzzaman, Khang, Young-Ho, Khater, Mona M, Khubchandani, Jagdish, Kim, Cho-Il, Kim, Daniel, Kim, Yun Jin, Kimokoti, Ruth W, Kisa, Adnan, Kivimäki, Mika, Kochhar, Sonali, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Krishan, Kewal, Kuate Defo, Barthelemy, Kucuk Bicer, Burcu, Kulkarni, Veena S, Kumar, Pushpendra, Lafranconi, Alessandra, Lakshmana Balaji, Arjun, Lalloo, Ratilal, Lallukka, Tea, Lam, Hilton, Lami, Faris Hasan, Lan, Qing, Lang, Justin J, Lansky, Sonia, Larsson, Anders O, Latifi, Arman, Leasher, Janet L, Lee, Paul H, Leigh, James, Leinsalu, Mall, Leung, Janni, Levi, Miriam, Li, Yichong, Lim, Lee-Ling, Lobato-Cordero, Andrea, Lopez, Alan D, Lotufo, Paulo A, Macarayan, Erlyn Rachelle King, Machado, Isis Eloah, Madotto, Fabiana, Magdy Abd El Razek, Hassan, Magdy Abd El Razek, Muhammed, Majdan, Marek, Majdzadeh, Reza, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Mapoma, Chabila Christopher, Martinez-Raga, Jose, Maulik, Pallab K, Mazidi, Mohsen, Mckee, Martin, Mehta, Varshil, Meier, Toni, Mekonen, Tesfa, Meles, Kidanu Gebremariam, Melese, Addisu, Memiah, Peter T N, Mendoza, Walter, Mengistu, Desalegn Tadese, Mensah, George A, Meretoja, Tuomo J, Mezgebe, Haftay Berhane, Miazgowski, Tomasz, Miller, Ted R, Mini, Gk, Mirica, Andreea, Mirrakhimov, Erkin M, Moazen, Babak, Mohammad, Karzan Abdulmuhsin, Mohammadifard, Noushin, Mohammed, Shafiu, Monasta, Lorenzo, Moraga, Paula, Morawska, Lidia, Mousavi, Seyyed Meysam, Mukhopadhyay, Satinath, Musa, Kamarul Imran, Naheed, Aliya, Naik, Gurudatta, Najafi, Farid, Nangia, Vinay, Nansseu, Jobert Richie, Nayak, Mudavath Siva Durga Prasad, Nejjari, Chakib, Neupane, Subas, Neupane, Sudan Prasad, Ngunjiri, Josephine W, Nguyen, Cuong Tat, Nguyen, Long Hoang, Nguyen, Trang Huyen, Ningrum, Dina Nur Anggraini, Nirayo, Yirga Legesse, Noubiap, Jean Jacques, Ofori-Asenso, Richard, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olagunju, Andrew T, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Oommen, Anu Mary, Oren, Eyal, Orpana, Heather M, Ortega-Altamirano, Doris D V, Ortiz, Justin R, Ota, Erika, Owolabi, Mayowa Ojo, Oyekale, Abayomi Samuel, P A, Mahesh, Pana, Adrian, Park, Eun-Kee, Parry, Charles D H, Parsian, Hadi, Patle, Ajay, Patton, George C, Paudel, Deepak, Petzold, Max, Phillips, Michael R, Pillay, Julian David, Postma, Maarten J, Pourmalek, Farshad, Prabhakaran, Dorairaj, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rafiei, Alireza, Rahim, Fakher, Rahimi-Movaghar, Afarin, Rahman, Mahfuzar, Rahman, Muhammad Aziz, Rai, Rajesh Kumar, Rajsic, Sasa, Raju, Sree Bhushan, Ram, Usha, Rana, Saleem M, Ranabhat, Chhabi Lal, Rawaf, David Laith, Rawaf, Salman, Reiner, Robert C, Reis, Cesar, Renzaho, Andre M N, Rezai, Mohammad Sadegh, Roever, Leonardo, Ronfani, Luca, Room, Robin, Roshandel, Gholamreza, Rostami, Ali, Roth, Gregory A, Roy, Ambuj, Sabde, Yogesh Damodar, Saddik, Basema, Safiri, Saeid, Sahebkar, Amirhossein, Saleem, Zikria, Salomon, Joshua A, Salvi, Sundeep Santosh, Sanabria, Juan, Sanchez-Niño, Maria Dolores, Santomauro, Damian Francesco, Santos, Itamar S, Santric Milicevic, Milena M M, Sarker, Abdur Razzaque, Sarmiento-Suárez, Rodrigo, Sarrafzadegan, Nizal, Sartorius, Benn, Satpathy, Maheswar, Sawhney, Monika, Saxena, Sonia, Saylan, Mete, Schaub, Michael P, Schmidt, Maria Inês, Schneider, Ione J C, Schöttker, Ben, Schutte, Aletta Elisabeth, Schwendicke, 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Maria Dolore, Santomauro, Damian Francesco, Santos, Itamar S, Santric Milicevic, Milena M M, Sarker, Abdur Razzaque, Sarmiento-Suárez, Rodrigo, Sarrafzadegan, Nizal, Sartorius, Benn, Satpathy, Maheswar, Sawhney, Monika, Saxena, Sonia, Saylan, Mete, Schaub, Michael P, Schmidt, Maria Inê, Schneider, Ione J C, Schöttker, Ben, Schutte, Aletta Elisabeth, Schwendicke, Falk, Sepanlou, Sadaf G, Shaikh, Masood Ali, Sharif, Mehdi, She, Jun, Sheikh, Aziz, Shen, Jiabin, Shiferaw, Mekonnen Sisay, Shigematsu, Mika, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shukla, Sharvari Rahul, Sigfusdottir, Inga Dora, Silva, Diego Augusto Santo, Silva, Natacha Torres Da, Silveira, Dayane Gabriele Alve, Sinha, Dhirendra Narain, Sitas, Freddy, Soares Filho, Adauto Martin, Soofi, Moslem, Sorensen, Reed J D, Soriano, Joan B, Sreeramareddy, Chandrashekhar T, Steckling, Nadine, Stein, Dan J, Sufiyan, Mu'awiyyah Babale, Sur, Patrick J, Sykes, Bryan L, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Tavakkoli, Mohammad, Tehrani-Banihashemi, Arash, Tekle, Merhawi Gebremedhin, Thapa, Subash, Thomas, Nihal, Topor-Madry, Roman, Topouzis, Foti, Tran, Bach Xuan, Troeger, Christopher E, Truelsen, Thomas Clement, Tsilimparis, Nikolao, Tyrovolas, Stefano, Ukwaja, Kingsley Nnanna, Ullah, Irfan, Uthman, Olalekan A, Valdez, Pascual R, Van Boven, Job F M, Vasankari, Tommi Juhani, Venketasubramanian, Narayanaswamy, Violante, Francesco S, Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vollset, Stein Emil, Vos, Theo, Wagnew, Fasil Wagnew Shiferaw, Waheed, Yasir, Wang, Yuan-Pang, Weiderpass, Elisabete, Weldegebreal, Fitsum, Weldegwergs, Kidu Gidey, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Widecka, Justyna, Wijeratne, Tissa, Wyper, Grant M A, Xu, Gelin, Yamada, Tomohide, Yano, Yuichiro, Ye, Pengpeng, Yimer, Ebrahim M, Yip, Paul, Yirsaw, Biruck Desalegn, Yisma, Engida, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z, Zachariah, Geevar, Zaidi, Zoubida, Zamani, Mohammad, Zhang, Xueying, Zodpey, Sanjay, Mokdad, Ali H, Naghavi, Mohsen, Murray, Christopher J L, and Gakidou, Emmanuela

Subjects
Adult, Male, Adolescent, Alcohol Drinking, Global Health, Risk Assessment, Global Burden of Disease, Young Adult, Age Distribution, Retrospective Studie, General & Internal Medicine, Cause of Death, Quality-Adjusted Life Year, Prevalence, Medicine (all) Alcohol GBD, Sex Distribution, Aged, Aged, 80 and over, Risk Factor, Medicine (all), Commerce, Middle Aged, Observational Studies as Topic, Prospective Studie, Population Surveillance, Female, Human medicine, Human
Abstract

Background: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week. Interpretation: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding: Bill & Melinda Gates Foundation.

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