TY - JOUR T1 - Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study. JF - JAMA Pediatr Y1 - 2017 A1 - Kassebaum, Nicholas A1 - Kyu, Hmwe Hmwe A1 - Zoeckler, Leo A1 - Olsen, Helen Elizabeth A1 - Thomas, Katie A1 - Pinho, Christine A1 - Bhutta, Zulfiqar A A1 - Dandona, Lalit A1 - Ferrari, Alize A1 - Ghiwot, Tsegaye Tewelde A1 - Hay, Simon I A1 - Kinfu, Yohannes A1 - Liang, Xiaofeng A1 - Lopez, Alan A1 - Malta, Deborah Carvalho A1 - Mokdad, Ali H A1 - Naghavi, Mohsen A1 - Patton, George C A1 - Salomon, Joshua A1 - Sartorius, Benn A1 - Topor-Madry, Roman A1 - Vollset, Stein Emil A1 - Werdecker, Andrea A1 - Whiteford, Harvey A A1 - Abate, Kalkidan Hasen A1 - Abbas, Kaja A1 - Damtew, Solomon Abrha A1 - Ahmed, Muktar Beshir A1 - Akseer, Nadia A1 - Al-Raddadi, Rajaa A1 - Alemayohu, Mulubirhan Assefa A1 - Altirkawi, Khalid A1 - Abajobir, Amanuel Alemu A1 - Amare, Azmeraw T A1 - Antonio, Carl A T A1 - Arnlöv, Johan A1 - Artaman, Al A1 - Asayesh, Hamid A1 - Avokpaho, Euripide Frinel G Arthur A1 - Awasthi, Ashish A1 - Ayala Quintanilla, Beatriz Paulina A1 - Bacha, Umar A1 - Betsu, Balem Demtsu A1 - Barac, Aleksandra A1 - Bärnighausen, Till Winfried A1 - Baye, Estifanos A1 - Bedi, Neeraj A1 - Bensenor, Isabela M A1 - Berhane, Adugnaw A1 - Bernabe, Eduardo A1 - Bernal, Oscar Alberto A1 - Beyene, Addisu Shunu A1 - Biadgilign, Sibhatu A1 - Bikbov, Boris A1 - Boyce, Cheryl Anne A1 - Brazinova, Alexandra A1 - Hailu, Gessessew Bugssa A1 - Carter, Austin A1 - Castañeda-Orjuela, Carlos A A1 - Catalá-López, Ferrán A1 - Charlson, Fiona J A1 - Chitheer, Abdulaal A A1 - Choi, Jee-Young Jasmine A1 - Ciobanu, Liliana G A1 - Crump, John A1 - Dandona, Rakhi A1 - Dellavalle, Robert P A1 - Deribew, Amare A1 - deVeber, Gabrielle A1 - Dicker, Daniel A1 - Ding, Eric L A1 - Dubey, Manisha A1 - Endries, Amanuel Yesuf A1 - Erskine, Holly E A1 - Faraon, Emerito Jose Aquino A1 - Faro, Andre A1 - Farzadfar, Farshad A1 - Fernandes, Joao C A1 - Fijabi, Daniel Obadare A1 - Fitzmaurice, Christina A1 - Fleming, Thomas D A1 - Flor, Luisa Sorio A1 - Foreman, Kyle J A1 - Franklin, Richard C A1 - Fraser, Maya S A1 - Frostad, Joseph J A1 - Fullman, Nancy A1 - Gebregergs, Gebremedhin Berhe A1 - Gebru, Alemseged Aregay A1 - Geleijnse, Johanna M A1 - Gibney, Katherine B A1 - Gidey Yihdego, Mahari A1 - Ginawi, Ibrahim Abdelmageem Mohamed A1 - Gishu, Melkamu Dedefo A1 - Gizachew, Tessema Assefa A1 - Glaser, Elizabeth A1 - Gold, Audra L A1 - Goldberg, Ellen A1 - Gona, Philimon A1 - Goto, Atsushi A1 - Gugnani, Harish Chander A1 - Jiang, Guohong A1 - Gupta, Rajeev A1 - Tesfay, Fisaha Haile A1 - Hankey, Graeme J A1 - Havmoeller, Rasmus A1 - Hijar, Martha A1 - Horino, Masako A1 - Hosgood, H Dean A1 - Hu, Guoqing A1 - Jacobsen, Kathryn H A1 - Jakovljevic, Mihajlo B A1 - Jayaraman, Sudha P A1 - Jha, Vivekanand A1 - Jibat, Tariku A1 - Johnson, Catherine O A1 - Jonas, Jost A1 - Kasaeian, Amir A1 - Kawakami, Norito A1 - Keiyoro, Peter N A1 - Khalil, Ibrahim A1 - Khang, Young-Ho A1 - Khubchandani, Jagdish A1 - Ahmad Kiadaliri, Aliasghar A A1 - Kieling, Christian A1 - Kim, Daniel A1 - Kissoon, Niranjan A1 - Knibbs, Luke D A1 - Koyanagi, Ai A1 - Krohn, Kristopher J A1 - Kuate Defo, Barthelemy A1 - Kucuk Bicer, Burcu A1 - Kulikoff, Rachel A1 - Kumar, G Anil A1 - Lal, Dharmesh Kumar A1 - Lam, Hilton Y A1 - Larson, Heidi J A1 - Larsson, Anders A1 - Laryea, Dennis Odai A1 - Leung, Janni A1 - Lim, Stephen S A1 - Lo, Loon-Tzian A1 - Lo, Warren D A1 - Looker, Katharine J A1 - Lotufo, Paulo A A1 - Magdy Abd El Razek, Hassan A1 - Malekzadeh, Reza A1 - Markos Shifti, Desalegn A1 - Mazidi, Mohsen A1 - Meaney, Peter A A1 - Meles, Kidanu Gebremariam A1 - Memiah, Peter A1 - Mendoza, Walter A1 - Abera Mengistie, Mubarek A1 - Mengistu, Gebremichael Welday A1 - Mensah, George A A1 - Miller, Ted R A1 - Mock, Charles A1 - Mohammadi, Alireza A1 - Mohammed, Shafiu A1 - Monasta, Lorenzo A1 - Mueller, Ulrich A1 - Nagata, Chie A1 - Naheed, Aliya A1 - Nguyen, Grant A1 - Nguyen, Quyen Le A1 - Nsoesie, Elaine A1 - Oh, In-Hwan A1 - Okoro, Anselm A1 - Olusanya, Jacob Olusegun A1 - Olusanya, Bolajoko O A1 - Ortiz, Alberto A1 - Paudel, Deepak A1 - Pereira, David M A1 - Perico, Norberto A1 - Petzold, Max A1 - Phillips, Michael Robert A1 - Polanczyk, Guilherme V A1 - Pourmalek, Farshad A1 - Qorbani, Mostafa A1 - Rafay, Anwar A1 - Rahimi-Movaghar, Vafa A1 - Rahman, Mahfuzar A1 - Rai, Rajesh Kumar A1 - Ram, Usha A1 - Rankin, Zane A1 - Remuzzi, Giuseppe A1 - Renzaho, Andre M N A1 - Roba, Hirbo Shore A1 - Rojas-Rueda, David A1 - Ronfani, Luca A1 - Sagar, Rajesh A1 - Sanabria, Juan Ramon A1 - Kedir Mohammed, Muktar Sano A1 - Santos, Itamar S A1 - Satpathy, Maheswar A1 - Sawhney, Monika A1 - Schöttker, Ben A1 - Schwebel, David C A1 - Scott, James G A1 - Sepanlou, Sadaf G A1 - Shaheen, Amira A1 - Shaikh, Masood Ali A1 - She, June A1 - Shiri, Rahman A1 - Shiue, Ivy A1 - Sigfusdottir, Inga Dora A1 - Singh, Jasvinder A1 - Silpakit, Naris A1 - Smith, Alison A1 - Sreeramareddy, Chandrashekhar A1 - Stanaway, Jeffrey D A1 - Stein, Dan J A1 - Steiner, Caitlyn A1 - Sufiyan, Muawiyyah Babale A1 - Swaminathan, Soumya A1 - Tabarés-Seisdedos, Rafael A1 - Tabb, Karen M A1 - Tadese, Fentaw A1 - Tavakkoli, Mohammad A1 - Taye, Bineyam A1 - Teeple, Stephanie A1 - Tegegne, Teketo Kassaw A1 - Temam Shifa, Girma A1 - Terkawi, Abdullah Sulieman A1 - Thomas, Bernadette A1 - Thomson, Alan J A1 - Tobe-Gai, Ruoyan A1 - Tonelli, Marcello A1 - Tran, Bach Xuan A1 - Troeger, Christopher A1 - Ukwaja, Kingsley N A1 - Uthman, Olalekan A1 - Vasankari, Tommi A1 - Venketasubramanian, Narayanaswamy A1 - Vlassov, Vasiliy Victorovich A1 - Weiderpass, Elisabete A1 - Weintraub, Robert A1 - Gebrehiwot, Solomon Weldemariam A1 - Westerman, Ronny A1 - Williams, Hywel C A1 - Wolfe, Charles D A A1 - Woodbrook, Rachel A1 - Yano, Yuichiro A1 - Yonemoto, Naohiro A1 - Yoon, Seok-Jun A1 - Younis, Mustafa Z A1 - Yu, Chuanhua A1 - Zaki, Maysaa El Sayed A1 - Zegeye, Elias Asfaw A1 - Zuhlke, Liesl Joanna A1 - Murray, Christopher J L A1 - Vos, Theo KW - Adolescent KW - Adolescent Health KW - Age Factors KW - Cause of Death KW - Child KW - Child Health KW - Child Mortality KW - Disabled Children KW - Female KW - Global Burden of Disease KW - Global Health KW - Humans KW - Male KW - Pregnancy KW - Pregnancy Complications KW - Risk Factors KW - Sex Factors KW - Wounds and Injuries AB -

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

VL - 171 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28384795?dopt=Abstract ER - TY - JOUR T1 - The Global Burden of Cancer 2013. JF - JAMA Oncol Y1 - 2015 A1 - Fitzmaurice, Christina A1 - Dicker, Daniel A1 - Pain, Amanda A1 - Hamavid, Hannah A1 - Moradi-Lakeh, Maziar A1 - MacIntyre, Michael F A1 - Allen, Christine A1 - Hansen, Gillian A1 - Woodbrook, Rachel A1 - Wolfe, Charles A1 - Hamadeh, Randah R A1 - Moore, Ami A1 - Werdecker, Andrea A1 - Gessner, Bradford D A1 - Te Ao, Braden A1 - McMahon, Brian A1 - Karimkhani, Chante A1 - Yu, Chuanhua A1 - Cooke, Graham S A1 - Schwebel, David C A1 - Carpenter, David O A1 - Pereira, David M A1 - Nash, Denis A1 - Kazi, Dhruv S A1 - De Leo, Diego A1 - Plass, Dietrich A1 - Ukwaja, Kingsley N A1 - Thurston, George D A1 - Yun Jin, Kim A1 - Simard, Edgar P A1 - Mills, Edward A1 - Park, Eun-Kee A1 - Catalá-López, Ferrán A1 - deVeber, Gabrielle A1 - Gotay, Carolyn A1 - Khan, Gulfaraz A1 - Hosgood, H Dean A1 - Santos, Itamar S A1 - Leasher, Janet L A1 - Singh, Jasvinder A1 - Leigh, James A1 - Jonas, Jost A1 - Sanabria, Juan A1 - Beardsley, Justin A1 - Jacobsen, Kathryn H A1 - Takahashi, Ken A1 - Franklin, Richard C A1 - Ronfani, Luca A1 - Montico, Marcella A1 - Naldi, Luigi A1 - Tonelli, Marcello A1 - Geleijnse, Johanna A1 - Petzold, Max A1 - Shrime, Mark G A1 - Younis, Mustafa A1 - Yonemoto, Naohiro A1 - Breitborde, Nicholas A1 - Yip, Paul A1 - Pourmalek, Farshad A1 - Lotufo, Paulo A A1 - Esteghamati, Alireza A1 - Hankey, Graeme J A1 - Ali, Raghib A1 - Lunevicius, Raimundas A1 - Malekzadeh, Reza A1 - Dellavalle, Robert A1 - Weintraub, Robert A1 - Lucas, Robyn A1 - Hay, Roderick A1 - Rojas-Rueda, David A1 - Westerman, Ronny A1 - Sepanlou, Sadaf G A1 - Nolte, Sandra A1 - Patten, Scott A1 - Weichenthal, Scott A1 - Abera, Semaw Ferede A1 - Fereshtehnejad, Seyed-Mohammad A1 - Shiue, Ivy A1 - Driscoll, Tim A1 - Vasankari, Tommi A1 - Alsharif, Ubai A1 - Rahimi-Movaghar, Vafa A1 - Vlassov, Vasiliy V A1 - Marcenes, W S A1 - Mekonnen, Wubegzier A1 - Melaku, Yohannes Adama A1 - Yano, Yuichiro A1 - Artaman, Al A1 - Campos, Ismael A1 - MacLachlan, Jennifer A1 - Mueller, Ulrich A1 - Kim, Daniel A1 - Trillini, Matias A1 - Eshrati, Babak A1 - Williams, Hywel C A1 - Shibuya, Kenji A1 - Dandona, Rakhi A1 - Murthy, Kinnari A1 - Cowie, Benjamin A1 - Amare, Azmeraw T A1 - Antonio, Carl Abelardo A1 - Castañeda-Orjuela, Carlos A1 - van Gool, Coen H A1 - Violante, Francesco A1 - Oh, In-Hwan A1 - Deribe, Kedede A1 - Soreide, Kjetil A1 - Knibbs, Luke A1 - Kereselidze, Maia A1 - Green, Mark A1 - Cárdenas, Rosario A1 - Roy, Nobhojit A1 - Tillman, Taavi A1 - Li, Yongmei A1 - Krueger, Hans A1 - Monasta, Lorenzo A1 - Dey, Subhojit A1 - Sheikhbahaei, Sara A1 - Hafezi-Nejad, Nima A1 - Kumar, G Anil A1 - Sreeramareddy, Chandrashekhar T A1 - Dandona, Lalit A1 - Wang, Haidong A1 - Vollset, Stein Emil A1 - Mokdad, Ali A1 - Salomon, Joshua A A1 - Lozano, Rafael A1 - Vos, Theo A1 - Forouzanfar, Mohammad A1 - Lopez, Alan A1 - Murray, Christopher A1 - Naghavi, Mohsen AB -

IMPORTANCE: Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.

OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013.

EVIDENCE REVIEW: The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs.

FINDINGS: In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries.

CONCLUSIONS AND RELEVANCE: Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

VL - 1 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26181261?dopt=Abstract ER - TY - JOUR T1 - Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. JF - Lancet Y1 - 2015 A1 - Murray, Christopher J L A1 - Barber, Ryan M A1 - Foreman, Kyle J A1 - Abbasoglu Ozgoren, Ayse A1 - Abd-Allah, Foad A1 - Abera, Semaw F A1 - Aboyans, Victor A1 - Abraham, Jerry P A1 - Abubakar, Ibrahim A1 - Abu-Raddad, Laith J A1 - Abu-Rmeileh, Niveen M A1 - Achoki, Tom A1 - Ackerman, Ilana N A1 - Ademi, Zanfina A1 - Adou, Arsène K A1 - Adsuar, José C A1 - Afshin, Ashkan A1 - Agardh, Emilie E A1 - Alam, Sayed Saidul A1 - Alasfoor, Deena A1 - Albittar, Mohammed I A1 - Alegretti, Miguel A A1 - Alemu, Zewdie A A1 - Alfonso-Cristancho, Rafael A1 - Alhabib, Samia A1 - Ali, Raghib A1 - Alla, François A1 - Allebeck, Peter A1 - AlMazroa, Mohammad A A1 - Alsharif, Ubai A1 - Alvarez, Elena A1 - Alvis-Guzmán, Nelson A1 - Amare, Azmeraw T A1 - Ameh, Emmanuel A A1 - Amini, Heresh A1 - Ammar, Walid A1 - Anderson, H Ross A1 - Anderson, Benjamin O A1 - Antonio, Carl Abelardo T A1 - Anwari, Palwasha A1 - Arnlöv, Johan A1 - Arsic Arsenijevic, Valentina S A1 - Artaman, Al A1 - Asghar, Rana J A1 - Assadi, Reza A1 - Atkins, Lydia S A1 - Avila, Marco A A1 - Awuah, Baffour A1 - Bachman, Victoria F A1 - Badawi, Alaa A1 - Bahit, Maria C A1 - Balakrishnan, Kalpana A1 - Banerjee, Amitava A1 - Barker-Collo, Suzanne L A1 - Barquera, Simon A1 - Barregard, Lars A1 - Barrero, Lope H A1 - Basu, Arindam A1 - Basu, Sanjay A1 - Basulaiman, Mohammed O A1 - Beardsley, Justin A1 - Bedi, Neeraj A1 - Beghi, Ettore A1 - Bekele, Tolesa A1 - Bell, Michelle L A1 - Benjet, Corina A1 - Bennett, Derrick A A1 - Bensenor, Isabela M A1 - Benzian, Habib A1 - Bernabe, Eduardo A1 - Bertozzi-Villa, Amelia A1 - Beyene, Tariku J A1 - Bhala, Neeraj A1 - Bhalla, Ashish A1 - Bhutta, Zulfiqar A A1 - Bienhoff, Kelly A1 - Bikbov, Boris A1 - Biryukov, Stan A1 - Blore, Jed D A1 - Blosser, Christopher D A1 - Blyth, Fiona M A1 - Bohensky, Megan A A1 - Bolliger, Ian W A1 - Bora Başara, Berrak A1 - Bornstein, Natan M A1 - Bose, Dipan A1 - Boufous, Soufiane A1 - Bourne, Rupert R A A1 - Boyers, Lindsay N A1 - Brainin, Michael A1 - Brayne, Carol E A1 - Brazinova, Alexandra A1 - Breitborde, Nicholas J K A1 - Brenner, Hermann A1 - Briggs, Adam D A1 - Brooks, Peter M A1 - Brown, Jonathan C A1 - Brugha, Traolach S A1 - Buchbinder, Rachelle A1 - Buckle, Geoffrey C A1 - Budke, Christine M A1 - Bulchis, Anne A1 - Bulloch, Andrew G A1 - Campos-Nonato, Ismael R A1 - Carabin, Hélène A1 - Carapetis, Jonathan R A1 - Cárdenas, Rosario A1 - Carpenter, David O A1 - Caso, Valeria A1 - Castañeda-Orjuela, Carlos A A1 - Castro, Ruben E A1 - Catalá-López, Ferrán A1 - Cavalleri, Fiorella A1 - Cavlin, Alanur A1 - Chadha, Vineet K A1 - Chang, Jung-Chen A1 - Charlson, Fiona J A1 - Chen, Honglei A1 - Chen, Wanqing A1 - Chiang, Peggy P A1 - Chimed-Ochir, Odgerel A1 - Chowdhury, Rajiv A1 - Christensen, Hanne A1 - Christophi, Costas A A1 - Cirillo, Massimo A1 - Coates, Matthew M A1 - Coffeng, Luc E A1 - Coggeshall, Megan S A1 - Colistro, Valentina A1 - Colquhoun, Samantha M A1 - Cooke, Graham S A1 - Cooper, Cyrus A1 - Cooper, Leslie T A1 - Coppola, Luis M A1 - Cortinovis, Monica A1 - Criqui, Michael H A1 - Crump, John A A1 - Cuevas-Nasu, Lucia A1 - Danawi, Hadi A1 - Dandona, Lalit A1 - Dandona, Rakhi A1 - Dansereau, Emily A1 - Dargan, Paul I A1 - Davey, Gail A1 - Davis, Adrian A1 - Davitoiu, Dragos V A1 - Dayama, Anand A1 - De Leo, Diego A1 - Degenhardt, Louisa A1 - del Pozo-Cruz, Borja A1 - Dellavalle, Robert P A1 - Deribe, Kebede A1 - Derrett, Sarah A1 - Des Jarlais, Don C A1 - Dessalegn, Muluken A1 - Dharmaratne, Samath D A1 - Dherani, Mukesh K A1 - Diaz-Torné, Cesar A1 - Dicker, Daniel A1 - Ding, Eric L A1 - Dokova, Klara A1 - Dorsey, E Ray A1 - Driscoll, Tim R A1 - Duan, Leilei A1 - Duber, Herbert C A1 - Ebel, Beth E A1 - Edmond, Karen M A1 - Elshrek, Yousef M A1 - Endres, Matthias A1 - Ermakov, Sergey P A1 - Erskine, Holly E A1 - Eshrati, Babak A1 - Esteghamati, Alireza A1 - Estep, Kara A1 - Faraon, Emerito Jose A A1 - Farzadfar, Farshad A1 - Fay, Derek F A1 - Feigin, Valery L A1 - Felson, David T A1 - Fereshtehnejad, Seyed-Mohammad A1 - Fernandes, Jefferson G A1 - Ferrari, Alize J A1 - Fitzmaurice, Christina A1 - Flaxman, Abraham D A1 - Fleming, Thomas D A1 - Foigt, Nataliya A1 - Forouzanfar, Mohammad H A1 - Fowkes, F Gerry R A1 - Paleo, Urbano Fra A1 - Franklin, Richard C A1 - Fürst, Thomas A1 - Gabbe, Belinda A1 - Gaffikin, Lynne A1 - Gankpé, Fortuné G A1 - Geleijnse, Johanna M A1 - Gessner, Bradford D A1 - Gething, Peter A1 - Gibney, Katherine B A1 - Giroud, Maurice A1 - Giussani, Giorgia A1 - Gomez Dantes, Hector A1 - Gona, Philimon A1 - Gonzalez-Medina, Diego A1 - Gosselin, Richard A A1 - Gotay, Carolyn C A1 - Goto, Atsushi A1 - Gouda, Hebe N A1 - Graetz, Nicholas A1 - Gugnani, Harish C A1 - Gupta, Rahul A1 - Gupta, Rajeev A1 - Gutiérrez, Reyna A A1 - Haagsma, Juanita A1 - Hafezi-Nejad, Nima A1 - Hagan, Holly A1 - Halasa, Yara A A1 - Hamadeh, Randah R A1 - Hamavid, Hannah A1 - Hammami, Mouhanad A1 - Hancock, Jamie A1 - Hankey, Graeme J A1 - Hansen, Gillian M A1 - Hao, Yuantao A1 - Harb, Hilda L A1 - Haro, Josep Maria A1 - 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Khader, Yousef S A1 - Khalifa, Shams Eldin A A1 - Khan, Ejaz A A1 - Khan, Gulfaraz A1 - Khang, Young-Ho A1 - Kieling, Christian A1 - Kim, Daniel A1 - Kim, Sungroul A1 - Kim, Yunjin A1 - Kinfu, Yohannes A1 - Kinge, Jonas M A1 - Kivipelto, Miia A1 - Knibbs, Luke D A1 - Knudsen, Ann Kristin A1 - Kokubo, Yoshihiro A1 - Kosen, Soewarta A1 - Krishnaswami, Sanjay A1 - Kuate Defo, Barthelemy A1 - Kucuk Bicer, Burcu A1 - Kuipers, Ernst J A1 - Kulkarni, Chanda A1 - Kulkarni, Veena S A1 - Kumar, G Anil A1 - Kyu, Hmwe H A1 - Lai, Taavi A1 - Lalloo, Ratilal A1 - Lallukka, Tea A1 - Lam, Hilton A1 - Lan, Qing A1 - Lansingh, Van C A1 - Larsson, Anders A1 - Lawrynowicz, Alicia E B A1 - Leasher, Janet L A1 - Leigh, James A1 - Leung, Ricky A1 - Levitz, Carly E A1 - Li, Bin A1 - Li, Yichong A1 - Li, Yongmei A1 - Lim, Stephen S A1 - Lind, Maggie A1 - Lipshultz, Steven E A1 - Liu, Shiwei A1 - Liu, Yang A1 - Lloyd, Belinda K A1 - Lofgren, Katherine T A1 - Logroscino, Giancarlo A1 - Looker, Katharine J A1 - Lortet-Tieulent, Joannie A1 - 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Yentür, Gökalp K A1 - Yip, Paul A1 - Yonemoto, Naohiro A1 - Yoon, Seok-Jun A1 - Younis, Mustafa Z A1 - Yu, Chuanhua A1 - Zaki, Maysaa E A1 - Zhao, Yong A1 - Zheng, Yingfeng A1 - Zonies, David A1 - Zou, Xiaonong A1 - Salomon, Joshua A A1 - Lopez, Alan D A1 - Vos, Theo KW - Aged KW - Chronic Disease KW - Communicable Diseases KW - Female KW - Global Health KW - Health Transition KW - Humans KW - Life Expectancy KW - Male KW - Middle Aged KW - Mortality, Premature KW - Quality-Adjusted Life Years KW - Socioeconomic Factors KW - Wounds and Injuries AB -

BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.

METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.

FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.

INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

FUNDING: Bill & Melinda Gates Foundation.

VL - 386 IS - 10009 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26321261?dopt=Abstract ER -