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1. Continuity of community-based healthcare provision during COVID-19: a multicountry interrupted time series analysis

Author

Caroline Whidden, Daniel Palazuelos, Madeleine Ballard, Jane Yang, Molly Christiansen, Carey Westgate, Amanda Yembrick, Diego Lassala, Fabien Munyaneza, Helen E Olsen, Anoushka Millear, Dianne Thakura, Afra Nuwasiima, Daniele J Ressler, and Wycliffe Okoth Omwanda

Subjects
Medicine
Abstract

Background Pandemics often precipitate declines in essential health service utilisation, which can ultimately kill more people than the disease outbreak itself. There is some evidence, however, that the presence of adequately supported community health workers (CHWs), that is, financially remunerated, trained, supplied and supervised in line with WHO guidelines, may blunt the impact of health system shocks. Yet, adequate support for CHWs is often missing or uneven across countries. This study assesses whether adequately supported CHWs can maintain the continuity of essential community-based health service provision during the COVID-19 pandemic.Methods Interrupted time series analysis. Monthly routine data from 27 districts across four countries in sub-Saharan Africa were extracted from CHW and facility reports for the period January 2018–June 2021. Descriptive analysis, null hypothesis testing, and segmented regression analysis were used to assess the presence and magnitude of a possible disruption in care utilisation after the earliest reported cases of COVID-19.Results CHWs across all sites were supported in line with the WHO Guideline and received COVID-19 adapted protocols, training and personal protective equipment within 45 days after the first case in each country. We found no disruptions to the coverage of proactive household visits or integrated community case management (iCCM) assessments provided by these prepared and protected CHWs, as well as no disruptions to the speed with which iCCM was received, pregnancies were registered or postnatal care received.Conclusion CHWs who were equipped and prepared for the pandemic were able to maintain speed and coverage of community-delivered care during the pandemic period. Given that the majority of CHWs globally remain unpaid and largely unsupported, this paper suggests that the opportunity cost of not professionalising CHWs may be larger than previously estimated, particularly in light of the inevitability of future pandemics.

Published
2022
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2. Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Bolajoko O. Olusanya, Adrian C. Davis, Donald Wertlieb, Nem-Yun Boo, M.K.C. Nair, Ricardo Halpern, Hannah Kuper, Cecilia Breinbauer, Petrus J de Vries, Melissa Gladstone, Neal Halfon, Vijaya Kancherla, Mphelekedzeni C. Mulaudzi, Angelina Kakooza-Mwesige, Felix A. Ogbo, Jacob O. Olusanya, Andrew N. Williams, Scott M. Wright, Helena Manguerra, Alison Smith, Michelle Echko, Chad Ikeda, Angela Liu, Anoushka Millear, Katherine Ballesteros, Emma Nichols, Holly E. Erskine, Damian Santomauro, Zane Rankin, Mari Smith, Harvey A. Whiteford, Helen E. Olsen, and Nicholas J. Kassebaum

Subjects
Public aspects of medicine, RA1-1270
Abstract

Summary: Background: The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health and wellbeing of all children to achieve optimal early childhood development. However, global epidemiological data on children with developmental disabilities are scarce. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 provides a comprehensive assessment of prevalence and years lived with disability (YLDs) for development disabilities among children younger than 5 years in 195 countries and territories from 1990 to 2016. Methods: We estimated prevalence and YLDs for epilepsy, intellectual disability, hearing loss, vision loss, autism spectrum disorder, and attention deficit hyperactivity disorder. YLDs were estimated as the product of the prevalence estimate and the disability weight for each mutually exclusive disorder, corrected for comorbidity. We used DisMod-MR 2.1, a Bayesian meta-regression tool, on a pool of primary data derived from systematic reviews of the literature, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Findings: Globally, 52·9 million (95% uncertainty interval [UI] 48·7–57·3; or 8·4% [7·7–9·1]) children younger than 5 years (54% males) had developmental disabilities in 2016 compared with 53·0 million (49·0–57·1; or 8·9% [8·2–9·5]) in 1990. About 95% of these children lived in low-income and middle-income countries. YLDs among these children increased from 3·8 million (95% UI 2·8–4·9) in 1990 to 3·9 million (2·9–5·2) in 2016. These disabilities accounted for 13·3% of the 29·3 million YLDs for all health conditions among children younger than 5 years in 2016. Vision loss was the most prevalent disability, followed by hearing loss, intellectual disability, and autism spectrum disorder. However, intellectual disability was the largest contributor to YLDs in both 1990 and 2016. Although the prevalence of developmental disabilities among children younger than 5 years decreased in all countries (except for North America) between 1990 and 2016, the number of children with developmental disabilities increased significantly in sub-Saharan Africa (71·3%) and in North Africa and the Middle East (7·6%). South Asia had the highest prevalence of children with developmental disabilities in 2016 and North America had the lowest. Interpretation: The global burden of developmental disabilities has not significantly improved since 1990, suggesting inadequate global attention on the developmental potential of children who survived childhood as a result of child survival programmes, particularly in sub-Saharan Africa and south Asia. The SDGs provide a framework for policy and action to address the needs of children with or at risk of developmental disabilities, particularly in resource-poor countries. Funding: The Bill & Melinda Gates Foundation.

Published
2018
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3. Continuity of community-based healthcare provision during COVID-19: a multicountry interrupted time series analysis

Author

Madeleine Ballard, Helen E Olsen, Anoushka Millear, Jane Yang, Caroline Whidden, Amanda Yembrick, Dianne Thakura, Afra Nuwasiima, Molly Christiansen, Daniele J Ressler, Wycliffe Okoth Omwanda, Diego Lassala, Daniel Palazuelos, Carey Westgate, and Fabien Munyaneza

Subjects
Community Health Workers, COVID-19, Humans, Interrupted Time Series Analysis, General Medicine, Community Health Services, Delivery of Health Care, Pandemics
Abstract

BackgroundPandemics often precipitate declines in essential health service utilisation, which can ultimately kill more people than the disease outbreak itself. There is some evidence, however, that the presence of adequately supported community health workers (CHWs), that is, financially remunerated, trained, supplied and supervised in line with WHO guidelines, may blunt the impact of health system shocks. Yet, adequate support for CHWs is often missing or uneven across countries. This study assesses whether adequately supported CHWs can maintain the continuity of essential community-based health service provision during the COVID-19 pandemic.MethodsInterrupted time series analysis. Monthly routine data from 27 districts across four countries in sub-Saharan Africa were extracted from CHW and facility reports for the period January 2018–June 2021. Descriptive analysis, null hypothesis testing, and segmented regression analysis were used to assess the presence and magnitude of a possible disruption in care utilisation after the earliest reported cases of COVID-19.ResultsCHWs across all sites were supported in line with the WHO Guideline and received COVID-19 adapted protocols, training and personal protective equipment within 45 days after the first case in each country. We found no disruptions to the coverage of proactive household visits or integrated community case management (iCCM) assessments provided by these prepared and protected CHWs, as well as no disruptions to the speed with which iCCM was received, pregnancies were registered or postnatal care received.ConclusionCHWs who were equipped and prepared for the pandemic were able to maintain speed and coverage of community-delivered care during the pandemic period. Given that the majority of CHWs globally remain unpaid and largely unsupported, this paper suggests that the opportunity cost of not professionalising CHWs may be larger than previously estimated, particularly in light of the inevitability of future pandemics.

Published
2022

4. Burden of disease in francophone Africa, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Nicholas J Kassebaum, Kris J. Krohn, Simon I. Hay, Yodé Miangotar, Faye Ziegeweid, Ali H. Mokdad, Helen E Olsen, Martin Herbas Ekat, Varsha Sarah Krish, Zacharie Tsala Dimbuene, Honoré Mimche, Christopher M Odell, Jobert Richie Nansseu, Charbel El Bcheraoui, Roger Tine, Christopher Troeger, and Tamer H. Farag

Subjects
Estimation, Population ageing, education.field_of_study, lcsh:Public aspects of medicine, 030231 tropical medicine, Population, lcsh:RA1-1270, General Medicine, Global Burden of Disease, 03 medical and health sciences, 0302 clinical medicine, Geography, Years of potential life lost, Cost of Illness, Family planning, Africa, Humans, Population growth, 030212 general & internal medicine, education, Disease burden, Demography, Cause of death
Abstract

Summary Background Peer-reviewed literature on health is almost exclusively published in English, limiting the uptake of research for decision making in francophone African countries. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to assess the burden of disease in francophone Africa and inform health professionals and their partners in the region. Methods We assessed the burden of disease in the 21 francophone African countries and compared the results with those for their non-francophone counterparts in three economic communities: the Economic Community of West African States, the Economic Community of Central African States, and the Southern African Development Community. GBD 2017 employed a variety of statistical models to determine the number of deaths from each cause, through the Cause of Death Ensemble model algorithm, using CoDCorrect to ensure that the number of deaths per cause did not exceed the total number of estimated deaths. After producing estimates for the number of deaths from each of the 282 fatal outcomes included in the GBD 2017 list of causes, the years of life lost (YLLs) due to premature death were calculated. Years lived with disability (YLDs) were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. All calculations are presented with 95% uncertainty intervals (UIs). A sample of 1000 draws was taken from the posterior distribution of each estimation step; aggregation of uncertainty across age, sex, and location was done on each draw, assuming independence of uncertainty. The lower and upper UIs represent the ordinal 25th and 975th draws of each quantity and attempt to describe modelling as well as sampling error. Findings In 2017, 779 deaths (95% UI 750–809) per 100 000 population occurred in francophone Africa, a decrease of 45·3% since 1990. Malaria, lower respiratory infections, neonatal disorders, diarrhoeal diseases, and tuberculosis were the top five Level 3 causes of death. These five causes were found among the six leading causes of death in most francophone countries. In 2017, francophone Africa experienced 53 570 DALYs (50 164–57 361) per 100 000 population, distributed between 43 708 YLLs (41 673–45 742) and 9862 YLDs (7331–12 749) per 100 000 population. In 2017, YLLs constituted the majority of DALYs in the 21 countries of francophone Africa. Age-specific and cause-specific mortality and population ageing were responsible for most of the reductions in disease burden, whereas population growth was responsible for most of the increases. Interpretation Francophone Africa still carries a high burden of communicable and neonatal diseases, probably due to the weakness of health-care systems and services, as evidenced by the almost complete attribution of DALYs to YLLs. To cope with this burden of disease, francophone Africa should define its priorities and invest more resources in health-system strengthening and in the quality and quantity of health-care services, especially in rural and remote areas. The region could also be prioritised in terms of technical and financial assistance focused on achieving these goals, as much as on demographic investments including education and family planning. Funding Bill & Melinda Gates Foundation.

Published
2020
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5. Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments

Author

Felix Akpojene Ogbo, Donald Wertlieb, Petrus J. de Vries, Cecilia Breinbauer, Charles R. Newton, Angelina Kakooza-Mwesige, Nem-Yun Boo, Nihad A. Almasri, Melissa Gladstone, Maureen Samms-Vaughan, Sophia Backhaus, Andrew N Williams, Vijaya Kancherla, G. L. Carr, Scott M. Wright, Amina Abubakar, Jalal Arabloo, Adrian Davis, Narendra K. Arora, Ricardo Halpern, Brad D. Berman, M. K. C. Nair, Chiara Servili, Tracey Smythe, Christie del Castillo-Hegyi, Jacob Olusegun Olusanya, Amira Shaheen, Mphelekedzeni C. Mulaudzi, Bolajoko O. Olusanya, Nicholas J Kassebaum, Ashok Pandey, Helen E Olsen, Rosa A. Hoekstra, Hannah Kuper, Aziz Eftekhari, and (GRDDC), Global Research on Developmental Disabilities Collaborators

Subjects
Male, Gerontology, Adolescent, Hearing loss, MEDLINE, Developing country, Blindness, Article, Global Burden of Disease, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Intellectual Disability, 030225 pediatrics, Intervention (counseling), Intellectual disability, Prevalence, medicine, Humans, Disabled Persons, Young adult, Hearing Loss, Child, Epilepsy, business.industry, Infant, medicine.disease, Systematic review, Child, Preschool, Pediatrics, Perinatology and Child Health, Female, medicine.symptom, business, Cohort study
Abstract

BACKGROUND: Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children METHODS: We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed. RESULTS: Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9–335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged CONCLUSIONS: The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.

Published
2020

6. The burden of child and maternal malnutrition and trends in its indicators in the states of India: the Global Burden of Disease Study 1990–2017

Author

William Godwin, Chris M Varghese, Neena Raina, Deepika Saraf, Zane Rankin, Christopher J L Murray, Nancy Fullman, Bhaskar Varanasi, Julian Chalek, Balakrishna Nagalla, Suparna Ghosh Jerath, Avula Laxmaiah, Rajni Kant, Varsha Krish, Simon I. Hay, Parul Mutreja, R S Sharma, Ashkan Afshin, Siddarth Ramji, Laishram Ladusingh, Brahmam N Ginnela, Rajkumar Hemalatha, Anita Kar, Lalit Dandona, Rakesh Lodha, Matthews Mathai, K. V. Radhakrishna, Rakhi Dandona, Indrapal I. Meshram, Mari Jeeva Sankar, Anoushka I Millear, Helen E Olsen, T. Longvah, G S Toteja, Ashalata Pati, Brandon Pickering, Reeta Rasaily, Rachakulla H Kumar, Anju Sinha, Melissa Furtado, Ryan Barber, Supriya Dwivedi, Rachita Gupta, Ajay Khera, William M. Gardner, K. Srinath Reddy, Christopher M Odell, Shally Awasthi, Hendrik J Bekedam, Zaozianlungliu Gonmei, Priyanka Gupta Bansal, Arlappa Nimmathota, Soumya Swaminathan, Joy K Chakma, G Anil Kumar, Helena Manguerra, Scott D Glenn, Stephen S Lim, Manorama Purwar, Nicholas J Kassebaum, Subodh S Gupta, Chander Shekhar, Reed Sorenson, and Anamika Pandey

Subjects
business.industry, Total fertility rate, Breastfeeding, Overweight, medicine.disease, Article, 03 medical and health sciences, Malnutrition, 0302 clinical medicine, 030225 pediatrics, Environmental health, Pediatrics, Perinatology and Child Health, Developmental and Educational Psychology, medicine, 030212 general & internal medicine, Underweight, medicine.symptom, Risk factor, business, Wasting, Disease burden
Abstract

Summary Background Malnutrition is a major contributor to disease burden in India. To inform subnational action, we aimed to assess the disease burden due to malnutrition and the trends in its indicators in every state of India in relation to Indian and global nutrition targets. Methods We analysed the disease burden attributable to child and maternal malnutrition, and the trends in the malnutrition indicators from 1990 to 2017 in every state of India using all accessible data from multiple sources, as part of Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three groups using their Socio-demographic Index (SDI) calculated by GBD on the basis of per capita income, mean education, and fertility rate in women younger than 25 years. We projected the prevalence of malnutrition indicators for the states of India up to 2030 on the basis of the 1990–2017 trends for comparison with India National Nutrition Mission (NNM) 2022 and WHO and UNICEF 2030 targets. Findings Malnutrition was the predominant risk factor for death in children younger than 5 years of age in every state of India in 2017, accounting for 68·2% (95% UI 65·8–70·7) of the total under-5 deaths, and the leading risk factor for health loss for all ages, responsible for 17·3% (16·3–18·2) of the total disability-adjusted life years (DALYs). The malnutrition DALY rate was much higher in the low SDI than in the middle SDI and high SDI state groups. This rate varied 6·8 times between the states in 2017, and was highest in the states of Uttar Pradesh, Bihar, Assam, and Rajasthan. The prevalence of low birthweight in India in 2017 was 21·4% (20·8–21·9), child stunting 39·3% (38·7–40·1), child wasting 15·7% (15·6–15·9), child underweight 32·7% (32·3–33·1), anaemia in children 59·7% (56·2–63·8), anaemia in women 15–49 years of age 54·4% (53·7–55·2), exclusive breastfeeding 53·3% (51·5–54·9), and child overweight 11·5% (8·5–14·9). If the trends estimated up to 2017 for the indicators in the NNM 2022 continue in India, there would be 8·9% excess prevalence for low birthweight, 9·6% for stunting, 4·8% for underweight, 11·7% for anaemia in children, and 13·8% for anaemia in women relative to the 2022 targets. For the additional indicators in the WHO and UNICEF 2030 targets, the trends up to 2017 would lead to 10·4% excess prevalence for wasting, 14·5% excess prevalence for overweight, and 10·7% less exclusive breastfeeding in 2030. The prevalence of malnutrition indicators, their rates of improvement, and the gaps between projected prevalence and targets vary substantially between the states. Interpretation Malnutrition continues to be the leading risk factor for disease burden in India. It is encouraging that India has set ambitious targets to reduce malnutrition through NNM. The trends up to 2017 indicate that substantially higher rates of improvement will be needed for all malnutrition indicators in most states to achieve the Indian 2022 and the global 2030 targets. The state-specific findings in this report indicate the effort needed in each state, which will be useful in tracking and motivating further progress. Similar subnational analyses might be useful for other low-income and middle-income countries. Funding Bill & Melinda Gates Foundation; Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Published
2019

7. Global, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Manisha Dubey, Michelle Echko, Mohamad-Hani Temsah, Craig Sable, Jean Jacques Noubiap, Ashish Awasthi, Nicholas J Kassebaum, Lemma Negesa, Molly R Nixon, Cuong Tat Nguyen, Paolo Cortesi, Anita Kar, Gene F. Kwan, Helen E Olsen, Emmanuel Peprah, Ionut Negoi, Trang Huyen Nguyen, Nu Thi Truong, Zoubida Zaidi, Samer Hamidi, Huong Lan Thi Nguyen, Robert G. Weintraub, Simon I. Hay, Christopher Hugo-Hamman, Mohsen Naghavi, Bach Xuan Tran, Lauren B. Wilner, Kathy J. Jenkins, Bistra Zheleva, Tung Thanh Tran, Ali H. Mokdad, Gregory A. Roth, Hagos Tasew Atalay, Shanti Patel, Ibrahim A Khalil, Kidu Gidey Weldegwergs, Son Hoang Nguyen, Marcos Roberto Tovani-Palone, Gerard R. Martin, Liesl Zühlke, Alison Smith, Zulfiqar A Bhutta, Jeffrey A. Towbin, Florian Fischer, Meghan S. Zimmerman, Jackie Lee Anne Boucher, Raman Krishna Kumar, Theo Vos, Long Hoang Nguyen, Chi Linh Hoang, Christopher J L Murray, Robert Reiner, Franz Castro, Kia Vosoughi, Ruxandra Irina Negoi, Desalegn Tadese Mengistu, Zimmerman, M, Smith, A, Sable, C, Echko, M, Wilner, L, Olsen, H, Atalay, H, Awasthi, A, Bhutta, Z, Boucher, J, Castro, F, Cortesi, P, Dubey, M, Fischer, F, Hamidi, S, Hay, S, Hoang, C, Hugo-Hamman, C, Jenkins, K, Kar, A, Khalil, I, Kumar, R, Kwan, G, Mengistu, D, Mokdad, A, Naghavi, M, Negesa, L, Negoi, I, Negoi, R, Nguyen, C, Nguyen, H, Nguyen, L, Nguyen, S, Nguyen, T, Nixon, M, Noubiap, J, Patel, S, Peprah, E, Reiner, R, Roth, G, Temsah, M, Tovani-Palone, M, Towbin, J, Tran, B, Tran, T, Truong, N, Vos, T, Vosoughi, K, Weintraub, R, Weldegwergs, K, Zaidi, Z, Zheleva, B, Zuhlke, L, Murray, C, Martin, G, and Kassebaum, N

Subjects
Heart Defects, Congenital, Pediatrics, medicine.medical_specialty, Adolescent, Heart disease, MED/42 - IGIENE GENERALE E APPLICATA, Psychological intervention, Burden, Global Health, Global Burden of Disease, 03 medical and health sciences, 0302 clinical medicine, Quality of life, 030225 pediatrics, Ductus arteriosus, Prevalence, Developmental and Educational Psychology, medicine, Humans, epidemiology, Disabled Persons, 030212 general & internal medicine, Child, Cause of death, Congenital Heart disease, business.industry, Infant, Newborn, Infant, Articles, medicine.disease, mortality, prevalnce, years lived with disability, medicine.anatomical_structure, Great vessels, Ventricle, Child, Preschool, Pediatrics, Perinatology and Child Health, Life course approach, business, Systematic Reviews as Topic
Abstract

Background: Previous congenital heart disease estimates came from few data sources, were geographically narrow, and did not evaluate congenital heart disease throughout the life course. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, this study aimed to provide comprehensive estimates of congenital heart disease mortality, prevalence, and disability by age for 195 countries and territories from 1990 to 2017. Methods: Mortality estimates were generated for aggregate congenital heart disease and non-fatal estimates for five subcategories (single ventricle and single ventricle pathway congenital heart anomalies; severe congenital heart anomalies excluding single ventricle heart defects; critical malformations of great vessels, congenital valvular heart disease, and patent ductus arteriosus; ventricular septal defect and atrial septal defect; and other congenital heart anomalies), for 1990 through to 2017. All available global data were systematically analysed to generate congenital heart disease mortality estimates (using Cause of Death Ensemble modelling) and prevalence estimates (DisMod-MR 2·1). Systematic literature reviews of all types of congenital anomalies to capture information on prevalence, associated mortality, and long-term health outcomes on congenital heart disease informed subsequent disability estimates. Findings: Congenital heart disease caused 261 247 deaths (95% uncertainty interval 216 567–308 159) globally in 2017, a 34·5% decline from 1990, with 180 624 deaths (146 825–214 178) being among infants (aged

Published
2020

8. Data needed to respond appropriately to anemia when it is a public health problem

Author

Scott D. Grosse, Andrea J. Sharma, Helen E Olsen, Zane Rankin, Maria Elena Jefferds, O. Yaw Addo, Anne M Williams, Zuguo Mei, Nicholas J Kassebaum, and Katherine E. Ballesteros

Subjects
0301 basic medicine, Burden of disease, medicine.medical_specialty, Pediatrics, Anemia, Iron, Population, Psychological intervention, Pre-Analytical Phase, Global Health, General Biochemistry, Genetics and Molecular Biology, World health, Article, 03 medical and health sciences, 0302 clinical medicine, History and Philosophy of Science, hemic and lymphatic diseases, Prevalence, Medicine, Humans, 030212 general & internal medicine, education, education.field_of_study, 030109 nutrition & dietetics, business.industry, General Neuroscience, Public health, medicine.disease, Blood Disorder, Iron-deficiency anemia, Public Health, business
Abstract

Although the proportion of anemia amenable to change varies by population, the World Health Organization (WHO) criteria used to describe the public health severity of anemia are based on population prevalences. We describe the importance of measuring iron and other etiologic indicators to better understand what proportion of anemia could be responsive to interventions. We discuss the necessity of measuring inflammation to interpret iron biomarkers and documenting anemia of inflammation. Finally, we suggest assessing nonmodifiable genetic blood disorders associated with anemia. Using aggregated results from the Global Burden of Disease 2016, we compare population prevalence of anemia with years lived with disability (YLD) estimates, and the relative contributions of mild, moderate, and severe anemia to YLD. Anemia prevalences correlated with YLD and the relative proportion of moderate or severe anemia increased with anemia prevalence. However, individual-level survey data revealed irregular patterns between anemia prevalence, the prevalence of moderate or severe anemia, and the prevalence of iron deficiency anemia (IDA). We conclude that although the WHO population prevalence criteria used to describe the public health severity of anemia are important for policymaking, etiologic-specific metrics that take into account IDA and other causes will be necessary for effective anemia control policies.

Published
2019

9. The State of US Health, 1990-2016 Burden of Diseases, Injuries, and Risk Factors Among US States

Author

Christopher Troeger, Scott D Glenn, Nancy Fullman, Michael H. Criqui, Benn Sartorius, Derrick Tsoi, Stein Emil Vollset, Andrea Werdecker, Danny V. Colombara, Eun-Kee Park, Harvey Whiteford, Mitch T Wallin, Ben Zipkin, Gregory R. Wagner, Jasvinder A. Singh, Amir Kasaeian, Talha Farid, Yohannes Kinfu, Tejas V. Patel, Janni Leung, George C Patton, Samir Soneji, Ben Anderson, Roman Topor-Madry, Maryam S. Farvid, Louisa Degenhardt, Jürgen Unützer, Paul S Briant, Stephen M. Amrock, Michelle Echko, Fiona J Charlson, Simon I. Hay, Janet L Leasher, Alexis J. Handal, Rasmus Havmoller, Mojde Mirarefin, Yuichiro Yano, Philimon Gona, Spencer L. James, Abdur Rahman Khan, Jacob E. Sunshine, Leslie T. Cooper, Patrick Liu, Brian J. Biroscak, Honglei Chen, H. Dean Hosgood, Peter J. Hotez, Sudha Jayaraman, Damian Santomauro, Leah E. Cahill, Hsiang Huang, Jean B. Nachega, Guoqing Hu, Bryan L. Sykes, Kaja Abbas, Michelle L. Bell, E. Ray Dorsey, Michael Brauer, Jagdish Khubchandani, Hmwe H Kyu, Kanyin Ong, Juan Sanabria, Mark Moses, Simon Yadgir, David C. Schwebel, Tahiya Alam, Jost B. Jonas, Holly E. Erskine, Zulfiqar A Bhutta, Christopher J L Murray, Amit Kandel, Max Griswold, Alexander Lee, Kristopher J. Krohn, Alireza Ahmadi, Theo Vos, Mustafa Z. Younis, Eyal Oren, Ricky Leung, Tahvi Frank, Elaine O. Nsoesie, Leslie Cornaby, Dariush Mozaffarian, Mostafa Qorbani, Vegard Skirbekk, Saverio Stranges, Erin C Mullany, Minh Nguyen, Helen E Olsen, Austin Carter, Tsegaye Telwelde Gebrehiwot, Ali H. Mokdad, Colin D. Rehm, Stan Biryukov, Daniel Kim, Ziyad Al-Aly, Ruth W Kimokoti, Eric L. Ding, Ira Martopullo, Dhaval Kolte, Alem Mehari, Alize J. Ferrari, Masako Horino, Joshua A. Salomon, Nicholas J K Breitborde, Gregory A. Roth, Emma Nichols, Berrin Serdar, Karen M. Tabb, Till Bärnighausen, Katherine Ballestros, Christina Fitzmaurice, Ted R. Miller, Shahrzad Bazargan-Hejazi, and Tomi Akinyemiju

Subjects
Adult, Male, medicine.medical_specialty, Poison control, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, Risk Factors, Injury prevention, Epidemiology, Disability-adjusted life year, Medicine, Humans, Disabled Persons, 030212 general & internal medicine, Mortality, business.industry, Mortality, Premature, Mortality rate, General Medicine, Health Status Disparities, Middle Aged, United States, Quality-adjusted life year, Years of potential life lost, Life expectancy, Wounds and Injuries, Female, Quality-Adjusted Life Years, Morbidity, business, Demography
Abstract

Introduction Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state. Objective To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016. Design and Setting A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year. Main Outcomes and Measures Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed. Results Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95%UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95%UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), andWest Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5%(95%UI, 42.8%to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5%of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states). Conclusions and Relevance There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

Published
2018

10. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

Author

Lim, Stephen S, Allen, Kate, Bhutta, Zulfiqar A, Dandona, Lalit, Forouzanfar, Mohammad H, Fullman, Nancy, Gething, Peter W, Goldberg, Ellen M, Hay, Simon I, Holmberg, Mollie, Kinfu, Yohannes, Kutz, Michael J, Larson, Heidi J, Liang, Xiaofeng, Lopez, Alan D, Lozano, Rafael, McNellan, Claire R, Mokdad, Ali H, Mooney, Meghan D, Naghavi, Mohsen, Olsen, Helen E, Pigott, David M, Salomon, Joshua A, Vos, Theo, Wang, Haidong, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen ME, Abyu, Gebre Yitayih, Achoki, Tom, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Afanvi, Kossivi Agbelenko, Afshin, Ashkan, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmadieh, Hamid, Ahmed, Kedir Yimam, Akanda, Ali Shafqat, Akinyemi, Rufus Olusola, Akinyemiju, Tomi F, Akseer, Nadia, Al-Aly, Ziyad, Alam, Khurshid, Alam, Uzma, Alasfoor, Deena, AlBuhairan, Fadia S, Aldhahri, Saleh Fahed, Aldridge, Robert William, Alemu, Zewdie Aderaw, Ali, Raghib, Alkerwi, Ala'a, Alkhateeb, Mohammad AB, Alla, Francois, Allebeck, Peter, Allen, Christine, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amberbir, Alemayehu, Amegah, Adeladza Kofi, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Benjamin O, Anderson, Gregory M, Antonio, Carl Abelardo T, Anwari, Palwasha, Arnlov, Johan, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Banerjee, Amitava, Barac, Aleksandra, Barber, Ryan, Barker-Collo, Suzanne L, Barnighausen, Till, Barrero, Lope H, Barrientos-Gutierrez, Tonatiuh, Basu, Sanjay, Bayou, Tigist Assefa, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bejot, Yannick, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Benzian, Habib, Berhane, Adugnaw, Bernabe, Eduardo, Bernal, Oscar Alberto, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhatt, Samir, Biadgilign, Sibhatu, Bienhoff, Kelly A, Bikbov, Boris, Binagwaho, Agnes, Bisanzio, Donal, Bjertness, Espen, Blore, Jed, Bourne, Rupert RA, Brainin, Michael, Brauer, Michael, Brazinova, Alexandra, Breitborde, Nicholas JK, Broday, David M, Brugha, Traolach S, Buchbinder, Rachelle, Butt, Zahid A, Cahill, Leah E, Campos-Nonato, Ismael Ricardo, Campuzano, Julio Cesar, Carabin, Helene, Cardenas, Rosario, Carrero, Juan Jesus, Carter, Austin, Casey, Daniel, Caso, Valeria, Castaneda-Orjuela, Carlos A, Castillo Rivas, Jacqueline, Catala-Lopez, Ferran, Cavalleri, Fiorella, Cecilio, Pedro, Chang, Hsing-Yi, Chang, Jung-Chen, Charlson, Fiona J, Che, Xuan, Chen, Alan Zian, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chisumpa, Vesper Hichilombwe, Choi, Jee-Young Jasmine, Chowdhury, Rajiv, Christensen, Hanne, Ciobanu, Liliana G, Cirillo, Massimo, Coates, Matthew M, Coggeshall, Megan, Cohen, Aaron J, Cooke, Graham S, Cooper, Cyrus, Cooper, Leslie Trumbull, Cowie, Benjamin C, Crump, John A, Damtew, Solomon Abrha, Dandona, Rakhi, Dargan, Paul I, das Neves, Jose, Davis, Adrian C, Davletov, Kairat, de Castro, E Filipa, De Leo, Diego, Degenhardt, Louisa, Del Gobbo, Liana C, Deribe, Kebede, Derrett, Sarah, Jarlais, Don C Des, Deshpande, Aniruddha, Deveber, Gabrielle A, Dey, Subhojit, Dharmaratne, Samath D, Dhillon, Preet K, Ding, Eric L, Dorsey, E Ray, Doyle, Kerrie E, Driscoll, Tim R, Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Ebrahimi, Hedyeh, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E, Eshrati, Babak, Esteghamati, Alireza, Fahimi, Saman, Farid, Talha A, Sofia e Sa Farinha, Carla, Faro, Andre, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Mendonca Felicio, Manuela, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fernandes, Joao C, Ferrari, Alize J, Fischer, Florian, Fitchett, Joseph RA, Fitzmaurice, Christina, Foigt, Nataliya, Foreman, Kyle, Fowkes, F Gerry R, Franca, Elisabeth Barboza, Franklin, Richard C, Fraser, Maya, Friedman, Joseph, Frostad, Joseph, Furst, Thomas, Gabbe, Belinda, Garcia-Basteiro, Alberto L, Gebre, Teshome, Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Gebru, Alemseged Aregay, Gessner, Bradford D, Gillum, Richard F, Ginawi, Ibrahim Abdelmageem Mohamed, Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Giussani, Giorgia, Godwin, William, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Graetz, Nicholas, Greenwell, Karen Fern, Griswold, Max, Gugnani, Harish, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gutierrez, Reyna A, Gyawali, Bishal, Haagsma, Juanita A, Haakenstad, Annie, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Gessessew Bugssa, Halasa, Yara A, Hamadeh, Randah Ribhi, Hamidi, Samer, Hammami, Mouhanad, Hankey, Graeme J, Harb, Hilda L, Haro, Josep Maria, Hassanvand, Mohammad Sadegh, Havmoeller, Rasmus, Heredia-Pi, Ileana Beatriz, Hoek, Hans W, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hoy, Damian G, Htet, Aung Soe, Hu, Guoqing, Huang, Hsiang, Iburg, Kim Moesgaard, Idrisov, Bulat T, Inoue, Manami, Islami, Farhad, Jacobs, Troy A, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, James, Peter, Jansen, Henrica AFM, Javanbakht, Mehdi, Jayaraman, Sudha P, Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jha, Vivekanand, Jiang, Ying, Jibat, Tariku, Jin, Ye, Jonas, Jost B, Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Kandel, Amit, Karch, Andre, Karema, Corine Kakizi, Karimkhani, Chante, Karunapema, Palitha, Kasaeian, Amir, Kassebaum, Nicholas J, Kaul, Anil, Kawakami, Norito, Kayibanda, Jeanne Francoise, Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khang, Young-Ho, Khoja, Tawfi K Ahmed Muthafer, Khosravi, Ardeshir, Khubchandani, Jagdish, Kieling, Christian, Kim, Cho-Il, Kim, Daniel, Kim, Sungroul, Kim, Yun Jin, Kimokoti, Ruth W, Kissoon, Niranjan, Kivipelto, Miia, Knibbs, Luke D, Kokubo, Yoshihiro, Kolte, Dhaval, Kosen, Soewarta, Kotsakis, Georgios A, Koul, Parvaiz A, Koyanagi, Ai, Kravchenko, Michael, Krueger, Hans, Defo, Barthelemy Kuate, Kuchenbecker, Ricardo S, Kuipers, Ernst J, Kulikoff, Xie Rachel, Kulkarni, Veena S, Kumar, G Anil, Kwan, Gene F, Kyu, Hmwe H, Lal, Aparna, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lam, Hilton, Lan, Qing, Langan, Sinead M, Larsson, Anders, Laryea, Dennis Odai, Latif, Asma Abdul, Leasher, Janet L, Leigh, James, Leinsalu, Mall, Leung, Janni, Leung, Ricky, Levi, Miriam, Li, Yichong, Li, Yongmei, Lind, Margaret, Linn, Shai, Lipshultz, Steven E, Liu, Patrick Y, Liu, Shiwei, Liu, Yang, Lloyd, Belinda K, Lo, Loon-Tzian, Logroscino, Giancarlo, Lotufo, Paulo A, Lucas, Robyn M, Lunevicius, Raimundas, Abd El Razek, Mohammed Magdy, Magis-Rodriguez, Carlos, Mahdavi, Mahdi, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Mapoma, Chabila C, Margolis, David Joel, Martin, Randall V, Martinez-Raga, Jose, Masiye, Felix, Mason-Jones, Amanda J, Massano, Joao, Matzopoulos, Richard, Mayosi, Bongani M, McGrath, John J, Mckee, Martin, Meaney, Peter A, Mehari, Alem, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Mensink, Gert BM, Meretoja, Atte, Meretoja, Tuomo J, Mesfin, Yonatan Moges, Mhimbira, Francis Apolinary, Micha, Renata, Miller, Ted R, Mills, Edward J, Mirarefi, Mojde, Misganaw, Awoke, Mitchell, Philip B, Mock, Charles N, Mohammadi, Alireza, Mohammed, Shafi U, Monasta, Lorenzo, De la Cruz Monis, Jonathan, Montanez Hernandez, Julio Cesar, Montico, Marcella, Moradi-Lakeh, Maziar, Morawska, Lidia, Mori, Rintaro, Mueller, Ulrich O, Murdoch, Michele E, Murimira, Brighton, Murray, Joseph, Murthy, Gudlavalleti Venkata Satyanarayana, Murthy, Srinivas, Musa, Kamarul Imran, Nachega, Jean B, Nagel, Gabriele, Naidoo, Kovin S, Naldi, Luigi, Nangia, Vinay, Neal, Bruce, Nejjari, Chakib, Newton, Charles R, Newton, John N, Ngalesoni, Frida Namnyak, Nguhiu, Peter, Nguyen, Grant, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Nolte, Sandra, Nomura, Marika, Norheim, Ole F, Norrving, Bo, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Osborne, Richard H, Ota, Erika, Owolabi, Mayowa O, Mahesh, PA, Park, Eun-Kee, Park, Hye-Youn, Parry, Charles D, Parsaeian, Mahboubeh, Patel, Tejas, Patel, Vikram, Caicedo, Angel J Paternina, Patil, Snehal T, Patten, Scott B, Patton, George C, Paudel, Deepak, Pedro, Joao Mario, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frederic B, Pillay, Julian David, Pinho, Christine, Pishgar, Farhad, Polinder, Suzanne, Poulton, Richie G, Pourmalek, Farshad, Qorbani, Mostafa, Rabiee, Rynaz HS, Radfar, Amir, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajsic, Sasa, Raju, Murugesan, Ram, Usha, Rana, Saleem M, Ranabhat, Chhabi Lal, Ranganathan, Kavitha, Rao, Puja C, Refaat, Amany H, Reitsma, Marissa B, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Rios Blancas, Maria Jesus, Roba, Hirbo Shore, Roberts, Bayard, Rodriguez, Alina, Rojas-Rueda, David, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A, Rothenbacher, Dietrich, Roy, Ambuj, Roy, Nobhojit, Sackey, Ben Benasco, Sagar, Rajesh, Saleh, Muhammad Muhammad, Sanabria, Juan R, Santos, Joao Vasco, Santomauro, Damian F, Santos, Itamar S, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Sawyer, Susan M, Schmidhuber, Josef, Schmidt, Maria Ines, Schneider, Ione JC, Schutte, Aletta E, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shackelford, Katya, Shaheen, Amira, Shaikh, Masood Ali, Levy, Teresa Shamah, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Sheth, Kevin N, Shey, Muki, Shi, Peilin, Shibuya, Kenji, Shigematsu, Mika, Shin, Min-Jeong, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Sigfusdottir, Inga Dora, Silpakit, Naris, Santos Silva, Diego Augusto, Silverberg, Jonathan I, Simard, Edgar P, Sindi, Shireen, Singh, Abhishek, Singh, Gitanjali M, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Skirbekk, Vegard, Sligar, Amber, Soneji, Samir, Soreide, Kjetil, Sorensen, Reed JD, Soriano, Joan B, Soshnikov, Sergey, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stahl, Hans-Christian, Stanaway, Jeff rey D, Stathopoulou, Vasiliki, Steckling, Nadine, Steel, Nicholas, Stein, Dan J, Steiner, Caitlyn, Stockl, Heidi, Stranges, Saverio, Strong, Mark, Sun, Jiandong, Sunguya, Bruno F, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra EI, Tabares-Seisdedos, Rafael, Tabb, Karen M, Talongwa, Roberto Tchio, Tarawneh, Mohammed Rasoul, Tavakkoli, Mohammad, Taye, Bineyam, Taylor, Hugh R, Tedla, Bemnet Amare, Tefera, Worku, Tegegne, Teketo Kassaw, Tekle, Dejen Yemane, Shifa, Girma Temam, Terkawi, Abdullah Sulieman, Tessema, Gizachew Assefa, Thakur, JS, Thomson, Alan J, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tillmann, Taavi, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Fotis, Tran, Bach Xuan, Truelsen, Thomas, Dimbuene, Zacharie Tsala, Tura, Abera Kenay, Tuzcu, Emin Murat, Tyrovolas, Stefanos, Ukwaja, Kingsley Nnanna, Undurraga, Eduardo A, Uneke, Chigozie Jesse, Uthman, Olalekan A, van Donkelaar, Aaron, Varakin, Yuri Y, Vasankari, Tommi, Nogales Vasconcelos, Ana Maria, Veerman, J Lennert, Venketasubramanian, Narayanaswamy, Verma, Raj Kumar, Violante, Francesco S, Vlassov, Vasiliy Victorovich, Volkow, Patricia, Vollset, Stein Emil, Wagner, Gregory R, Wallin, Mitchell T, Wang, Linhong, Wanga, Valentine, Watkins, David A, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Wilkinson, James D, Wiysonge, Charles Shey, Wolfe, Charles DA, Wolfe, Ingrid, Won, Sungho, Woolf, Anthony D, Workie, Shimelash Bitew, Wubshet, Mamo, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zambrana-Torrelio, Carlos, Zapata, Tomas, Zegeye, Elias Asfaw, Zhao, Yi, Zhou, Maigeng, Zodpey, Sanjay, Zonies, David, Murray, Christopher JL, Collaborators, GBD 2015 SDG, Stephen S., Lim, Kate, Allen, Zulfi qar A., Bhutta, Lalit, Dandona, Mohammad H., Forouzanfar, Nancy, Fullman, Peter W., Gething, Ellen M., Goldberg, Simon I., Hay, Mollie, Holmberg, Yohannes, Kinfu, Michael J., Kutz, Heidi J., Larson, Xiaofeng, Liang, Alan D., Lopez, Rafael, Lozano, Claire R., Mcnellan, Ali H., Mokdad, Meghan D., Mooney, Mohsen, Naghavi, Helen E., Olsen, David M., Pigott, Joshua A., Salomon, Theo, Vo, Haidong, Wang, Amanuel Alemu, Abajobir, Kalkidan Hassen, Abate, Cristiana, Abbafati, Kaja M., Abba, Foad Abd, Allah, Abdishakur M., Abdulle, Biju, Abraham, Ibrahim, Abubakar, Laith J., Abu Raddad, Niveen M. E., Abu Rmeileh, Gebre Yitayih, Abyu, Tom, Achoki, Akindele Olupelumi, Adebiyi, Isaac Akinkunmi, Adedeji, Kossivi Agbelenko, Afanvi, Ashkan, Afshin, Arnav, Agarwal, Anurag, Agrawal, Aliasghar Ahmad, Kiadaliri, Hamid, Ahmadieh, Kedir Yimam, Ahmed, Ali Shafqat, Akanda, Rufus Olusola, Akinyemi, Tomi F., Akinyemiju, Nadia, Akseer, Ziyad Al, Aly, Khurshid, Alam, Uzma, Alam, Deena, Alasfoor, Fadia S., Albuhairan, Saleh Fahed, Aldhahri, Robert William, Aldridge, Zewdie Aderaw, Alemu, Raghib, Ali, Ala’A, Alkerwi, Mohammad AB, Alkhateeb, François, Alla, Peter, Allebeck, Christine, Allen, Rajaa Al, Raddadi, Khalid A., Altirkawi, Elena Alvarez, Martin, Nelson Alvis, Guzman, Azmeraw T., Amare, Alemayehu, Amberbir, Adeladza Kofi, Amegah, Heresh, Amini, Walid, Ammar, Stephen Marc, Amrock, Hjalte H., Andersen, Benjamin O., Anderson, Gregory M., Anderson, Carl Abelardo T., Antonio, Palwasha, Anwari, Johan, Ärnlöv, Al, Artaman, Hamid, Asayesh, Rana Jawad, Asghar, Suleman, Atique, Euripide Frinel G., Arthur Avokpaho, Ashish, Awasthi, Beatriz Paulina Ayala, Quintanilla, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Amitava, Banerjee, Aleksandra, Barac, Ryan, Barber, Suzanne L., Barker Collo, Till, Bärnighausen, Lope H., Barrero, Tonatiuh Barrientos, Gutierrez, Sanjay, Basu, Tigist Assefa, Bayou, Shahrzad Bazargan, Hejazi, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Yannick, Béjot, Michelle L., Bell, Aminu K., Bello, Derrick A., Bennett, Isabela M., Bensenor, Habib, Benzian, Adugnaw, Berhane, Eduardo, Bernabé, Oscar Alberto, Bernal, Balem Demtsu, Betsu, Addisu Shunu, Beyene, Neeraj, Bhala, Samir, Bhatt, Sibhatu, Biadgilign, Kelly A., Bienhoff, Boris, Bikbov, Agnes, Binagwaho, Donal, Bisanzio, Espen, Bjertne, Jed, Blore, Rupert R. A., Bourne, Michael, Brainin, Michael, Brauer, Alexandra, Brazinova, Nicholas J. K., Breitborde, David M., Broday, Traolach S., Brugha, Rachelle, Buchbinder, Zahid A., Butt, Leah E., Cahill, Ismael Ricardo Campos, Nonato, Julio Cesar, Campuzano, Hélène, Carabin, Rosario, Cárdena, Juan Jesus, Carrero, Austin, Carter, Daniel, Casey, Valeria, Caso, Carlos A., Castañeda Orjuela, Jacqueline Castillo, Riva, Ferrán Catalá, López, Fiorella, Cavalleri, Pedro, Cecílio, Hsing Yi, Chang, Jung Chen, Chang, Fiona J., Charlson, Xuan, Che, Alan Zian, Chen, Peggy Pei Chia, Chiang, Mirriam, Chibalabala, Vesper Hichilombwe, Chisumpa, Jee Young Jasmine, Choi, Rajiv, Chowdhury, Hanne, Christensen, Liliana G., Ciobanu, Cirillo, Massimo, Matthew M., Coate, Megan, Coggeshall, Aaron J., Cohen, Graham S., Cooke, Cyrus, Cooper, Leslie Trumbull, Cooper, Benjamin C., Cowie, John A., Crump, Solomon Abrha, Damtew, Rakhi, Dandona, Paul I., Dargan, José das, Neve, Adrian C., Davi, Kairat, Davletov, E., Filipa de Castro, Diego De, Leo, Louisa, Degenhardt, Liana C., Del Gobbo, Kebede, Deribe, Sarah, Derrett, Don C., Des Jarlai, Aniruddha, Deshpande, Gabrielle A., Deveber, Subhojit, Dey, Samath D., Dharmaratne, Preet K., Dhillon, Eric L., Ding, E., Ray Dorsey, Kerrie E., Doyle, Tim R., Driscoll, Leilei, Duan, Manisha, Dubey, Bruce Bartholow, Duncan, Hedyeh, Ebrahimi, Aman Yesuf, Endrie, Sergey Petrovich, Ermakov, Holly E., Erskine, Babak, Eshrati, Alireza, Esteghamati, Saman, Fahimi, Talha A., Farid, Carla Sofi a. e., Sa Farinha, André, Faro, Maryam S., Farvid, Farshad, Farzadfar, Valery L., Feigin, Manuela Mendonca, Felicio, Seyed Mohammad, Fereshtehnejad, Jefferson G., Fernande, Joao C., Fernande, Alize J., Ferrari, Florian, Fischer, Joseph R. 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Gerry R., Fowke, Elisabeth Barboza, Franca, Richard C., Franklin, Maya, Fraser, Joseph, Friedman, Joseph, Frostad, Thomas, Fürst, Belinda, Gabbe, Alberto L., Garcia Basteiro, Teshome, Gebre, Tsegaye Tewelde, Gebrehiwot, Amanuel Tesfay, Gebremedhin, Alemseged Aregay, Gebru, Bradford D., Gessner, Richard F., Gillum, Ibrahim Abdelmageem Mohamed, Ginawi, Ababi Zergaw, Giref, Maurice, Giroud, Melkamu Dedefo, Gishu, William, Godwin, Philimon, Gona, Amador, Goodridge, Sameer Vali, Gopalani, Carolyn C., Gotay, Atsushi, Goto, Hebe N., Gouda, Nicholas, Graetz, Karen Fern, Greenwell, Max, Griswold, Yuming, Guo, Rahul, Gupta, Rajeev, Gupta, Vipin, Gupta, Reyna A., Gutiérrez, Bishal, Gyawali, Juanita A., Haagsma, Annie, Haakenstad, Nima Hafezi, Nejad, Demewoz, Haile, Gessessew Bugssa, Hailu, Yara A., Halasa, Randah Ribhi, Hamadeh, Samer, Hamidi, Mouhanad, Hammami, Graeme J., Hankey, Hilda L., Harb, Josep Maria, Haro, Mohammad Sadegh, Hassanvand, Rasmus, Havmoeller, Ileana Beatriz Heredia, Pi, Hans W., Hoek, Masako, Horino, Nobuyuki, Horita, H., Dean Hosgood, Damian G., Hoy, Aung Soe, Htet, Guoqing, Hu, Hsiang, Huang, Kim Moesgaard, Iburg, Bulat T., Idrisov, Manami, Inoue, Farhad, Islami, Troy A., Jacob, Kathryn H., Jacobsen, Nader, Jahanmehr, Mihajlo B., Jakovljevic, Peter, Jame, Henrica A. F. M., Jansen, Mehdi, Javanbakht, Achala Upendra, Jayatilleke, Sun Ha, Jee, Panniyammakal, Jeemon, Vivekanand, Jha, Ying, Jiang, Tariku, Jibat, Ye, Jin, Jost B., Jona, Zubair, Kabir, Yogeshwar, Kalkonde, Ritul, Kamal, Haidong, Kan, Amit, Kandel, André, Karch, Corine Kakizi, Karema, Chante, Karimkhani, Palitha, Karunapema, Amir, Kasaeian, Nicholas J., Kassebaum, Anil, Kaul, Norito, Kawakami, Jeanne Françoise, Kayibanda, Peter Njenga, Keiyoro, Laura, Kemmer, Andrew Haddon, Kemp, Andre Pascal, Kengne, Andre, Keren, Chandrasekharan Nair, Kesavachandran, Yousef Saleh, Khader, Abdur Rahman, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khan, Young Ho, Khang, Tawfi k., Ahmed Muthafer Khoja, Ardeshir, Khosravi, Jagdish, Khubchandani, Christian, Kieling, Cho il, Kim, Daniel, Kim, Sungroul, Kim, Yun Jin, Kim, Ruth W., Kimokoti, Niranjan, Kissoon, Miia, Kivipelto, Luke D., Knibb, Yoshihiro, Kokubo, Dhaval, Kolte, Soewarta, Kosen, Georgios A., Kotsaki, Parvaiz A., Koul, Ai, Koyanagi, Michael, Kravchenko, Hans, Krueger, Barthelemy Kuate, Defo, Ricardo S., Kuchenbecker, Ernst J., Kuiper, Xie Rachel, Kulikoff, Veena S., Kulkarni, G., Anil Kumar, Gene F., Kwan, Hmwe H., Kyu, Aparna, Lal, Dharmesh Kumar, Lal, Ratilal, Lalloo, Hilton, Lam, Qing, Lan, Sinead M., Langan, Anders, Larsson, Dennis Odai, Laryea, Asma Abdul, Latif, Janet L., Leasher, James, Leigh, Mall, Leinsalu, Janni, Leung, Ricky, Leung, Miriam, Levi, Yichong, Li, Yongmei, Li, Margaret, Lind, Shai, Linn, Steven E., Lipshultz, Patrick Y., Liu, Shiwei, Liu, Yang, Liu, Belinda K., Lloyd, Loon Tzian, Lo, Giancarlo, Logroscino, Paulo A., Lotufo, Robyn M., Luca, Raimundas, Luneviciu, Mohammed Magdy Abd El, Razek, Carlos Magis, Rodriguez, Mahdi, Mahdavi, Marek, Majdan, Azeem, Majeed, Reza, Malekzadeh, Deborah Carvalho, Malta, Chabila C., Mapoma, David Joel, Margoli, Randall V., Martin, Jose Martinez, Raga, Felix, Masiye, Amanda J., Mason Jone, João, Massano, Richard, Matzopoulo, Bongani M., Mayosi, John J., Mcgrath, Martin, Mckee, Peter A., Meaney, Alem, Mehari, Alemayehu B., Mekonnen, Yohannes Adama, Melaku, Peter, Memiah, Ziad A., Memish, Walter, Mendoza, Gert B. M., Mensink, Atte, Meretoja, Tuomo J., Meretoja, Yonatan Moges Mesfi, N, Francis Apolinary, Mhimbira, Renata, Micha, Ted R., Miller, Edward J., Mill, Mojde Mirarefi, N, Awoke, Misganaw, Philip B., Mitchell, Charles N., Mock, Alireza, Mohammadi, Shafi u., Mohammed, Lorenzo, Monasta, Jonathan de la Cruz, Moni, Julio Cesar Montañez, Hernandez, Marcella, Montico, Maziar Moradi, Lakeh, Lidia, Morawska, Rintaro, Mori, Ulrich O., Mueller, Michele E., Murdoch, Brighton, Murimira, Joseph, Murray, Gudlavalleti Venkata Satyanarayana, Murthy, Srinivas, Murthy, Kamarul Imran, Musa, Jean B., Nachega, Gabriele, Nagel, Kovin S., Naidoo, Luigi, Naldi, Vinay, Nangia, Bruce, Neal, Chakib, Nejjari, Charles R., Newton, John N., Newton, Frida Namnyak, Ngalesoni, Peter, Nguhiu, Grant, Nguyen, Quyen Le, Nguyen, Muhammad Imran, Nisar, Patrick Martial Nkamedjie, Pete, Sandra, Nolte, Marika, Nomura, Ole F., Norheim, Bo, Norrving, Carla Makhlouf, Obermeyer, Felix Akpojene, Ogbo, In Hwan, Oh, Olanrewaju, Oladimeji, Pedro R., Olivare, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Olusanya, John Nelson, Opio, Eyal, Oren, Alberto, Ortiz, Richard H., Osborne, Erika, Ota, Mayowa O., Owolabi, Mahesh, Pa, Eun Kee, Park, Hye Youn, Park, Charles D., Parry, Mahboubeh, Parsaeian, Tejas, Patel, Vikram, Patel, Angel J., Paternina Caicedo, Snehal T., Patil, Scott B., Patten, George C., Patton, Deepak, Paudel, João Mário, Pedro, David M., Pereira, Norberto, Perico, Konrad, Pesudov, Max, Petzold, Michael Robert, Phillip, Frédéric B., Piel, Julian David, Pillay, Christine, Pinho, Farhad, Pishgar, Suzanne, Polinder, Richie G., Poulton, Farshad, Pourmalek, Mostafa, Qorbani, Rynaz H. S., Rabiee, Amir, Radfar, Vafa Rahimi, Movaghar, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rahman, Rajesh Kumar, Rai, Sasa, Rajsic, Murugesan, Raju, Usha, Ram, Saleem M., Rana, Chhabi Lal, Ranabhat, Kavitha, Ranganathan, Puja C., Rao, Amany H., Refaat, Marissa B., Reitsma, Giuseppe, Remuzzi, Serge, Resnikoff, Antonio L., Ribeiro, Maria Jesus Rios, Blanca, Hirbo Shore, Roba, Bayard, Robert, Alina, Rodriguez, David Rojas, Rueda, Luca, Ronfani, Gholamreza, Roshandel, Gregory A., Roth, Dietrich, Rothenbacher, Ambuj, Roy, Nobhojit, Roy, Ben Benasco, Sackey, Rajesh, Sagar, Muhammad Muhammad, Saleh, Juan R., Sanabria, Damian F., Santomauro, Itamar S., Santo, Rodrigo Sarmiento, Suarez, Benn, Sartoriu, Maheswar, Satpathy, Miloje, Savic, Monika, Sawhney, Susan M., Sawyer, Josef, Schmidhuber, Maria Inês, Schmidt, Ione J. C., Schneider, Aletta E., Schutte, David C., Schwebel, Soraya, Seedat, Sadaf G., Sepanlou, Edson E., Servan Mori, Katya, Shackelford, Amira, Shaheen, Masood Ali, Shaikh, Teresa Shamah, Levy, Rajesh, Sharma, Jun, She, Sara, Sheikhbahaei, Jiabin, Shen, Kevin N., Sheth, Muki, Shey, Peilin, Shi, Kenji, Shibuya, Mika, Shigematsu, Min Jeong, Shin, Rahman, Shiri, Kawkab, Shishani, Ivy, Shiue, Inga Dora, Sigfusdottir, Naris, Silpakit, Diego Augusto Santos, Silva, Jonathan I., Silverberg, Edgar P., Simard, Shireen, Sindi, Abhishek, Singh, Gitanjali M., Singh, Jasvinder A., Singh, Om Prakash, Singh, Prashant Kumar, Singh, Vegard, Skirbekk, Amber, Sligar, Samir, Soneji, Kjetil, Søreide, Reed J. D., Sorensen, Joan B., Soriano, Sergey, Soshnikov, Luciano A., Sposato, Chandrashekhar T., Sreeramareddy, Hans Christian, Stahl, Jeff rey D., Stanaway, Vasiliki, Stathopoulou, Nadine, Steckling, Nicholas, Steel, Dan J., Stein, Caitlyn, Steiner, Heidi, Stöckl, Saverio, Strange, Mark, Strong, Jiandong, Sun, Bruno F., Sunguya, Patrick, Sur, Soumya, Swaminathan, Bryan L., Syke, Cassandra E. I., Szoeke, Rafael Tabarés, Seisdedo, Karen M., Tabb, Roberto Tchio, Talongwa, Mohammed Rasoul, Tarawneh, Mohammad, Tavakkoli, Bineyam, Taye, Hugh R., Taylor, Bemnet Amare, Tedla, Worku, Tefera, Teketo Kassaw, Tegegne, Dejen Yemane, Tekle, Girma Temam, Shifa, Abdullah Sulieman, Terkawi, Gizachew Assefa, Tessema, J. S., Thakur, Alan J., Thomson, Andrew L., Thorne Lyman, Amanda G., Thrift, George D., Thurston, Taavi, Tillmann, Ruoyan Tobe, Gai, Marcello, Tonelli, Roman Topor, Madry, Fotis, Topouzi, Bach Xuan, Tran, Zacharie Tsala, Dimbuene, Abera Kenay, Tura, Emin Murat, Tuzcu, Stefanos, Tyrovola, Kingsley Nnanna, Ukwaja, Eduardo A., Undurraga, Chigozie Jesse, Uneke, Olalekan A., Uthman, Aaron van, Donkelaar, Yuri Y., Varakin, Tommi, Vasankari, Ana Maria Nogales, Vasconcelo, J., Lennert Veerman, Narayanaswamy, Venketasubramanian, Raj Kumar, Verma, Francesco S., Violante, Vasiliy Victorovich, Vlassov, Patricia, Volkow, Stein Emil, Vollset, Gregory R., Wagner, Mitchell T., Wallin, Linhong, Wang, Valentine, Wanga, David A., Watkin, Scott, Weichenthal, Elisabete, Weiderpa, Robert G., Weintraub, Daniel J., Wei, Andrea, Werdecker, Ronny, Westerman, Harvey A., Whiteford, James D., Wilkinson, Charles Shey, Wiysonge, Charles D. A., Wolfe, Ingrid, Wolfe, Sungho, Won, Anthony D., Woolf, Shimelash Bitew, Workie, Mamo, Wubshet, Gelin, Xu, Ajit Kumar, Yadav, Bereket, Yakob, Ayalnesh Zemene, Yalew, Lijing L., Yan, Yuichiro, Yano, Mehdi, Yaseri, Pengpeng, Ye, Paul, Yip, Naohiro, Yonemoto, Seok Jun, Yoon, Mustafa Z., Youni, Chuanhua, Yu, Zoubida, Zaidi, Maysaa El Sayed, Zaki, Carlos Zambrana, Torrelio, Tomas, Zapata, Elias Asfaw, Zegeye, Yi, Zhao, Maigeng, Zhou, Sanjay, Zodpey, David, Zonie, Christopher J. L., Murray, Lim, Stephen S, Allen, Kate, Bhutta, Zulfiqar A, Dandona, Lalit, Forouzanfar, Mohammad H, Fullman, Nancy, Gething, Peter W, Goldberg, Ellen M, Hay, Simon I, Holmberg, Mollie, Kinfu, Yohanne, Kutz, Michael J, Larson, Heidi J, Liang, Xiaofeng, Lopez, Alan D, Lozano, Rafael, Mcnellan, Claire R, Mokdad, Ali H, Mooney, Meghan D, Naghavi, Mohsen, Olsen, Helen E, Pigott, David M, Salomon, Joshua A, Vos, Theo, Wang, Haidong, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen M E, Abyu, Gebre Yitayih, Achoki, Tom, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Afanvi, Kossivi Agbelenko, Afshin, Ashkan, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ahmadieh, Hamid, Ahmed, Kedir Yimam, Akanda, Ali Shafqat, Akinyemi, Rufus Olusola, Akinyemiju, Tomi F, Akseer, Nadia, Al-Aly, Ziyad, Alam, Khurshid, Alam, Uzma, Alasfoor, Deena, Albuhairan, Fadia S, Aldhahri, Saleh Fahed, Aldridge, Robert William, Alemu, Zewdie Aderaw, Ali, Raghib, Alkerwi, Ala'A, Alkhateeb, Mohammad AB, Alla, Françoi, Allebeck, Peter, Allen, Christine, Al-Raddadi, Rajaa, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amberbir, Alemayehu, Amegah, Adeladza Kofi, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Benjamin O, Anderson, Gregory M, Antonio, Carl Abelardo T, Anwari, Palwasha, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Banerjee, Amitava, Barac, Aleksandra, Barber, Ryan, Barker-Collo, Suzanne L, Bärnighausen, Till, Barrero, Lope H, Barrientos-Gutierrez, Tonatiuh, Basu, Sanjay, Bayou, Tigist Assefa, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Benzian, Habib, Berhane, Adugnaw, Bernabé, Eduardo, Bernal, Oscar Alberto, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhatt, Samir, Biadgilign, Sibhatu, Bienhoff, Kelly A, Bikbov, Bori, Binagwaho, Agne, Bisanzio, Donal, Bjertness, Espen, Blore, Jed, Bourne, Rupert R A, Brainin, Michael, Brauer, Michael, Brazinova, Alexandra, Breitborde, Nicholas J K, Broday, David M, Brugha, Traolach S, Buchbinder, Rachelle, Butt, Zahid A, Cahill, Leah E, Campos-Nonato, Ismael Ricardo, Campuzano, Julio Cesar, Carabin, Hélène, Cárdenas, Rosario, Carrero, Juan Jesu, Carter, Austin, Casey, Daniel, Caso, Valeria, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Catalá-López, Ferrán, Cavalleri, Fiorella, Cecílio, Pedro, Chang, Hsing-Yi, Chang, Jung-Chen, Charlson, Fiona J, Che, Xuan, Chen, Alan Zian, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chisumpa, Vesper Hichilombwe, Choi, Jee-Young Jasmine, Chowdhury, Rajiv, Christensen, Hanne, Ciobanu, Liliana G, Coates, Matthew M, Coggeshall, Megan, Cohen, Aaron J, Cooke, Graham S, Cooper, Cyru, Cooper, Leslie Trumbull, Cowie, Benjamin C, Crump, John A, Damtew, Solomon Abrha, Dandona, Rakhi, Dargan, Paul I, Neves, José da, Davis, Adrian C, Davletov, Kairat, de Castro, E Filipa, De Leo, Diego, Degenhardt, Louisa, Del Gobbo, Liana C, Deribe, Kebede, Derrett, Sarah, Des Jarlais, Don C, Deshpande, Aniruddha, Deveber, Gabrielle A, Dey, Subhojit, Dharmaratne, Samath D, Dhillon, Preet K, Ding, Eric L, Dorsey, E Ray, Doyle, Kerrie E, Driscoll, Tim R, Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Ebrahimi, Hedyeh, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Erskine, Holly E, Eshrati, Babak, Esteghamati, Alireza, Fahimi, Saman, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, André, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Felicio, Manuela Mendonca, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fernandes, Joao C, Ferrari, Alize J, Fischer, Florian, Fitchett, Joseph R A, Fitzmaurice, Christina, Foigt, Nataliya, Foreman, Kyle, Fowkes, F Gerry R, Franca, Elisabeth Barboza, Franklin, Richard C, Fraser, Maya, Friedman, Joseph, Frostad, Joseph, Fürst, Thoma, Gabbe, Belinda, Garcia-Basteiro, Alberto L, Gebre, Teshome, Gebrehiwot, Tsegaye Tewelde, Gebremedhin, Amanuel Tesfay, Gebru, Alemseged Aregay, Gessner, Bradford D, Gillum, Richard F, Ginawi, Ibrahim Abdelmageem Mohamed, Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Godwin, William, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Graetz, Nichola, Greenwell, Karen Fern, Griswold, Max, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gutiérrez, Reyna A, Gyawali, Bishal, Haagsma, Juanita A, Haakenstad, Annie, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Gessessew Bugssa, Halasa, Yara A, Hamadeh, Randah Ribhi, Hamidi, Samer, Hammami, Mouhanad, Hankey, Graeme J, Harb, Hilda L, Haro, Josep Maria, Hassanvand, Mohammad Sadegh, Havmoeller, Rasmu, Heredia-Pi, Ileana Beatriz, Hoek, Hans W, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hoy, Damian G, Htet, Aung Soe, Hu, Guoqing, Huang, Hsiang, Iburg, Kim Moesgaard, Idrisov, Bulat T, Inoue, Manami, Islami, Farhad, Jacobs, Troy A, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, James, Peter, Jansen, Henrica A F M, Javanbakht, Mehdi, Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jha, Vivekanand, Jiang, Ying, Jibat, Tariku, Jin, Ye, Jonas, Jost B, Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, Ritul, Kan, Haidong, Kandel, Amit, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Karunapema, Palitha, Kasaeian, Amir, Kassebaum, Nicholas J, Kaul, Anil, Kawakami, Norito, Kayibanda, Jeanne Françoise, Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khan, Gulfaraz, Khang, Young-Ho, Khoja, Tawfik Ahmed Muthafer, Khosravi, Ardeshir, Khubchandani, Jagdish, Kieling, Christian, Kim, Cho-il, Kim, Daniel, Kim, Sungroul, Kim, Yun Jin, Kimokoti, Ruth W, Kissoon, Niranjan, Kivipelto, Miia, Knibbs, Luke D, Kokubo, Yoshihiro, Kolte, Dhaval, Kosen, Soewarta, Kotsakis, Georgios A, Koul, Parvaiz A, Koyanagi, Ai, Kravchenko, Michael, Krueger, Han, Defo, Barthelemy Kuate, Kuchenbecker, Ricardo S, Kuipers, Ernst J, Kulikoff, Xie Rachel, Kulkarni, Veena S, Kumar, G Anil, Kwan, Gene F, Kyu, Hmwe H, Lal, Aparna, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lam, Hilton, Lan, Qing, Langan, Sinead M, Larsson, Ander, Laryea, Dennis Odai, Latif, Asma Abdul, Leasher, Janet L, Leigh, Jame, Leinsalu, Mall, Leung, Janni, Leung, Ricky, Levi, Miriam, Li, Yichong, Li, Yongmei, Lind, Margaret, Linn, Shai, Lipshultz, Steven E, Liu, Patrick Y, Liu, Shiwei, Liu, Yang, Lloyd, Belinda K, Lo, Loon-Tzian, Logroscino, Giancarlo, Lotufo, Paulo A, Lucas, Robyn M, Lunevicius, Raimunda, El Razek, Mohammed Magdy Abd, Magis-Rodriguez, Carlo, Mahdavi, Mahdi, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Malta, Deborah Carvalho, Mapoma, Chabila C, Margolis, David Joel, Martin, Randall V, Martinez-Raga, Jose, Masiye, Felix, Mason-Jones, Amanda J, Massano, João, Matzopoulos, Richard, Mayosi, Bongani M, Mcgrath, John J, Mckee, Martin, Meaney, Peter A, Mehari, Alem, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Mensink, Gert B M, Meretoja, Atte, Meretoja, Tuomo J, Mesfin, Yonatan Moge, Mhimbira, Francis Apolinary, Micha, Renata, Miller, Ted R, Mills, Edward J, Mirarefin, Mojde, Misganaw, Awoke, Mitchell, Philip B, Mock, Charles N, Mohammadi, Alireza, Mohammed, Shafiu, Monasta, Lorenzo, de la Cruz Monis, Jonathan, Hernandez, Julio Cesar Montañez, Montico, Marcella, Moradi-Lakeh, Maziar, Morawska, Lidia, Mori, Rintaro, Mueller, Ulrich O, Murdoch, Michele E, Murimira, Brighton, Murray, Joseph, Murthy, Gudlavalleti Venkata Satyanarayana, Murthy, Sriniva, Musa, Kamarul Imran, Nachega, Jean B, Nagel, Gabriele, Naidoo, Kovin S, Naldi, Luigi, Nangia, Vinay, Neal, Bruce, Nejjari, Chakib, Newton, Charles R, Newton, John N, Ngalesoni, Frida Namnyak, Nguhiu, Peter, Nguyen, Grant, Le Nguyen, Quyen, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Nolte, Sandra, Nomura, Marika, Norheim, Ole F, Norrving, Bo, Obermeyer, Carla Makhlouf, Ogbo, Felix Akpojene, Oh, In-Hwan, Oladimeji, Olanrewaju, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Osborne, Richard H, Ota, Erika, Owolabi, Mayowa O, Pa, Mahesh, Park, Eun-Kee, Park, Hye-Youn, Parry, Charles D, Parsaeian, Mahboubeh, Patel, Teja, Patel, Vikram, Caicedo, Angel J Paternina, Patil, Snehal T, Patten, Scott B, Patton, George C, Paudel, Deepak, Pedro, João Mário, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B, Pillay, Julian David, Pinho, Christine, Pishgar, Farhad, Polinder, Suzanne, Poulton, Richie G, Pourmalek, Farshad, Qorbani, Mostafa, Rabiee, Rynaz H S, Radfar, Amir, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajsic, Sasa, Raju, Murugesan, Ram, Usha, Rana, Saleem M, Ranabhat, Chhabi Lal, Ranganathan, Kavitha, Rao, Puja C, Refaat, Amany H, Reitsma, Marissa B, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Blancas, Maria Jesus Rio, Roba, Hirbo Shore, Roberts, Bayard, Rodriguez, Alina, Rojas-Rueda, David, Ronfani, Luca, Roshandel, Gholamreza, Roth, Gregory A, Rothenbacher, Dietrich, Roy, Ambuj, Roy, Nobhojit, Sackey, Ben Benasco, Sagar, Rajesh, Saleh, Muhammad Muhammad, Sanabria, Juan R, Santomauro, Damian F, Santos, Itamar S, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Sawyer, Susan M, Schmidhuber, Josef, Schmidt, Maria Inê, Schneider, Ione J C, Schutte, Aletta E, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shackelford, Katya, Shaheen, Amira, Shaikh, Masood Ali, Levy, Teresa Shamah, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Sheth, Kevin N, Shey, Muki, Shi, Peilin, Shibuya, Kenji, Shigematsu, Mika, Shin, Min-Jeong, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Sigfusdottir, Inga Dora, Silpakit, Nari, Silva, Diego Augusto Santo, Silverberg, Jonathan I, Simard, Edgar P, Sindi, Shireen, Singh, Abhishek, Singh, Gitanjali M, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Skirbekk, Vegard, Sligar, Amber, Soneji, Samir, Søreide, Kjetil, Sorensen, Reed J D, Soriano, Joan B, Soshnikov, Sergey, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stahl, Hans-Christian, Stanaway, Jeffrey D, Stathopoulou, Vasiliki, Steckling, Nadine, Steel, Nichola, Stein, Dan J, Steiner, Caitlyn, Stöckl, Heidi, Stranges, Saverio, Strong, Mark, Sun, Jiandong, Sunguya, Bruno F, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Talongwa, Roberto Tchio, Tarawneh, Mohammed Rasoul, Tavakkoli, Mohammad, Taye, Bineyam, Taylor, Hugh R, Tedla, Bemnet Amare, Tefera, Worku, Tegegne, Teketo Kassaw, Tekle, Dejen Yemane, Shifa, Girma Temam, Terkawi, Abdullah Sulieman, Tessema, Gizachew Assefa, Thakur, J.S., Thomson, Alan J, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tillmann, Taavi, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Tran, Bach Xuan, Dimbuene, Zacharie Tsala, Tura, Abera Kenay, Tuzcu, Emin Murat, Tyrovolas, Stefano, Ukwaja, Kingsley Nnanna, Undurraga, Eduardo A, Uneke, Chigozie Jesse, Uthman, Olalekan A, van Donkelaar, Aaron, Varakin, Yuri Y, Vasankari, Tommi, Vasconcelos, Ana Maria Nogale, Veerman, J Lennert, Venketasubramanian, Narayanaswamy, Verma, Raj Kumar, Violante, Francesco S, Vlassov, Vasiliy Victorovich, Volkow, Patricia, Vollset, Stein Emil, Wagner, Gregory R, Wallin, Mitchell T, Wang, Linhong, Wanga, Valentine, Watkins, David A, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A, Wilkinson, James D, Wiysonge, Charles Shey, Wolfe, Charles D A, Wolfe, Ingrid, Won, Sungho, Woolf, Anthony D, Workie, Shimelash Bitew, Wubshet, Mamo, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, El Sayed Zaki, Maysaa, Zambrana-Torrelio, Carlo, Zapata, Toma, Zegeye, Elias Asfaw, Zhao, Yi, Zhou, Maigeng, Zodpey, Sanjay, Zonies, David, and Murray, Christopher J L

Subjects
Conservation of Natural Resources, spline regressions, Health Status, Global Health, Goal, Health Statu, Cost of Illness, Risk Factors, Universal Health Insurance, Quality-Adjusted Life Year, health-related SDG performance indicators, socio-demographic index, Health Status Indicators, Humans, Conservation of Natural Resource, Disabled Persons, Health Status Indicator, Medicine(all), Insurance, Health, Risk Factor, Medicine (all), Public Health, Global Health, Social Medicine and Epidemiology, Articles, Cost of Illne, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Disabled Person, Quality-Adjusted Life Years, Universal Coverage, Goals, Human
Abstract

Summary Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8–61·8) and varied widely by country, ranging from 85·5 (84·2–86·5) in Iceland to 20·4 (15·4–24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r2=0·88) and the MDG index (r2=0·92), whereas the non-MDG index had a weaker relation with SDI (r2=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0–10·4), and gains on the MDG index (a median change of 10·0 [6·7–13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1–8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs. Funding Bill & Melinda Gates Foundation.

Published
2016

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