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5. Early detection of diabetic kidney disease by urinary proteomics and subsequent intervention with spironolactone to delay progression (PRIORITY): a prospective observational study and embedded randomised placebo-controlled trial

Author

Tofte, N. Lindhardt, M. Adamova, K. Bakker, S.J.L. Beige, J. Beulens, J.W.J. Birkenfeld, A.L. Currie, G. Delles, C. Dimos, I. Francová, L. Frimodt-Møller, M. Girman, P. Göke, R. Havrdova, T. Heerspink, H.J.L. Kooy, A. Laverman, G.D. Mischak, H. Navis, G. Nijpels, G. Noutsou, M. Ortiz, A. Parvanova, A. Persson, F. Petrie, J.R. Ruggenenti, P.L. Rutters, F. Rychlík, I. Siwy, J. Spasovski, G. Speeckaert, M. Trillini, M. Zürbig, P. von der Leyen, H. Rossing, P. Zimmermann, S. Rädisch, B. Hävemeier, A. Busmann, A. Wittkop, U. Neuhaus, B. Ax-Smolarski, R. Zieglschmid, V. Bollweber, E. Wölk, H. Curovic, V.R. Tougaard, N.H. Eickhoff, M.K. Pilemann-Lyberg, S. Winther, S.A. Rosenlund, S.V. Hansen, T.W. von Scholten, B.J. Hansen, C.S. Zobel, E.H. Laursen, J.C. Theilade, S. Jelstrup, L. Juhl, T.R. Riis, D. Hermann, J.A. Lundgaard, A.G. Halkjær, M.L.D. Aabo, L. Frost Lerche, T. Lajer, M. Stefansen, R.J. Campbell, M.A. Durban, A. Raad, J. Prigge, M. Schiemann, M. Wilson, R. Kean, S. Douglas, E. Surtees, P. Gant, C. Yeung, S.M.H. Hagedoorn, I. Flynn, J. Galloway, J. Brooksbank, K. Aparicio, C. Iliev, I.P. Nones, F. Lo Bue, F. Melacini, D. Cugini, D. Prandini, S. Lecchi, V. Yakymchuk, S. Gherardi, G. Villa, A. Villa, D. Gaspari, F. Cannata, A.N. Ferrari, S. Stucchi, N. Albrechtová, Š. Eldeik, E. Amanaki, R. Fernandez-Fernandez, B. Sanchez-Rodriguez, J. Vázquez, C. Sanz, A.B. Sanchez-Niño, M.D. Ramos, A.M. Gonzalo, M.Á. Schmidt, U. Selim, G. Gjorgovski, T. Stratrova, S.S. Stojceva-Taneva, O. Schutten-Westerneng, P. Wierbos, B. Huvers, F. De Bruin, A.K. Lapauw, B. de Man, E. Rokegem, K. Inion, S. Kreutzmann, K. Dewettinck, I. Boukens-de Graaf, C. Clerc-de Jong, F. Entius, J. Nannings, M. van Steenderen, S. Petry, F.W. Kilic, C. PRIORITY investigators

Abstract

Background: Microalbuminuria is an early sign of kidney disease in people with diabetes and indicates increased risk of cardiovascular disease. We tested whether a urinary proteomic risk classifier (CKD273) score was associated with development of microalbuminuria and whether progression to microalbuminuria could be prevented with the mineralocorticoid receptor antagonist spironolactone. Methods: In this multicentre, prospective, observational study with embedded randomised controlled trial (PRIORITY), we recruited people with type 2 diabetes, normal urinary albumin excretion, and preserved renal function from 15 specialist centres in ten European countries. All participants (observational cohort) were tested with the CKD273 classifier and classified as high risk (CKD273 classifier score >0·154) or low risk (≤0·154). Participants who were classified as high risk were entered into a randomised controlled trial and randomly assigned (1:1), by use of an interactive web-response system, to receive spironolactone 25 mg once daily or matched placebo (trial cohort). The primary endpoint was development of confirmed microalbuminuria in all individuals with available data (observational cohort). Secondary endpoints included reduction in incidence of microalbuminuria with spironolactone (trial cohort, intention-to-treat population) and association between CKD273 risk score and measures of impaired renal function based on estimated glomerular filtration rate (eGFR; observational cohort). Adverse events (particularly gynaecomastia and hyperkalaemia) and serious adverse events were recorded for the intention-to-treat population (trial cohort). This study is registered with the EU Clinical Trials Register (EudraCT 20120-004523-4) and ClinicalTrials.gov (NCT02040441) and is completed. Findings: Between March 25, 2014, and Sept 30, 2018, we enrolled and followed-up 1775 participants (observational cohort), 1559 (88%) of 1775 participants had a low-risk urinary proteomic pattern and 216 (12%) had a high-risk pattern, of whom 209 were included in the trial cohort and assigned to spironolactone (n=102) or placebo (n=107). The overall median follow-up time was 2·51 years (IQR 2·0–3·0). Progression to microalbuminuria was seen in 61 (28%) of 216 high-risk participants and 139 (9%) of 1559 low-risk participants (hazard ratio [HR] 2·48, 95% CI 1·80–3·42; p

Published
2020

6. Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))

Author

Stanaway, J.D. Afshin, A. Gakidou, E. Lim, S.S. Abate, D. Abate, K.H. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdollahpour, I. Abdulkader, R.S. Abebe, M. Abebe, Z. Abera, S.F. Abil, O.Z. Abraha, H.N. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M.E. Accrombessi, M.M.K. Acharya, D. Acharya, P. Adamu, A.A. Adane, A.A. Adebayo, O.M. Adedoyin, R.A. Adekanmbi, V. Ademi, Z. Adetokunboh, O.O. Adib, M.G. Admasie, A. Adsuar, J.C. Afanvi, K.A. Afarideh, M. Agarwal, G. Aggarwal, A. Aghayan, S.A. Agrawal, A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akbari, M.E. Akinyemiju, T. Akseer, N. Al-Aly, Z. Al-Eyadhy, A. Al-Mekhlafi, H.M. Alahdab, F. Alam, K. Alam, S. Alam, T. Alashi, A. Alavian, S.M. Alene, K.A. Ali, K. Ali, S.M. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Ammar, W. Anber, N.H. Anderson, J.A. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Ansha, M.G. Antó, J.M. Antonio, C.A.T. Anwari, P. Appiah, L.T. Appiah, S.C.Y. Arabloo, J. Aremu, O. Ärnlöv, J. Artaman, A. Aryal, K.K. Asayesh, H. Ataro, Z. Ausloos, M. Avokpaho, E.F.G.A. Awasthi, A. Ayala Quintanilla, B.P. Ayer, R. Ayuk, T.B. Azzopardi, P.S. Babazadeh, A. Badali, H. Badawi, A. Balakrishnan, K. Bali, A.G. Ball, K. Ballew, S.H. Banach, M. Banoub, J.A.M. Barac, A. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Basu, S. Baune, B.T. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Béjot, Y. Bekele, B.B. Bekru, E.T. Belay, E. Belay, Y.A. Bell, M.L. Bello, A.K. Bennett, D.A. Bensenor, I.M. Bergeron, G. Berhane, A. Bernabe, E. Bernstein, R.S. Beuran, M. Beyranvand, T. Bhala, N. Bhalla, A. Bhattarai, S. Bhutta, Z.A. Biadgo, B. Bijani, A. Bikbov, B. Bilano, V. Bililign, N. Bin Sayeed, M.S. Bisanzio, D. Biswas, T. Bjørge, T. Blacker, B.F. Bleyer, A. Borschmann, R. Bou-Orm, I.R. Boufous, S. Bourne, R. Brady, O.J. Brauer, M. Brazinova, A. Breitborde, N.J.K. Brenner, H. Briko, A.N. Britton, G. Brugha, T. Buchbinder, R. Burnett, R.T. Busse, R. Butt, Z.A. Cahill, L.E. Cahuana-Hurtado, L. Campos-Nonato, I.R. Cárdenas, R. Carreras, G. Carrero, J.J. Carvalho, F. Castañeda-Orjuela, C.A. Castillo Rivas, J. Castro, F. Catalá-López, F. Causey, K. Cercy, K.M. Cerin, E. Chaiah, Y. Chang, H.-Y. Chang, J.-C. Chang, K.-L. Charlson, F.J. Chattopadhyay, A. Chattu, V.K. Chee, M.L. Cheng, C.-Y. Chew, A. Chiang, P.P.-C. Chimed-Ochir, O. Chin, K.L. Chitheer, A. Choi, J.-Y.J. Chowdhury, R. Christensen, H. Christopher, D.J. Chung, S.-C. Cicuttini, F.M. Cirillo, M. Cohen, A.J. Collado-Mateo, D. Cooper, C. Cooper, O.R. Coresh, J. Cornaby, L. Cortesi, P.A. Cortinovis, M. Costa, M. Cousin, E. Criqui, M.H. Cromwell, E.A. Cundiff, D.K. Daba, A.K. Dachew, B.A. Dadi, A.F. Damasceno, A.A.M. Dandona, L. Dandona, R. Darby, S.C. Dargan, P.I. Daryani, A. Das Gupta, R. Das Neves, J. Dasa, T.T. Dash, A.P. Davitoiu, D.V. Davletov, K. De la Cruz-Góngora, V. De La Hoz, F.P. De Leo, D. De Neve, J.-W. Degenhardt, L. Deiparine, S. Dellavalle, R.P. Demoz, G.T. Denova-Gutiérrez, E. Deribe, K. Dervenis, N. Deshpande, A. Des Jarlais, D.C. Dessie, G.A. Deveber, G.A. Dey, S. Dharmaratne, S.D. Dhimal, M. Dinberu, M.T. Ding, E.L. Diro, H.D. Djalalinia, S. Do, H.P. Dokova, K. Doku, D.T. Doyle, K.E. Driscoll, T.R. Dubey, M. Dubljanin, E. Duken, E.E. Duncan, B.B. Duraes, A.R. Ebert, N. Ebrahimi, H. Ebrahimpour, S. Edvardsson, D. Effiong, A. Eggen, A.E. El Bcheraoui, C. El-Khatib, Z. Elyazar, I.R. Enayati, A. Endries, A.Y. Er, B. Erskine, H.E. Eskandarieh, S. Esteghamati, A. Estep, K. Fakhim, H. Faramarzi, M. Fareed, M. Farid, T.A. Sá Farinha, C.S.E. Farioli, A. Faro, A. Farvid, M.S. Farzaei, M.H. Fatima, B. Fay, K.A. Fazaeli, A.A. Feigin, V.L. Feigl, A.B. Fereshtehnejad, S.-M. Fernandes, E. Fernandes, J.C. Ferrara, G. Ferrari, A.J. Ferreira, M.L. Filip, I. Finger, J.D. Fischer, F. Foigt, N.A. Foreman, K.J. Fukumoto, T. Fullman, N. Fürst, T. Furtado, J.M. Futran, N.D. Gall, S. Gallus, S. Gamkrelidze, A. Ganji, M. Garcia-Basteiro, A.L. Gardner, W.M. Gebre, A.K. Gebremedhin, A.T. Gebremichael, T.G. Gelano, T.F. Geleijnse, J.M. Geramo, Y.C.D. Gething, P.W. Gezae, K.E. Ghadimi, R. Ghadiri, K. Ghasemi Falavarjani, K.G. Ghasemi-Kasman, M. Ghimire, M. Ghosh, R. Ghoshal, A.G. Giampaoli, S. Gill, P.S. Gill, T.K. Gillum, R.F. Ginawi, I.A. Giussani, G. Gnedovskaya, E.V. Godwin, W.W. Goli, S. Gómez-Dantés, H. Gona, P.N. Gopalani, S.V. Goulart, A.C. Grada, A. Grams, M.E. Grosso, G. Gugnani, H.C. Guo, Y. Gupta, R. Gupta, R. Gupta, T. Gutiérrez, R.A. Gutiérrez-Torres, D.S. Haagsma, J.A. Habtewold, T.D. Hachinski, V. Hafezi-Nejad, N. Hagos, T.B. Hailegiyorgis, T.T. Hailu, G.B. Haj-Mirzaian, A. Haj-Mirzaian, A. Hamadeh, R.R. Hamidi, S. Handal, A.J. Hankey, G.J. Hao, Y. Harb, H.L. Harikrishnan, S. Haro, J.M. Hassankhani, H. Hassen, H.Y. Havmoeller, R. Hawley, C.N. Hay, S.I. Hedayatizadeh-Omran, A. Heibati, B. Heidari, B. Heidari, M. Hendrie, D. Henok, A. Heredia-Pi, I. Herteliu, C. Heydarpour, F. Heydarpour, S. Hibstu, D.T. Higazi, T.B. Hilawe, E.H. Hoek, H.W. Hoffman, H.J. Hole, M.K. Homaie Rad, E. Hoogar, P. Hosgood, H.D. Hosseini, S.M. Hosseinzadeh, M. Hostiuc, M. Hostiuc, S. Hoy, D.G. Hsairi, M. Hsiao, T. Hu, G. Hu, H. Huang, J.J. Hussen, M.A. Huynh, C.K. Iburg, K.M. Ikeda, N. Ilesanmi, O.S. Iqbal, U. Irvani, S.S.N. Irvine, C.M.S. Islam, S.M.S. Islami, F. Jackson, M.D. Jacobsen, K.H. Jahangiry, L. Jahanmehr, N. Jain, S.K. Jakovljevic, M. James, S.L. Jassal, S.K. Jayatilleke, A.U. Jeemon, P. Jha, R.P. Jha, V. Ji, J.S. Jonas, J.B. Jonnagaddala, J. Jorjoran Shushtari, Z.J. Joshi, A. Jozwiak, J.J. Jürisson, M. Kabir, Z. Kahsay, A. Kalani, R. Kanchan, T. Kant, S. Kar, C. Karami, M. Karami Matin, B.K. Karch, A. Karema, C. Karimi, N. Karimi, S.M. Kasaeian, A. Kassa, D.H. Kassa, G.M. Kassa, T.D. Kassebaum, N.J. Katikireddi, S.V. Kaul, A. Kawakami, N. Kazemi, Z. Kazemi Karyani, A. Kefale, A.T. Keiyoro, P.N. Kemp, G.R. Kengne, A.P. Keren, A. Kesavachandran, C.N. Khader, Y.S. Khafaei, B. Khafaie, M.A. Khajavi, A. Khalid, N. Khalil, I.A. Khan, G. Khan, M.S. Khan, M.A. Khang, Y.-H. Khater, M.M. Khazaei, M. Khazaie, H. Khoja, A.T. Khosravi, A. Khosravi, M.H. Kiadaliri, A.A. Kiirithio, D.N. Kim, C.-I. Kim, D. Kim, Y.-E. Kim, Y.J. Kimokoti, R.W. Kinfu, Y. Kisa, A. Kissimova-Skarbek, K. Kivimäki, M. Knibbs, L.D. Knudsen, A.K.S. Kochhar, S. Kokubo, Y. Kolola, T. Kopec, J.A. Kosen, S. Koul, P.A. Koyanagi, A. Kravchenko, M.A. Krishan, K. Krohn, K.J. Kromhout, H. Kuate Defo, B. Kucuk Bicer, B. Kumar, G.A. Kumar, M. Kuzin, I. Kyu, H.H. Lachat, C. Lad, D.P. Lad, S.D. Lafranconi, A. Lalloo, R. Lallukka, T. Lami, F.H. Lang, J.J. Lansingh, V.C. Larson, S.L. Latifi, A. Lazarus, J.V. Lee, P.H. Leigh, J. Leili, M. Leshargie, C.T. Leung, J. Levi, M. Lewycka, S. Li, S. Li, Y. Liang, J. Liang, X. Liao, Y. Liben, M.L. Lim, L.-L. Linn, S. Liu, S. Lodha, R. Logroscino, G. Lopez, A.D. Lorkowski, S. Lotufo, P.A. Lozano, R. Lucas, T.C.D. Lunevicius, R. Ma, S. Macarayan, E.R.K. Machado, Í.E. Madotto, F. Mai, H.T. Majdan, M. Majdzadeh, R. Majeed, A. Malekzadeh, R. Malta, D.C. Mamun, A.A. Manda, A.-L. Manguerra, H. Mansournia, M.A. Mantovani, L.G. Maravilla, J.C. Marcenes, W. Marks, A. Martin, R.V. Martins, S.C.O. Martins-Melo, F.R. März, W. Marzan, M.B. Massenburg, B.B. Mathur, M.R. Mathur, P. Matsushita, K. Maulik, P.K. Mazidi, M. McAlinden, C. McGrath, J.J. McKee, M. Mehrotra, R. Mehta, K.M. Mehta, V. Meier, T. Mekonnen, F.A. Melaku, Y.A. Melese, A. Melku, M. Memiah, P.N. Memish, Z.A. Mendoza, W. Mengistu, D.T. Mensah, G.A. Mensink, G.B.M. Mereta, S.T. Meretoja, A. Meretoja, T.J. Mestrovic, T. Mezgebe, H.B. Miazgowski, B. Miazgowski, T. Millear, A.I. Miller, T.R. Miller-Petrie, M.K. Mini, G.K. Mirarefin, M. Mirica, A. Mirrakhimov, E.M. Misganaw, A.T. Mitiku, H. Moazen, B. Mohajer, B. Mohammad, K.A. Mohammadi, M. Mohammadifard, N. Mohammadnia-Afrouzi, M. Mohammed, S. Mohebi, F. Mokdad, A.H. Molokhia, M. Momeniha, F. Monasta, L. Moodley, Y. Moradi, G. Moradi-Lakeh, M. Moradinazar, M. Moraga, P. Morawska, L. Morgado-Da-Costa, J. Morrison, S.D. Moschos, M.M. Mouodi, S. Mousavi, S.M. Mozaffarian, D. Mruts, K.B. Muche, A.A. Muchie, K.F. Mueller, U.O. Muhammed, O.S. Mukhopadhyay, S. Muller, K. Musa, K.I. Mustafa, G. Nabhan, A.F. Naghavi, M. Naheed, A. Nahvijou, A. Naik, G. Naik, N. Najafi, F. Nangia, V. Nansseu, J.R. Nascimento, B.R. Neal, B. Neamati, N. Negoi, I. Negoi, R.I. Neupane, S. Newton, C.R.J. Ngunjiri, J.W. Nguyen, A.Q. Nguyen, G. Nguyen, H.T. Nguyen, H.L.T. Nguyen, H.T. Nguyen, M. Nguyen, N.B. Nichols, E. Nie, J. Ningrum, D.N.A. Nirayo, Y.L. Nishi, N. Nixon, M.R. Nojomi, M. Nomura, S. Norheim, O.F. Noroozi, M. Norrving, B. Noubiap, J.J. Nouri, H.R. Nourollahpour Shiadeh, M. Nowroozi, M.R. Nsoesie, E.O. Nyasulu, P.S. Obermeyer, C.M. Odell, C.M. Ofori-Asenso, R. Ogbo, F.A. Oh, I.-H. Oladimeji, O. Olagunju, A.T. Olagunju, T.O. Olivares, P.R. Olsen, H.E. Olusanya, B.O. Olusanya, J.O. Ong, K.L. Ong, S.K. Oren, E. Orpana, H.M. Ortiz, A. Ota, E. Otstavnov, S.S. Øverland, S. Owolabi, M.O. Mahesh, P.A. Pacella, R. Pakhare, A.P. Pakpour, A.H. Pana, A. Panda-Jonas, S. Park, E.-K. Parry, C.D.H. Parsian, H. Patel, S. Pati, S. Patil, S.T. Patle, A. Patton, G.C. Paudel, D. Paulson, K.R. Paz Ballesteros, W.C. Pearce, N. Pereira, A. Pereira, D.M. Perico, N. Pesudovs, K. Petzold, M. Pham, H.Q. Phillips, M.R. Pillay, J.D. Piradov, M.A. Pirsaheb, M. Pischon, T. Pishgar, F. Plana-Ripoll, O. Plass, D. Polinder, S. Polkinghorne, K.R. Postma, M.J. Poulton, R. Pourshams, A. Poustchi, H. Prabhakaran, D. Prakash, S. Prasad, N. Purcell, C.A. Purwar, M.B. Qorbani, M. Radfar, A. Rafay, A. Rafiei, A. Rahim, F. Rahimi, Z. Rahimi-Movaghar, A. Rahimi-Movaghar, V. Rahman, M. Rahman, M.H.U. Rahman, M.A. Rai, R.K. Rajati, F. Rajsic, S. Raju, S.B. Ram, U. Ranabhat, C.L. Ranjan, P. Rath, G.K. Rawaf, D.L. Rawaf, S. Reddy, K.S. Rehm, C.D. Rehm, J. Reiner, R.C. Reitsma, M.B. Remuzzi, G. Renzaho, A.M.N. Resnikoff, S. Reynales-Shigematsu, L.M. Rezaei, S. Ribeiro, A.L.P. Rivera, J.A. Roba, K.T. Rodríguez-Ramírez, S. Roever, L. Román, Y. Ronfani, L. Roshandel, G. Rostami, A. Roth, G.A. Rothenbacher, D. Roy, A. Rubagotti, E. Rushton, L. Sabanayagam, C. Sachdev, P.S. Saddik, B. Sadeghi, E. Saeedi Moghaddam, S. Safari, H. Safari, Y. Safari-Faramani, R. Safdarian, M. Safi, S. Safiri, S. Sagar, R. Sahebkar, A. Sahraian, M.A. Sajadi, H.S. Salam, N. Salamati, P. Saleem, Z. Salimi, Y. Salimzadeh, H. Salomon, J.A. Salvi, D.D. Salz, I. Samy, A.M. Sanabria, J. Sanchez-Niño, M.D. Sánchez-Pimienta, T.G. Sanders, T. Sang, Y. Santomauro, D.F. Santos, I.S. Santos, J.V. Santric Milicevic, M.M. Sao Jose, B.P. Sardana, M. Sarker, A.R. Sarmiento-Suárez, R. Sarrafzadegan, N. Sartorius, B. Sarvi, S. Sathian, B. Satpathy, M. Sawant, A.R. Sawhney, M. Saylan, M. Sayyah, M. Schaeffner, E. Schmidt, M.I. Schneider, I.J.C. Schöttker, B. Schutte, A.E. Schwebel, D.C. Schwendicke, F. Scott, J.G. Seedat, S. Sekerija, M. Sepanlou, S.G. Serre, M.L. Serván-Mori, E. Seyedmousavi, S. Shabaninejad, H. Shaddick, G. Shafieesabet, A. Shahbazi, M. Shaheen, A.A. Shaikh, M.A. Shamah Levy, T. Shams-Beyranvand, M. Shamsi, M. Sharafi, H. Sharafi, K. Sharif, M. Sharif-Alhoseini, M. Sharifi, H. Sharma, J. Sharma, M. Sharma, R. She, J. Sheikh, A. Shi, P. Shibuya, K. Shiferaw, M.S. Shigematsu, M. Shin, M.-J. Shiri, R. Shirkoohi, R. Shiue, I. Shokraneh, F. Shoman, H. Shrime, M.G. Shupler, M.S. Si, S. Siabani, S. Sibai, A.M. Siddiqi, T.J. Sigfusdottir, I.D. Sigurvinsdottir, R. Silva, D.A.S. Silva, J.P. Silveira, D.G.A. Singh, J.A. Singh, N.P. Singh, V. Sinha, D.N. Skiadaresi, E. Skirbekk, V. Smith, D.L. Smith, M. Sobaih, B.H. Sobhani, S. Somayaji, R. Soofi, M. Sorensen, R.J.D. Soriano, J.B. Soyiri, I.N. Spinelli, A. Sposato, L.A. Sreeramareddy, C.T. Srinivasan, V. Starodubov, V.I. Steckling, N. Stein, D.J. Stein, M.B. Stevanovic, G. Stockfelt, L. Stokes, M.A. Sturua, L. Subart, M.L. Sudaryanto, A. Sufiyan, M.B. Sulo, G. Sunguya, B.F. Sur, P.J. Sykes, B.L. Szoeke, C.E.I. Tabarés-Seisdedos, R. Tabuchi, T. Tadakamadla, S.K. Takahashi, K. Tandon, N. Tassew, S.G. Tavakkoli, M. Taveira, N. Tehrani-Banihashemi, A. Tekalign, T.G. Tekelemedhin, S.W. Tekle, M.G. Temesgen, H. Temsah, M.-H. Temsah, O. Terkawi, A.S. Tessema, B. Teweldemedhin, M. Thankappan, K.R. Theis, A. Thirunavukkarasu, S. Thomas, H.J. Thomas, M.L. Thomas, N. Thurston, G.D. Tilahun, B. Tillmann, T. To, Q.G. Tobollik, M. Tonelli, M. Topor-Madry, R. Torre, A.E. Tortajada-Girbés, M. Touvier, M. Tovani-Palone, M.R. Towbin, J.A. Tran, B.X. Tran, K.B. Truelsen, T.C. Truong, N.T. Tsadik, A.G. Tudor Car, L. Tuzcu, E.M. Tymeson, H.D. Tyrovolas, S. Ukwaja, K.N. Ullah, I. Updike, R.L. Usman, M.S. Uthman, O.A. Vaduganathan, M. Vaezi, A. Valdez, P.R. Van Donkelaar, A. Varavikova, E. Varughese, S. Vasankari, T.J. Venkateswaran, V. Venketasubramanian, N. Villafaina, S. Violante, F.S. Vladimirov, S.K. Vlassov, V. Vollset, S.E. Vos, T. Vosoughi, K. Vu, G.T. Vujcic, I.S. Wagnew, F.S. Waheed, Y. Waller, S.G. Walson, J.L. Wang, Y. Wang, Y. Wang, Y.-P. Weiderpass, E. Weintraub, R.H. Weldegebreal, F. Werdecker, A. Werkneh, A.A. West, J.J. Westerman, R. Whiteford, H.A. Widecka, J. Wijeratne, T. Winkler, A.S. Wiyeh, A.B. Wiysonge, C.S. Wolfe, C.D.A. Wong, T.Y. Wu, S. Xavier, D. Xu, G. Yadgir, S. Yadollahpour, A. Yahyazadeh Jabbari, S.H. Yamada, T. Yan, L.L. Yano, Y. Yaseri, M. Yasin, Y.J. Yeshaneh, A. Yimer, E.M. Yip, P. Yisma, E. Yonemoto, N. Yoon, S.-J. Yotebieng, M. Younis, M.Z. Yousefifard, M. Yu, C. Zaidi, Z. Zaman, S.B. Zamani, M. Zavala-Arciniega, L. Zhang, A.L. Zhang, H. Zhang, K. Zhou, M. Zimsen, S.R.M. Zodpey, S. Murray, C.J.L. GBD 2017 Risk Factor Collaborators

Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Published
2019

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

Author

Lozano, R. Fullman, N. Abate, D. Abay, S.M. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdel-Rahman, O. Abdi, A. Abdollahpour, I. Abdulkader, R.S. Abebe, N.D. Abebe, Z. Abejie, A.N. Abera, S.F. Abil, O.Z. Aboyans, V. Abraha, H.N. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M. Abyu, G.Y. Accrombessi, M.M.K. Acharya, D. Acharya, P. Adamu, A.A. Adebayo, O.M. Adedeji, I.A. Adedoyin, R.A. Adekanmbi, V. Adetokunboh, O.O. Adhena, B.M. Adhikari, T.B. Adib, M.G. Adou, A.K. Adsuar, J.C. Afarideh, M. Afshari, M. Afshin, A. Agarwal, G. Aghayan, S.A. Agius, D. Agrawal, A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Ahmed, S. Akalu, T.Y. Akanda, A.S. Akbari, M.E. Akibu, M. Akinyemi, R.O. Akinyemiju, T. Akseer, N. Alahdab, F. Al-Aly, Z. Alam, K. Alam, T. Albujeer, A. Alebel, A. Alene, K.A. Al-Eyadhy, A. Alhabib, S. Ali, R. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Allen, C.A. Almasi, A. Al-Maskari, F. 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Vujcic, I.S. Wagner, G.R. Wagnew, F.S. Waheed, Y. Walson, J.L. Wang, Y. Wang, Y.-P. Wassie, M.M. Weiderpass, E. Weintraub, R.G. Weiss, J. Weldegebreal, F. Weldegwergs, K.G. Werdecker, A. Werkneh, A.A. West, T.E. Westerman, R. Whisnant, J.L. Whiteford, H.A. Widecka, J. Widecka, K. Wijeratne, T. Wilner, L.B. Winkler, A.S. Wiyeh, A.B. Wiysonge, C.S. Wolde, H.F. Wolfe, C.D.A. Wu, S. Xavier, D. Xu, G. Xu, R. Yadollahpour, A. Jabbari, S.H.Y. Yakob, B. Yamada, T. Yan, L.L. Yano, Y. Yaseri, M. Yasin, Y.J. Ye, P. Yearwood, J.A. Yeshaneh, A. Yimer, E.M. Yip, P. Yirsaw, B.D. Yisma, E. Yonemoto, N. Yonga, G. Yoon, S.-J. Yotebieng, M. Younis, M.Z. Yousefifard, M. Yu, C. Zaman, S.B. Zamani, M. Zare, Z. Zavala-Arciniega, L. Zegeye, D.T. Zegeye, E.A. Zeleke, A.J. Zendehdel, K. Zerfu, T.A. Zhang, A.L. Zhang, X. Zhou, M. Zhu, J. Zimsen, S.R.M. Zodpey, S. Zoeckler, L. Zucker, I. Zuhlke, L.J.J. Lim, S.S. Murray, C.J.L. GBD 2017 SDG Collaborators

Abstract

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

Published
2018

8. Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Murray, C.J.L. Callender, C.S.K.H. Kulikoff, X.R. Srinivasan, V. Abate, D. Abate, K.H. Abay, S.M. Abbasi, N. Abbastabar, H. Abdela, J. Abdelalim, A. Abdel-Rahman, O. Abdi, A. Abdoli, N. Abdollahpour, I. Abdulkader, R.S. Abebe, H.T. Abebe, M. Abebe, Z. Abebo, T.A. Abejie, A.N. Aboyans, V. Abraha, H.N. Abreu, D.M.X. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M.E. Accrombessi, M.M.K. Acharya, P. Adamu, A.A. Adebayo, O.M. Adedeji, I.A. Adekanmbi, V. Adetokunboh, O.O. Adhena, B.M. Adhikari, T.B. Adib, M.G. Adou, A.K. Adsuar, J.C. Afarideh, M. Afshin, A. Agarwal, G. Agesa, K.M. Aghayan, S.A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmed, M.B. Ahmed, S. Aichour, A.N. Aichour, I. Aichour, M.T.E. Akanda, A.S. Akbari, M.E. Akibu, M. Akinyemi, R.O. Akinyemiju, T. Akseer, N. Alahdab, F. Al-Aly, Z. Alam, K. Alebel, A. Aleman, A.V. Alene, K.A. Al-Eyadhy, A. Ali, R. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Almasi, A. Alonso, J. Al-Raddadi, R.M. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Ammar, W. Anber, N.H. Andrei, C.L. Androudi, S. Animut, M.D. Ansari, H. Ansha, M.G. Antonio, C.A.T. Appiah, S.C.Y. Aremu, O. Areri, H.A. Arian, N. Ärnlöv, J. Artaman, A. Aryal, K.K. Asayesh, H. Asfaw, E.T. Asgedom, S.W. Assadi, R. Atey, T.M.M. Atique, S. Atteraya, M.S. Ausloos, M. Avokpaho, E.F.G.A. Awasthi, A. Ayala Quintanilla, B.P. Ayele, Y. Ayer, R. Ayuk, T.B. Azzopardi, P.S. Babalola, T.K. Babazadeh, A. Badali, H. Badawi, A. Bali, A.G. Banach, M. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Basaleem, H. Bassat, Q. Basu, A. Baune, B.T. Baynes, H.W. Beghi, E. Behzadifar, M. Behzadifar, M. Bekele, B.B. Belachew, A.B. Belay, A.G. Belay, E. Belay, S.A. Belay, Y.A. Bell, M.L. Bello, A.K. Bennett, D.A. Bensenor, I.M. Bergeron, G. Berhane, A. Berman, A.E. Bernabe, E. Bernstein, R.S. Bertolacci, G.J. Beuran, M. Bhattarai, S. Bhaumik, S. Bhutta, Z.A. Biadgo, B. Bijani, A. Bikbov, B. Bililign, N. Bin Sayeed, M.S. Birlik, S.M. Birungi, C. 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Khazaie, H. Khoja, A.T. Khosravi, A. Khosravi, M.H. Kibret, G.D. Kidanemariam, Z.T. Kiirithio, D.N. Kilgore, P.E. Kim, D. Kim, J.Y. Kim, Y.-E. Kim, Y.J. Kimokoti, R.W. Kinfu, Y. Kinra, S. Kisa, A. Kivimäki, M. Kochhar, S. Kokubo, Y. Kolola, T. Kopec, J.A. Kosek, M.N. Kosen, S. Koul, P.A. Koyanagi, A. Krishan, K. Krishnaswami, S. Krohn, K.J. Defo, B.K. Bicer, B.K. Kumar, G.A. Kumar, M. Kumar, P. Kumsa, F.A. Kutz, M.J. Lad, S.D. Lafranconi, A. Lal, D.K. Lalloo, R. Lam, H. Lami, F.H. Lang, J.J. Lansky, S. Lansingh, V.C. Laryea, D.O. Lassi, Z.S. Latifi, A. Laxmaiah, A. Lazarus, J.V. Lee, J.B. Lee, P.H. Leigh, J. Leshargie, C.T. Leta, S. Levi, M. Li, S. Li, X. Li, Y. Liang, J. Liang, X. Liben, M.L. Lim, L.-L. Limenih, M.A. Linn, S. Liu, S. Lorkowski, S. Lotufo, P.A. Lozano, R. Lunevicius, R. Mabika, C.M. Macarayan, E.R.K. Mackay, M.T. Madotto, F. Mahmood, T.A.E. Mahotra, N.B. Majdan, M. Majdzadeh, R. Majeed, A. Malekzadeh, R. Malik, M.A. Mamun, A.A. Manamo, W.A. Manda, A.-L. Mangalam, S. Mansournia, M.A. Mantovani, L.G. Mapoma, C.C. Marami, D. Maravilla, J.C. Marcenes, W. Marina, S. Martins-Melo, F.R. März, W. Marzan, M.B. Mashamba-Thompson, T.P. Masiye, F. Mason-Jones, A.J. Massenburg, B.B. Mathur, M.R. Maulik, P.K. Mazidi, M. McGrath, J.J. Mehata, S. Mehendale, S.M. Mehndiratta, M.M. Mehrotra, R. Mehrzadi, S. Mehta, K.M. Mehta, V. Mekonnen, T.C. Meles, H.G. Meles, K.G. Melese, A. Melku, M. Memiah, P.T.N. Memish, Z.A. Mendoza, W. Mengesha, M.M. Mengistu, D.T. Mengistu, G. Mensah, G.A. Mereta, S.T. Meretoja, A. Meretoja, T.J. Mestrovic, T. Mezgebe, H.B. Miangotar, Y. Miazgowski, B. Miazgowski, T. Miller, T.R. Miller-Petrie, M.K. Mini, G.K. Mirabi, P. Mirica, A. Mirrakhimov, E.M. Misganaw, A.T. Moazen, B. Mohammad, K.A. Mohammadi, M. Mohammadifard, N. Mohammadi-Khanaposhtani, M. Mohammed, M.A. Mohammed, S. Mokdad, A.H. Mola, G.D. Molokhia, M. Monasta, L. Montañez, J.C. Moradi, G. Moradi, M. Moradi-Lakeh, M. Moradinazar, M. Moraga, P. Morgado-Da-Costa, J. Mori, R. Morrison, S.D. Mosapour, A. Moschos, M.M. Mousavi, S.M. Muche, A.A. Muchie, K.F. Mueller, U.O. Mukhopadhyay, S. Murphy, T.B. Muller, K. Murthy, G.V.S. Musa, J. Musa, K.I. Mustafa, G. Muthupandian, S. Nachega, J.B. Nagel, G. Naghavi, M. Naheed, A. Nahvijou, A. Naik, G. Naik, P. Najafi, F. Naldi, L. Nangia, V. Nansseu, J.R. Nascimento, B.R. Nawaz, H. Ncama, B.P. Neamati, N. Negoi, I. Negoi, R.I. Neupane, S. Newton, C.R.J. Ngalesoni, F.N. Ngunjiri, J.W. Nguyen, G. Nguyen, L.H. Nguyen, T.H. Ningrum, D.N.A. Nirayo, Y.L. Nisar, M.I. Nixon, M.R. Nomura, S. Noroozi, M. Noubiap, J.J. Nouri, H.R. Nourollahpour Shiadeh, M. Nowroozi, M.R. Nyandwi, A. Nyasulu, P.S. Odell, C.M. Ofori-Asenso, R. Ogah, O.S. Ogbo, F.A. Oh, I.-H. Okoro, A. Oladimeji, O. Olagunju, A.T. Olagunju, T.O. Olivares, P.R. Olusanya, B.O. Olusanya, J.O. Ong, S.K. Ortiz, A. Osgood-Zimmerman, A. Ota, E. Otieno, B.A. Otstavnov, S.S. Owolabi, M.O. Oyekale, A.S. Mahesh, P.A. Pakhale, S. Pakhare, A.P. Pana, A. Panda, B.K. Panda-Jonas, S. Pandey, A.R. Park, E.-K. Parsian, H. Patel, S. Patil, S.T. Patle, A. Patton, G.C. Paturi, V.R. Paudel, D. Pedroso, M.M. Peprah, E.K. Pereira, D.M. Perico, N. Pesudovs, K. Petri, W.A. Petzold, M. Pierce, M. Pigott, D.M. Pillay, J.D. Pirsaheb, M. Polanczyk, G.V. Postma, M.J. Pourmalek, F. Pourshams, A. Poustchi, H. Prakash, S. Prasad, N. Purcell, C.A. Purwar, M.B. Qorbani, M. Quansah, R. Radfar, A. Rafay, A. Rafiei, A. Rahim, F. Rahimi-Movaghar, A. Rahimi-Movaghar, V. Rahman, M. Rahman, M.S. Ur Rahman, M.H. Rahman, M.A. Ur Rahman, S. Rai, R.K. Rajati, F. Rajsic, S. Ram, U. Ranabhat, C.L. Ranjan, P. Rawaf, D.L. Rawaf, S. Ray, S.E. Razo-García, C. Reiner, R.C. Reis, C. Remuzzi, G. Renzaho, A.M.N. Resnikoff, S. Rezaei, S. Rezaeian, S. Rezai, M.S. Riahi, S.M. Rios-Blancas, M.J. Roba, K.T. Roberts, N.L.S. Roever, L. Ronfani, L. Roshandel, G. Rostami, A. Rubagotti, E. Ruhago, G.M. Sabde, Y.D. Sachdev, P.S. Saddik, B. Moghaddam, S.S. Safari, H. Safari, Y. Safari-Faramani, R. Safdarian, M. Safi, S. Safiri, S. Sagar, R. Sahebkar, A. Sahraian, M.A. Sajadi, H.S. Salahshoor, M. Salam, N. Salama, J.S. Salamati, P. Saldanha, R.D.F. Saleem, Z. Salimi, Y. Salimzadeh, H. Salomon, J.A. Salvi, S.S. Salz, I. Sambala, E.Z. Samy, A.M. Sanabria, J. Sanchez-Niño, M.D. Santos, I.S. Santric Milicevic, M.M. Sao Jose, B.P. Sardana, M. Sarker, A.R. Sarmiento-Suárez, R. Saroshe, S. Sarrafzadegan, N. Sartorius, B. Sarvi, S. Sathian, B. Satpathy, M. Sawant, A.R. Sawhney, M. Saxena, S. Schaeffner, E. Schelonka, K. Schneider, I.J.C. Schwebel, D.C. Schwendicke, F. Seedat, S. Sekerija, M. Sepanlou, S.G. Serván-Mori, E. Shabaninejad, H. Shackelford, K.A. Shafieesabet, A. Shaheen, A.A. Shaikh, M.A. Shakir, R.A. Shams-Beyranvand, M. Shamsi, M. Shamsizadeh, M. Sharafi, H. Sharafi, K. Sharif, M. Sharif-Alhoseini, M. Sharma, J. Sharma, R. She, J. Sheikh, A. Shi, P. Shibuya, K. Shigematsu, M. Shiri, R. Shirkoohi, R. Shiue, I. Shokraneh, F. Shukla, S.R. Si, S. Siabani, S. Sibai, A.M. 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Tsilimparis, N. Car, L.T. Ukwaja, K.N. Ullah, I. Usman, M.S. Uthman, O.A. Uzun, S.B. Vaduganathan, M. Vaezi, A. Vaidya, G. Valdez, P.R. Varavikova, E. Varughese, S. Vasankari, T.J. Vasconcelos, A.M.N. Venketasubramanian, N. Villafaina, S. Violante, F.S. Vladimirov, S.K. Vlassov, V. Vollset, S.E. Vos, T. Vosoughi, K. Vujcic, I.S. Wagnew, F.S. Waheed, Y. Walson, J.L. Wang, Y. Wang, Y.-P. Weiderpass, E. Weintraub, R.G. Weldegwergs, K.G. Werdecker, A. Westerman, R. Whiteford, H. Widecka, J. Widecka, K. Wijeratne, T. Winkler, A.S. Wiysonge, C.S. Wolfe, C.D.A. Wu, S. Wyper, G.M.A. Xu, G. Yamada, T. Yano, Y. Yaseri, M. Yasin, Y.J. Ye, P. Yentür, G.K. Yeshaneh, A. Yimer, E.M. Yip, P. Yisma, E. Yonemoto, N. Yoon, S.-J. Yotebieng, M. Younis, M.Z. Yousefifard, M. Yu, C. Zadnik, V. Zaidi, Z. Zaman, S.B. Zamani, M. Zare, Z. Zeleke, M.M. Zenebe, Z.M. Zerfu, T.A. Zhang, X. Zhao, X.-J. Zhou, M. Zhu, J. Zimsen, S.R.M. Zodpey, S. Zoeckler, L. Lopez, A.D. Lim, S.S. GBD 2017 Population Fertility Collaborators

Abstract

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Published
2018

9. Research update for articles published in EJCI in 2016

Author

Adlbrecht, C. Blanco-Verea, A. Bouzas-Mosquera, M.C. Brion, M. Burtscher, M. Carbone, F. Chang, T.-T. Charmandari, E. Chen, J.-W. Correia-Costa, L. Dullaart, R.P.F. Eleftheriades, M. Fernandez-Fernandez, B. Goliasch, G. Gremmel, T. Groeneveld, M.E. Henrique, A. Huelsmann, M. Jung, C. Lichtenauer, M. Montecucco, F. Nicolaides, N.C. Niessner, A. Palmeira, C. Pirklbauer, M. Sanchez-Niño, M.D. Sotiriadis, A. Sousa, T. Sulzgruber, P. van Beek, A.P. Veronese, N. Winter, M.-P. Yeung, K.K. Bouzas-Mosquera, A.

Published
2018

12. Research update for articles published in EJCI in 2016

Author

Christopher Adlbrecht, Alejandro Blanco-Verea, María C. Bouzas-Mosquera, María Brion, Martin Burtscher, Federico Carbone, Ting-Ting Chang, Evangelia Charmandari, Jaw-Wen Chen, Liane Correia-Costa, Robin P. F. Dullaart, Makarios Eleftheriades, Beatriz Fernandez-Fernandez, Georg Goliasch, Thomas Gremmel, Menno Evert Groeneveld, Alexandrino Henrique, Martin Huelsmann, Christian Jung, Michael Lichtenauer, Fabrizio Montecucco, Nicolas C. Nicolaides, Alexander Niessner, Carlos Palmeira, Markus Pirklbauer, Maria Dolores Sanchez-Niño, Alexandros Sotiriadis, Teresa Sousa, Patrick Sulzgruber, André P. van Beek, Nicola Veronese, Max-Paul Winter, Kak Khee Yeung, Alberto Bouzas-Mosquera, Adlbrecht, C., Blanco-Verea, A., Bouzas-Mosquera, M.C., Brion, M., Burtscher, M., Carbone, F., Chang, T.-T., Charmandari, E., Chen, J.-W., Correia-Costa, L., Dullaart, R.P.F., Eleftheriades, M., Fernandez-Fernandez, B., Goliasch, G., Gremmel, T., Groeneveld, M.E., Henrique, A., Huelsmann, M., Jung, C., Lichtenauer, M., Montecucco, F., Nicolaides, N.C., Niessner, A., Palmeira, C., Pirklbauer, M., Sanchez-Niño, M.D., Sotiriadis, A., Sousa, T., Sulzgruber, P., van Beek, A.P., Veronese, N., Winter, M.-P., Yeung, K.K., and Bouzas-Mosquera, A.

Subjects
ABDOMINAL AORTIC-ANEURYSM, GENERAL-POPULATION, ADVANCED HEART-FAILURE, Clinical Biochemistry, EJCI, BLOOD-PRESSURE, DIABETES-MELLITUS, General Medicine, Biochemistry, Maratón, Tratamiento médico, MYOCARDIAL-INFARCTION, CARDIOVASCULAR-DISEASE, Atleta, Hipertensión, CORONARY-ARTERY-DISEASE, Ecocardiografía, BONE-MINERAL DENSITY, ENDOTHELIN RECEPTOR BLOCKADE, Sistema cardiovascular
Abstract

The association of an excessive blood pressure increase with exercise (i.e., an increase in systolic blood pressure with exercise ≥95th percentile) with lower risk of subsequent events in patients with known or suspected coronary artery disease has been consistently verified even in those with baseline hypertension. Nonetheless, this negative association, also confirmed in another study on a Japanese population, might depend on peak VO2, such that the prognostic value of blood pressure response might be limited in patients with preserved exercise capacity. In addition, a hypertensive response with exercise (defined as a systolic blood pressure ≥220 mmHg during the test) has also been associated with lower risk of echocardiographic myocardial ischemia. These findings might be mediated mainly by the degree of exercise-induced increase in cardiac output, which is a main determinant of blerved.ood pressure response and may be blunted or even reversed in the presence of significant coronary artery disease. Sin financiación 2.784 JCR (2018) Q1, 37/160 Medicine, General & Internal; Q2, 67/136 Medicine, Research & Experimental 1.097 SJR (2018) Q1, 470/2844 Medicine (miscellaneous), 27/133 Clinical Biochemistry; Q2, 140/462 Biochemistry No data IDR 2018 UEM

Published
2018
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