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

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.

%B JAMA Pediatr %V 171 %P 573-592 %8 2017 Jun 01 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28384795?dopt=Abstract %R 10.1001/jamapediatrics.2017.0250 %0 Journal Article %J Lancet %D 2015 %T Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Forouzanfar, Mohammad H %A Alexander, Lily %A Anderson, H Ross %A Bachman, Victoria F %A Biryukov, Stan %A Brauer, Michael %A Burnett, Richard %A Casey, Daniel %A Coates, Matthew M %A Cohen, Aaron %A Delwiche, Kristen %A Estep, Kara %A Frostad, Joseph J %A Astha, K C %A Kyu, Hmwe H %A Moradi-Lakeh, Maziar %A Ng, Marie %A Slepak, Erica Leigh %A Thomas, Bernadette A %A Wagner, Joseph %A Aasvang, Gunn Marit %A Abbafati, Cristiana %A Abbasoglu Ozgoren, Ayse %A Abd-Allah, Foad %A Abera, Semaw F %A Aboyans, Victor %A Abraham, Biju %A Abraham, Jerry Puthenpurakal %A Abubakar, Ibrahim %A Abu-Rmeileh, Niveen M E %A Aburto, Tania C %A Achoki, Tom %A Adelekan, Ademola %A Adofo, Koranteng %A Adou, Arsène K %A Adsuar, José C %A Afshin, Ashkan %A Agardh, Emilie E %A Al Khabouri, Mazin J %A Al Lami, Faris H %A Alam, Sayed Saidul %A Alasfoor, Deena %A Albittar, Mohammed I %A Alegretti, Miguel A %A Aleman, Alicia V %A Alemu, Zewdie A %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Ali, Mohammed K %A Alla, François %A Allebeck, Peter %A Allen, Peter J %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Ameh, Emmanuel A %A Ameli, Omid %A Amini, Heresh %A Ammar, Walid %A Anderson, Benjamin O %A Antonio, Carl Abelardo T %A Anwari, Palwasha %A Argeseanu Cunningham, Solveig %A Arnlöv, Johan %A Arsenijevic, Valentina S Arsic %A Artaman, Al %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Atkinson, Charles %A Avila, Marco A %A Awuah, Baffour %A Badawi, Alaa %A Bahit, Maria C %A Bakfalouni, Talal %A Balakrishnan, Kalpana %A Balalla, Shivanthi %A Balu, Ravi Kumar %A Banerjee, Amitava %A Barber, Ryan M %A Barker-Collo, Suzanne L %A Barquera, Simon %A Barregard, Lars %A Barrero, Lope H %A Barrientos-Gutierrez, Tonatiuh %A Basto-Abreu, Ana C %A Basu, Arindam %A Basu, Sanjay %A Basulaiman, Mohammed O %A Batis Ruvalcaba, Carolina %A Beardsley, Justin %A Bedi, Neeraj %A Bekele, Tolesa %A Bell, Michelle L %A Benjet, Corina %A Bennett, Derrick A %A Benzian, Habib %A Bernabe, Eduardo %A Beyene, Tariku J %A Bhala, Neeraj %A Bhalla, Ashish %A Bhutta, Zulfiqar A %A Bikbov, Boris %A Bin Abdulhak, Aref A %A Blore, Jed D %A Blyth, Fiona M %A Bohensky, Megan A %A Bora Başara, Berrak %A Borges, Guilherme %A Bornstein, Natan M %A Bose, Dipan %A Boufous, Soufiane %A Bourne, Rupert R %A Brainin, Michael %A Brazinova, Alexandra %A Breitborde, Nicholas J %A Brenner, Hermann %A Briggs, Adam D M %A Broday, David M %A Brooks, Peter M %A Bruce, Nigel G %A Brugha, Traolach S %A Brunekreef, Bert %A Buchbinder, Rachelle %A Bui, Linh N %A Bukhman, Gene %A Bulloch, Andrew G %A Burch, Michael %A Burney, Peter G J %A Campos-Nonato, Ismael R %A Campuzano, Julio C %A Cantoral, Alejandra J %A Caravanos, Jack %A Cárdenas, Rosario %A Cardis, Elisabeth %A Carpenter, David O %A Caso, Valeria %A Castañeda-Orjuela, Carlos A %A Castro, Ruben E %A Catalá-López, Ferrán %A Cavalleri, Fiorella %A Cavlin, Alanur %A Chadha, Vineet K %A Chang, Jung-Chen %A Charlson, Fiona J %A Chen, Honglei %A Chen, Wanqing %A Chen, Zhengming %A Chiang, Peggy P %A Chimed-Ochir, Odgerel %A Chowdhury, Rajiv %A Christophi, Costas A %A Chuang, Ting-Wu %A Chugh, Sumeet S %A Cirillo, Massimo %A Claßen, Thomas K D %A Colistro, Valentina %A Colomar, Mercedes %A Colquhoun, Samantha M %A Contreras, Alejandra G %A Cooper, Cyrus %A Cooperrider, Kimberly %A Cooper, Leslie T %A Coresh, Josef %A Courville, Karen J %A Criqui, Michael H %A Cuevas-Nasu, Lucia %A Damsere-Derry, James %A Danawi, Hadi %A Dandona, Lalit %A Dandona, Rakhi %A Dargan, Paul I %A Davis, Adrian %A Davitoiu, Dragos V %A Dayama, Anand %A de Castro, E Filipa %A De la Cruz-Góngora, Vanessa %A De Leo, Diego %A de Lima, Graça %A Degenhardt, Louisa %A del Pozo-Cruz, Borja %A Dellavalle, Robert P %A Deribe, Kebede %A Derrett, Sarah %A Des Jarlais, Don C %A Dessalegn, Muluken %A deVeber, Gabrielle A %A Devries, Karen M %A Dharmaratne, Samath D %A Dherani, Mukesh K %A Dicker, Daniel %A Ding, Eric L %A Dokova, Klara %A Dorsey, E Ray %A Driscoll, Tim R %A Duan, Leilei %A Durrani, Adnan M %A Ebel, Beth E %A Ellenbogen, Richard G %A Elshrek, Yousef M %A Endres, Matthias %A Ermakov, Sergey P %A Erskine, Holly E %A Eshrati, Babak %A Esteghamati, Alireza %A Fahimi, Saman %A Faraon, Emerito Jose A %A Farzadfar, Farshad %A Fay, Derek F J %A Feigin, Valery L %A Feigl, Andrea B %A Fereshtehnejad, Seyed-Mohammad %A Ferrari, Alize J %A Ferri, Cleusa P %A Flaxman, Abraham D %A Fleming, Thomas D %A Foigt, Nataliya %A Foreman, Kyle J %A Paleo, Urbano Fra %A Franklin, Richard C %A Gabbe, Belinda %A Gaffikin, Lynne %A Gakidou, Emmanuela %A Gamkrelidze, Amiran %A Gankpé, Fortuné G %A Gansevoort, Ron T %A García-Guerra, Francisco A %A Gasana, Evariste %A Geleijnse, Johanna M %A Gessner, Bradford D %A Gething, Pete %A Gibney, Katherine B %A Gillum, Richard F %A Ginawi, Ibrahim A M %A Giroud, Maurice %A Giussani, Giorgia %A Goenka, Shifalika %A Goginashvili, Ketevan %A Gomez Dantes, Hector %A Gona, Philimon %A Gonzalez de Cosio, Teresita %A González-Castell, Dinorah %A Gotay, Carolyn C %A Goto, Atsushi %A Gouda, Hebe N %A Guerrant, Richard L %A Gugnani, Harish C %A Guillemin, Francis %A Gunnell, David %A Gupta, Rahul %A Gupta, Rajeev %A Gutiérrez, Reyna A %A Hafezi-Nejad, Nima %A Hagan, Holly %A Hagstromer, Maria %A Halasa, Yara A %A Hamadeh, Randah R %A Hammami, Mouhanad %A Hankey, Graeme J %A Hao, Yuantao %A Harb, Hilda L %A Haregu, Tilahun Nigatu %A Haro, Josep Maria %A Havmoeller, Rasmus %A Hay, Simon I %A Hedayati, Mohammad T %A Heredia-Pi, Ileana B %A Hernandez, Lucia %A Heuton, Kyle R %A Heydarpour, Pouria %A Hijar, Martha %A Hoek, Hans W %A Hoffman, Howard J %A Hornberger, John C %A Hosgood, H Dean %A Hoy, Damian G %A Hsairi, Mohamed %A Hu, Guoqing %A Hu, Howard %A Huang, Cheng %A Huang, John J %A Hubbell, Bryan J %A Huiart, Laetitia %A Husseini, Abdullatif %A Iannarone, Marissa L %A Iburg, Kim M %A Idrisov, Bulat T %A Ikeda, Nayu %A Innos, Kaire %A Inoue, Manami %A Islami, Farhad %A Ismayilova, Samaya %A Jacobsen, Kathryn H %A Jansen, Henrica A %A Jarvis, Deborah L %A Jassal, Simerjot K %A Jauregui, Alejandra %A Jayaraman, Sudha %A Jeemon, Panniyammakal %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Fan %A Jiang, Guohong %A Jiang, Ying %A Jonas, Jost B %A Juel, Knud %A Kan, Haidong %A Kany Roseline, Sidibe S %A Karam, Nadim E %A Karch, André %A Karema, Corine K %A Karthikeyan, Ganesan %A Kaul, Anil %A Kawakami, Norito %A Kazi, Dhruv S %A Kemp, Andrew H %A Kengne, Andre P %A Keren, Andre %A Khader, Yousef S %A Khalifa, Shams Eldin Ali Hassan %A Khan, Ejaz A %A Khang, Young-Ho %A Khatibzadeh, Shahab %A Khonelidze, Irma %A Kieling, Christian %A Kim, Daniel %A Kim, Sungroul %A Kim, Yunjin %A Kimokoti, Ruth W %A Kinfu, Yohannes %A Kinge, Jonas M %A Kissela, Brett M %A Kivipelto, Miia %A Knibbs, Luke D %A Knudsen, Ann Kristin %A Kokubo, Yoshihiro %A Kose, M Rifat %A Kosen, Soewarta %A Kraemer, Alexander %A Kravchenko, Michael %A Krishnaswami, Sanjay %A Kromhout, Hans %A Ku, Tiffany %A Kuate Defo, Barthelemy %A Kucuk Bicer, Burcu %A Kuipers, Ernst J %A Kulkarni, Chanda %A Kulkarni, Veena S %A Kumar, G Anil %A Kwan, Gene F %A Lai, Taavi %A Lakshmana Balaji, Arjun %A Lalloo, Ratilal %A Lallukka, Tea %A Lam, Hilton %A Lan, Qing %A Lansingh, Van C %A Larson, Heidi J %A Larsson, Anders %A Laryea, Dennis O %A Lavados, Pablo M %A Lawrynowicz, Alicia E %A Leasher, Janet L %A Lee, Jong-Tae %A Leigh, James %A Leung, Ricky %A Levi, Miriam %A Li, Yichong %A Li, Yongmei %A Liang, Juan %A Liang, Xiaofeng %A Lim, Stephen S %A Lindsay, M Patrice %A Lipshultz, Steven E %A Liu, Shiwei %A Liu, Yang %A Lloyd, Belinda K %A Logroscino, Giancarlo %A London, Stephanie J %A Lopez, Nancy %A Lortet-Tieulent, Joannie %A Lotufo, Paulo A %A Lozano, Rafael %A Lunevicius, Raimundas %A Ma, Jixiang %A Ma, Stefan %A Machado, Vasco M P %A MacIntyre, Michael F %A Magis-Rodriguez, Carlos %A Mahdi, Abbas A %A Majdan, Marek %A Malekzadeh, Reza %A Mangalam, Srikanth %A Mapoma, Christopher C %A Marape, Marape %A Marcenes, Wagner %A Margolis, David J %A Margono, Christopher %A Marks, Guy B %A Martin, Randall V %A Marzan, Melvin B %A Mashal, Mohammad T %A Masiye, Felix %A Mason-Jones, Amanda J %A Matsushita, Kunihiro %A Matzopoulos, Richard %A Mayosi, Bongani M %A Mazorodze, Tasara T %A McKay, Abigail C %A McKee, Martin %A McLain, Abigail %A Meaney, Peter A %A Medina, Catalina %A Mehndiratta, Man Mohan %A Mejia-Rodriguez, Fabiola %A Mekonnen, Wubegzier %A Melaku, Yohannes A %A Meltzer, Michele %A Memish, Ziad A %A Mendoza, Walter %A Mensah, George A %A Meretoja, Atte %A Mhimbira, Francis Apolinary %A Micha, Renata %A Miller, Ted R %A Mills, Edward J %A Misganaw, Awoke %A Mishra, Santosh %A Mohamed Ibrahim, Norlinah %A Mohammad, Karzan A %A Mokdad, Ali H %A Mola, Glen L %A Monasta, Lorenzo %A Montañez Hernandez, Julio C %A Montico, Marcella %A Moore, Ami R %A Morawska, Lidia %A Mori, Rintaro %A Moschandreas, Joanna %A Moturi, Wilkister N %A Mozaffarian, Dariush %A Mueller, Ulrich O %A Mukaigawara, Mitsuru %A Mullany, Erin C %A Murthy, Kinnari S %A Naghavi, Mohsen %A Nahas, Ziad %A Naheed, Aliya %A Naidoo, Kovin S %A Naldi, Luigi %A Nand, Devina %A Nangia, Vinay %A Narayan, K M Venkat %A Nash, Denis %A Neal, Bruce %A Nejjari, Chakib %A Neupane, Sudan P %A Newton, Charles R %A Ngalesoni, Frida N %A Ngirabega, Jean de Dieu %A Nguyen, Grant %A Nguyen, Nhung T %A Nieuwenhuijsen, Mark J %A Nisar, Muhammad I %A Nogueira, José R %A Nolla, Joan M %A Nolte, Sandra %A Norheim, Ole F %A Norman, Rosana E %A Norrving, Bo %A Nyakarahuka, Luke %A Oh, In-Hwan %A Ohkubo, Takayoshi %A Olusanya, Bolajoko O %A Omer, Saad B %A Opio, John Nelson %A Orozco, Ricardo %A Pagcatipunan, Rodolfo S %A Pain, Amanda W %A Pandian, Jeyaraj D %A Panelo, Carlo Irwin A %A Papachristou, Christina %A Park, Eun-Kee %A Parry, Charles D %A Paternina Caicedo, Angel J %A Patten, Scott B %A Paul, Vinod K %A Pavlin, Boris I %A Pearce, Neil %A Pedraza, Lilia S %A Pedroza, Andrea %A Pejin Stokic, Ljiljana %A Pekericli, Ayfer %A Pereira, David M %A Perez-Padilla, Rogelio %A Perez-Ruiz, Fernando %A Perico, Norberto %A Perry, Samuel A L %A Pervaiz, Aslam %A Pesudovs, Konrad %A Peterson, Carrie B %A Petzold, Max %A Phillips, Michael R %A Phua, Hwee Pin %A Plass, Dietrich %A Poenaru, Dan %A Polanczyk, Guilherme V %A Polinder, Suzanne %A Pond, Constance D %A Pope, C Arden %A Pope, Daniel %A Popova, Svetlana %A Pourmalek, Farshad %A Powles, John %A Prabhakaran, Dorairaj %A Prasad, Noela M %A Qato, Dima M %A Quezada, Amado D %A Quistberg, D Alex A %A Racapé, Lionel %A Rafay, Anwar %A Rahimi, Kazem %A Rahimi-Movaghar, Vafa %A Rahman, Sajjad Ur %A Raju, Murugesan %A Rakovac, Ivo %A Rana, Saleem M %A Rao, Mayuree %A Razavi, Homie %A Reddy, K Srinath %A Refaat, Amany H %A Rehm, Jürgen %A Remuzzi, Giuseppe %A Ribeiro, Antonio L %A Riccio, Patricia M %A Richardson, Lee %A Riederer, Anne %A Robinson, Margaret %A Roca, Anna %A Rodriguez, Alina %A Rojas-Rueda, David %A Romieu, Isabelle %A Ronfani, Luca %A Room, Robin %A Roy, Nobhojit %A Ruhago, George M %A Rushton, Lesley %A Sabin, Nsanzimana %A Sacco, Ralph L %A Saha, Sukanta %A Sahathevan, Ramesh %A Sahraian, Mohammad Ali %A Salomon, Joshua A %A Salvo, Deborah %A Sampson, Uchechukwu K %A Sanabria, Juan R %A Sanchez, Luz Maria %A Sánchez-Pimienta, Tania G %A Sanchez-Riera, Lidia %A Sandar, Logan %A Santos, Itamar S %A Sapkota, Amir %A Satpathy, Maheswar %A Saunders, James E %A Sawhney, Monika %A Saylan, Mete I %A Scarborough, Peter %A Schmidt, Jürgen C %A Schneider, Ione J C %A Schöttker, Ben %A Schwebel, David C %A Scott, James G %A Seedat, Soraya %A Sepanlou, Sadaf G %A Serdar, Berrin %A Servan-Mori, Edson E %A Shaddick, Gavin %A Shahraz, Saeid %A Levy, Teresa Shamah %A Shangguan, Siyi %A She, Jun %A Sheikhbahaei, Sara %A Shibuya, Kenji %A Shin, Hwashin H %A Shinohara, Yukito %A Shiri, Rahman %A Shishani, Kawkab %A Shiue, Ivy %A Sigfusdottir, Inga D %A Silberberg, Donald H %A Simard, Edgar P %A Sindi, Shireen %A Singh, Abhishek %A Singh, Gitanjali M %A Singh, Jasvinder A %A Skirbekk, Vegard %A Sliwa, Karen %A Soljak, Michael %A Soneji, Samir %A Søreide, Kjetil %A Soshnikov, Sergey %A Sposato, Luciano A %A Sreeramareddy, Chandrashekhar T %A Stapelberg, Nicolas J C %A Stathopoulou, Vasiliki %A Steckling, Nadine %A Stein, Dan J %A Stein, Murray B %A Stephens, Natalie %A Stöckl, Heidi %A Straif, Kurt %A Stroumpoulis, Konstantinos %A Sturua, Lela %A Sunguya, Bruno F %A Swaminathan, Soumya %A Swaroop, Mamta %A Sykes, Bryan L %A Tabb, Karen M %A Takahashi, Ken %A Talongwa, Roberto T %A Tandon, Nikhil %A Tanne, David %A Tanner, Marcel %A Tavakkoli, Mohammad %A Te Ao, Braden J %A Teixeira, Carolina M %A Téllez Rojo, Martha M %A Terkawi, Abdullah S %A Texcalac-Sangrador, José Luis %A Thackway, Sarah V %A Thomson, Blake %A Thorne-Lyman, Andrew L %A Thrift, Amanda G %A Thurston, George D %A Tillmann, Taavi %A Tobollik, Myriam %A Tonelli, Marcello %A Topouzis, Fotis %A Towbin, Jeffrey A %A Toyoshima, Hideaki %A Traebert, Jefferson %A Tran, Bach X %A Trasande, Leonardo %A Trillini, Matias %A Trujillo, Ulises %A Dimbuene, Zacharie Tsala %A Tsilimbaris, Miltiadis %A Tuzcu, Emin Murat %A Uchendu, Uche S %A Ukwaja, Kingsley N %A Uzun, Selen B %A van de Vijver, Steven %A Van Dingenen, Rita %A van Gool, Coen H %A van Os, Jim %A Varakin, Yuri Y %A Vasankari, Tommi J %A Vasconcelos, Ana Maria N %A Vavilala, Monica S %A Veerman, Lennert J %A Velasquez-Melendez, Gustavo %A Venketasubramanian, N %A Vijayakumar, Lakshmi %A Villalpando, Salvador %A Violante, Francesco S %A Vlassov, Vasiliy Victorovich %A Vollset, Stein Emil %A Wagner, Gregory R %A Waller, Stephen G %A Wallin, Mitchell T %A Wan, Xia %A Wang, Haidong %A Wang, JianLi %A Wang, Linhong %A Wang, Wenzhi %A Wang, Yanping %A Warouw, Tati S %A Watts, Charlotte H %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Werdecker, Andrea %A Wessells, K Ryan %A Westerman, Ronny %A Whiteford, Harvey A %A Wilkinson, James D %A Williams, Hywel C %A Williams, Thomas N %A Woldeyohannes, Solomon M %A Wolfe, Charles D A %A Wong, John Q %A Woolf, Anthony D %A Wright, Jonathan L %A Wurtz, Brittany %A Xu, Gelin %A Yan, Lijing L %A Yang, Gonghuan %A Yano, Yuichiro %A Ye, Pengpeng %A Yenesew, Muluken %A Yentür, Gökalp K %A Yip, Paul %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa Z %A Younoussi, Zourkaleini %A Yu, Chuanhua %A Zaki, Maysaa E %A Zhao, Yong %A Zheng, Yingfeng %A Zhou, Maigeng %A Zhu, Jun %A Zhu, Shankuan %A Zou, Xiaonong %A Zunt, Joseph R %A Lopez, Alan D %A Vos, Theo %A Murray, Christopher J %X

BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.

FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.

INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 386 %P 2287-323 %8 2015 Dec 5 %G eng %N 10010 %1 http://www.ncbi.nlm.nih.gov/pubmed/26364544?dopt=Abstract %R 10.1016/S0140-6736(15)00128-2 %0 Journal Article %J Lancet %D 2015 %T 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. %A Murray, Christopher J L %A Barber, Ryan M %A Foreman, Kyle J %A Abbasoglu Ozgoren, Ayse %A Abd-Allah, Foad %A Abera, Semaw F %A Aboyans, Victor %A Abraham, Jerry P %A Abubakar, Ibrahim %A Abu-Raddad, Laith J %A Abu-Rmeileh, Niveen M %A Achoki, Tom %A Ackerman, Ilana N %A Ademi, Zanfina %A Adou, Arsène K %A Adsuar, José C %A Afshin, Ashkan %A Agardh, Emilie E %A Alam, Sayed Saidul %A Alasfoor, Deena %A Albittar, Mohammed I %A Alegretti, Miguel A %A Alemu, Zewdie A %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Alla, François %A Allebeck, Peter %A AlMazroa, Mohammad A %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amare, Azmeraw T %A Ameh, Emmanuel A %A Amini, Heresh %A Ammar, Walid %A Anderson, H Ross %A Anderson, Benjamin O %A Antonio, Carl Abelardo T %A Anwari, Palwasha %A Arnlöv, Johan %A Arsic Arsenijevic, Valentina S %A Artaman, Al %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Avila, Marco A %A Awuah, Baffour %A Bachman, Victoria F %A Badawi, Alaa %A Bahit, Maria C %A Balakrishnan, Kalpana %A Banerjee, Amitava %A Barker-Collo, Suzanne L %A Barquera, Simon %A Barregard, Lars %A Barrero, Lope H %A Basu, Arindam %A Basu, Sanjay %A Basulaiman, Mohammed O %A Beardsley, Justin %A Bedi, Neeraj %A Beghi, Ettore %A Bekele, Tolesa %A Bell, Michelle L %A Benjet, Corina %A Bennett, Derrick A %A Bensenor, Isabela M %A Benzian, Habib %A Bernabe, Eduardo %A Bertozzi-Villa, Amelia %A Beyene, Tariku J %A Bhala, Neeraj %A Bhalla, Ashish %A Bhutta, Zulfiqar A %A Bienhoff, Kelly %A Bikbov, Boris %A Biryukov, Stan %A Blore, Jed D %A Blosser, Christopher D %A Blyth, Fiona M %A Bohensky, Megan A %A Bolliger, Ian W %A Bora Başara, Berrak %A Bornstein, Natan M %A Bose, Dipan %A Boufous, Soufiane %A Bourne, Rupert R A %A Boyers, Lindsay N %A Brainin, Michael %A Brayne, Carol E %A Brazinova, Alexandra %A Breitborde, Nicholas J K %A Brenner, Hermann %A Briggs, Adam D %A Brooks, Peter M %A Brown, Jonathan C %A Brugha, Traolach S %A Buchbinder, Rachelle %A Buckle, Geoffrey C %A Budke, Christine M %A Bulchis, Anne %A Bulloch, Andrew G %A Campos-Nonato, Ismael R %A Carabin, Hélène %A Carapetis, Jonathan R %A Cárdenas, Rosario %A Carpenter, David O %A Caso, Valeria %A Castañeda-Orjuela, Carlos A %A Castro, Ruben E %A Catalá-López, Ferrán %A Cavalleri, Fiorella %A Cavlin, Alanur %A Chadha, Vineet K %A Chang, Jung-Chen %A Charlson, Fiona J %A Chen, Honglei %A Chen, Wanqing %A Chiang, Peggy P %A Chimed-Ochir, Odgerel %A Chowdhury, Rajiv %A Christensen, Hanne %A Christophi, Costas A %A Cirillo, Massimo %A Coates, Matthew M %A Coffeng, Luc E %A Coggeshall, Megan S %A Colistro, Valentina %A Colquhoun, Samantha M %A Cooke, Graham S %A Cooper, Cyrus %A Cooper, Leslie T %A Coppola, Luis M %A Cortinovis, Monica %A Criqui, Michael H %A Crump, John A %A Cuevas-Nasu, Lucia %A Danawi, Hadi %A Dandona, Lalit %A Dandona, Rakhi %A Dansereau, Emily %A Dargan, Paul I %A Davey, Gail %A Davis, Adrian %A Davitoiu, Dragos V %A Dayama, Anand %A De Leo, Diego %A Degenhardt, Louisa %A del Pozo-Cruz, Borja %A Dellavalle, Robert P %A Deribe, Kebede %A Derrett, Sarah %A Des Jarlais, Don C %A Dessalegn, Muluken %A Dharmaratne, Samath D %A Dherani, Mukesh K %A Diaz-Torné, Cesar %A Dicker, Daniel %A Ding, Eric L %A Dokova, Klara %A Dorsey, E Ray %A Driscoll, Tim R %A Duan, Leilei %A Duber, Herbert C %A Ebel, Beth E %A Edmond, Karen M %A Elshrek, Yousef M %A Endres, Matthias %A Ermakov, Sergey P %A Erskine, Holly E %A Eshrati, Babak %A Esteghamati, Alireza %A Estep, Kara %A Faraon, Emerito Jose A %A Farzadfar, Farshad %A Fay, Derek F %A Feigin, Valery L %A Felson, David T %A Fereshtehnejad, Seyed-Mohammad %A Fernandes, Jefferson G %A Ferrari, Alize J %A Fitzmaurice, Christina %A Flaxman, Abraham D %A Fleming, Thomas D %A Foigt, Nataliya %A Forouzanfar, Mohammad H %A Fowkes, F Gerry R %A Paleo, Urbano Fra %A Franklin, Richard C %A Fürst, Thomas %A Gabbe, Belinda %A Gaffikin, Lynne %A Gankpé, Fortuné G %A Geleijnse, Johanna M %A Gessner, Bradford D %A Gething, Peter %A Gibney, Katherine B %A Giroud, Maurice %A Giussani, Giorgia %A Gomez Dantes, Hector %A Gona, Philimon %A Gonzalez-Medina, Diego %A Gosselin, Richard A %A Gotay, Carolyn C %A Goto, Atsushi %A Gouda, Hebe N %A Graetz, Nicholas %A Gugnani, Harish C %A Gupta, Rahul %A Gupta, Rajeev %A Gutiérrez, Reyna A %A Haagsma, Juanita %A Hafezi-Nejad, Nima %A Hagan, Holly %A Halasa, Yara A %A Hamadeh, Randah R %A Hamavid, Hannah %A Hammami, Mouhanad %A Hancock, Jamie %A Hankey, Graeme J %A Hansen, Gillian M %A Hao, Yuantao %A Harb, Hilda L %A Haro, Josep Maria %A Havmoeller, Rasmus %A Hay, Simon I %A Hay, Roderick J %A Heredia-Pi, Ileana B %A Heuton, Kyle R %A Heydarpour, Pouria %A Higashi, Hideki %A Hijar, Martha %A Hoek, Hans W %A Hoffman, Howard J %A Hosgood, H Dean %A Hossain, Mazeda %A Hotez, Peter J %A Hoy, Damian G %A Hsairi, Mohamed %A Hu, Guoqing %A Huang, Cheng %A Huang, John J %A Husseini, Abdullatif %A Huynh, Chantal %A Iannarone, Marissa L %A Iburg, Kim M %A Innos, Kaire %A Inoue, Manami %A Islami, Farhad %A Jacobsen, Kathryn H %A Jarvis, Deborah L %A Jassal, Simerjot K %A Jee, Sun Ha %A Jeemon, Panniyammakal %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Guohong %A Jiang, Ying %A Jonas, Jost B %A Juel, Knud %A Kan, Haidong %A Karch, André %A Karema, Corine K %A Karimkhani, Chante %A Karthikeyan, Ganesan %A Kassebaum, Nicholas J %A Kaul, Anil %A Kawakami, Norito %A Kazanjan, Konstantin %A Kemp, Andrew H %A Kengne, Andre P %A Keren, Andre %A Khader, Yousef S %A Khalifa, Shams Eldin A %A Khan, Ejaz A %A Khan, Gulfaraz %A Khang, Young-Ho %A Kieling, Christian %A Kim, Daniel %A Kim, Sungroul %A Kim, Yunjin %A Kinfu, Yohannes %A Kinge, Jonas M %A Kivipelto, Miia %A Knibbs, Luke D %A Knudsen, Ann Kristin %A Kokubo, Yoshihiro %A Kosen, Soewarta %A Krishnaswami, Sanjay %A Kuate Defo, Barthelemy %A Kucuk Bicer, Burcu %A Kuipers, Ernst J %A Kulkarni, Chanda %A Kulkarni, Veena S %A Kumar, G Anil %A Kyu, Hmwe H %A Lai, Taavi %A Lalloo, Ratilal %A Lallukka, Tea %A Lam, Hilton %A Lan, Qing %A Lansingh, Van C %A Larsson, Anders %A Lawrynowicz, Alicia E B %A Leasher, Janet L %A Leigh, James %A Leung, Ricky %A Levitz, Carly E %A Li, Bin %A Li, Yichong %A Li, Yongmei %A Lim, Stephen S %A Lind, Maggie %A Lipshultz, Steven E %A Liu, Shiwei %A Liu, Yang %A Lloyd, Belinda K %A Lofgren, Katherine T %A Logroscino, Giancarlo %A Looker, Katharine J %A Lortet-Tieulent, Joannie %A Lotufo, Paulo A %A Lozano, Rafael %A Lucas, Robyn M %A Lunevicius, Raimundas %A Lyons, Ronan A %A Ma, Stefan %A MacIntyre, Michael F %A Mackay, Mark T %A Majdan, Marek %A Malekzadeh, Reza %A Marcenes, Wagner %A Margolis, David J %A Margono, Christopher %A Marzan, Melvin B %A Masci, Joseph R %A Mashal, Mohammad T %A Matzopoulos, Richard %A Mayosi, Bongani M %A Mazorodze, Tasara T %A Mcgill, Neil W %A McGrath, John J %A McKee, Martin %A McLain, Abigail %A Meaney, Peter A %A Medina, Catalina %A Mehndiratta, Man Mohan %A Mekonnen, Wubegzier %A Melaku, Yohannes A %A Meltzer, Michele %A Memish, Ziad A %A Mensah, George A %A Meretoja, Atte %A Mhimbira, Francis A %A Micha, Renata %A Miller, Ted R %A Mills, Edward J %A Mitchell, Philip B %A Mock, Charles N %A Mohamed Ibrahim, Norlinah %A Mohammad, Karzan A %A Mokdad, Ali H %A Mola, Glen L D %A Monasta, Lorenzo %A Montañez Hernandez, Julio C %A Montico, Marcella %A Montine, Thomas J %A Mooney, Meghan D %A Moore, Ami R %A Moradi-Lakeh, Maziar %A Moran, Andrew E %A Mori, Rintaro %A Moschandreas, Joanna %A Moturi, Wilkister N %A Moyer, Madeline L %A Mozaffarian, Dariush %A Msemburi, William T %A Mueller, Ulrich O %A Mukaigawara, Mitsuru %A Mullany, Erin C %A Murdoch, Michele E %A Murray, Joseph %A Murthy, Kinnari S %A Naghavi, Mohsen %A Naheed, Aliya %A Naidoo, Kovin S %A Naldi, Luigi %A Nand, Devina %A Nangia, Vinay %A Narayan, K M Venkat %A Nejjari, Chakib %A Neupane, Sudan P %A Newton, Charles R %A Ng, Marie %A Ngalesoni, Frida N %A Nguyen, Grant %A Nisar, Muhammad I %A Nolte, Sandra %A Norheim, Ole F %A Norman, Rosana E %A Norrving, Bo %A Nyakarahuka, Luke %A Oh, In-Hwan %A Ohkubo, Takayoshi %A Ohno, Summer L %A Olusanya, Bolajoko O %A Opio, John Nelson %A Ortblad, Katrina %A Ortiz, Alberto %A Pain, Amanda W %A Pandian, Jeyaraj D %A Panelo, Carlo Irwin A %A Papachristou, Christina %A Park, Eun-Kee %A Park, Jae-Hyun %A Patten, Scott B %A Patton, George C %A Paul, Vinod K %A Pavlin, Boris I %A Pearce, Neil %A Pereira, David M %A Perez-Padilla, Rogelio %A Perez-Ruiz, Fernando %A Perico, Norberto %A Pervaiz, Aslam %A Pesudovs, Konrad %A Peterson, Carrie B %A Petzold, Max %A Phillips, Michael R %A Phillips, Bryan K %A Phillips, David E %A Piel, Frédéric B %A Plass, Dietrich %A Poenaru, Dan %A Polinder, Suzanne %A Pope, Daniel %A Popova, Svetlana %A Poulton, Richie G %A Pourmalek, Farshad %A Prabhakaran, Dorairaj %A Prasad, Noela M %A Pullan, Rachel L %A Qato, Dima M %A Quistberg, D Alex %A Rafay, Anwar %A Rahimi, Kazem %A Rahman, Sajjad U %A Raju, Murugesan %A Rana, Saleem M %A Razavi, Homie %A Reddy, K Srinath %A Refaat, Amany %A Remuzzi, Giuseppe %A Resnikoff, Serge %A Ribeiro, Antonio L %A Richardson, Lee %A Richardus, Jan Hendrik %A Roberts, D Allen %A Rojas-Rueda, David %A Ronfani, Luca %A Roth, Gregory A %A Rothenbacher, Dietrich %A Rothstein, David H %A Rowley, Jane T %A Roy, Nobhojit %A Ruhago, George M %A Saeedi, Mohammad Y %A Saha, Sukanta %A Sahraian, Mohammad Ali %A Sampson, Uchechukwu K A %A Sanabria, Juan R %A Sandar, Logan %A Santos, Itamar S %A Satpathy, Maheswar %A Sawhney, Monika %A Scarborough, Peter %A Schneider, Ione J %A Schöttker, Ben %A Schumacher, Austin E %A Schwebel, David C %A Scott, James G %A Seedat, Soraya %A Sepanlou, Sadaf G %A Serina, Peter T %A Servan-Mori, Edson E %A Shackelford, Katya A %A Shaheen, Amira %A Shahraz, Saeid %A Shamah Levy, Teresa %A Shangguan, Siyi %A She, Jun %A Sheikhbahaei, Sara %A Shi, Peilin %A Shibuya, Kenji %A Shinohara, Yukito %A Shiri, Rahman %A Shishani, Kawkab %A Shiue, Ivy %A Shrime, Mark G %A Sigfusdottir, Inga D %A Silberberg, Donald H %A Simard, Edgar P %A Sindi, Shireen %A Singh, Abhishek %A Singh, Jasvinder A %A Singh, Lavanya %A Skirbekk, Vegard %A Slepak, Erica Leigh %A Sliwa, Karen %A Soneji, Samir %A Søreide, Kjetil %A Soshnikov, Sergey %A Sposato, Luciano A %A Sreeramareddy, Chandrashekhar T %A Stanaway, Jeffrey D %A Stathopoulou, Vasiliki %A Stein, Dan J %A Stein, Murray B %A Steiner, Caitlyn %A Steiner, Timothy J %A Stevens, Antony %A Stewart, Andrea %A Stovner, Lars J %A Stroumpoulis, Konstantinos %A Sunguya, Bruno F %A Swaminathan, Soumya %A Swaroop, Mamta %A Sykes, Bryan L %A Tabb, Karen M %A Takahashi, Ken %A Tandon, Nikhil %A Tanne, David %A Tanner, Marcel %A Tavakkoli, Mohammad %A Taylor, Hugh R %A Te Ao, Braden J %A Tediosi, Fabrizio %A Temesgen, Awoke M %A Templin, Tara %A Ten Have, Margreet %A Tenkorang, Eric Y %A Terkawi, Abdullah S %A Thomson, Blake %A Thorne-Lyman, Andrew L %A Thrift, Amanda G %A Thurston, George D %A Tillmann, Taavi %A Tonelli, Marcello %A Topouzis, Fotis %A Toyoshima, Hideaki %A Traebert, Jefferson %A Tran, Bach X %A Trillini, Matias %A Truelsen, Thomas %A Tsilimbaris, Miltiadis %A Tuzcu, Emin M %A Uchendu, Uche S %A Ukwaja, Kingsley N %A Undurraga, Eduardo A %A Uzun, Selen B %A Van Brakel, Wim H %A van de Vijver, Steven %A van Gool, Coen H %A van Os, Jim %A Vasankari, Tommi J %A Venketasubramanian, N %A Violante, Francesco S %A Vlassov, Vasiliy V %A Vollset, Stein Emil %A Wagner, Gregory R %A Wagner, Joseph %A Waller, Stephen G %A Wan, Xia %A Wang, Haidong %A Wang, JianLi %A Wang, Linhong %A Warouw, Tati S %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Wenzhi, Wang %A Werdecker, Andrea %A Westerman, Ronny %A Whiteford, Harvey A %A Wilkinson, James D %A Williams, Thomas N %A Wolfe, Charles D %A Wolock, Timothy M %A Woolf, Anthony D %A Wulf, Sarah %A Wurtz, Brittany %A Xu, Gelin %A Yan, Lijing L %A Yano, Yuichiro %A Ye, Pengpeng %A Yentür, Gökalp K %A Yip, Paul %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa Z %A Yu, Chuanhua %A Zaki, Maysaa E %A Zhao, Yong %A Zheng, Yingfeng %A Zonies, David %A Zou, Xiaonong %A Salomon, Joshua A %A Lopez, Alan D %A Vos, Theo %K Aged %K Chronic Disease %K Communicable Diseases %K Female %K Global Health %K Health Transition %K Humans %K Life Expectancy %K Male %K Middle Aged %K Mortality, Premature %K Quality-Adjusted Life Years %K Socioeconomic Factors %K Wounds and Injuries %X

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.

%B Lancet %V 386 %P 2145-91 %8 2015 Nov 28 %G eng %N 10009 %1 http://www.ncbi.nlm.nih.gov/pubmed/26321261?dopt=Abstract %R 10.1016/S0140-6736(15)61340-X %0 Journal Article %J Lancet %D 2014 %T Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Kassebaum, Nicholas J %A Bertozzi-Villa, Amelia %A Coggeshall, Megan S %A Shackelford, Katya A %A Steiner, Caitlyn %A Heuton, Kyle R %A Gonzalez-Medina, Diego %A Barber, Ryan %A Huynh, Chantal %A Dicker, Daniel %A Templin, Tara %A Wolock, Timothy M %A Ozgoren, Ayse Abbasoglu %A Abd-Allah, Foad %A Abera, Semaw Ferede %A Abubakar, Ibrahim %A Achoki, Tom %A Adelekan, Ademola %A Ademi, Zanfina %A Adou, Arsène Kouablan %A Adsuar, José C %A Agardh, Emilie E %A Akena, Dickens %A Alasfoor, Deena %A Alemu, Zewdie Aderaw %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Al Kahbouri, Mazin J %A Alla, François %A Allen, Peter J %A AlMazroa, Mohammad A %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Amini, Hassan %A Ammar, Walid %A Antonio, Carl A T %A Anwari, Palwasha %A Arnlöv, Johan %A Arsenijevic, Valentina S Arsic %A Artaman, Ali %A Asad, Majed Masoud %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Badawi, Alaa %A Balakrishnan, Kalpana %A Basu, Arindam %A Basu, Sanjay %A Beardsley, Justin %A Bedi, Neeraj %A Bekele, Tolesa %A Bell, Michelle L %A Bernabe, Eduardo %A Beyene, Tariku J %A Bhutta, Zulfiqar %A Bin Abdulhak, Aref %A Blore, Jed D %A Basara, Berrak Bora %A Bose, Dipan %A Breitborde, Nicholas %A Cárdenas, Rosario %A Castañeda-Orjuela, Carlos A %A Castro, Ruben Estanislao %A Catalá-López, Ferrán %A Cavlin, Alanur %A Chang, Jung-Chen %A Che, Xuan %A Christophi, Costas A %A Chugh, Sumeet S %A Cirillo, Massimo %A Colquhoun, Samantha M %A Cooper, Leslie Trumbull %A Cooper, Cyrus %A da Costa Leite, Iuri %A Dandona, Lalit %A Dandona, Rakhi %A Davis, Adrian %A Dayama, Anand %A Degenhardt, Louisa %A De Leo, Diego %A del Pozo-Cruz, Borja %A Deribe, Kebede %A Dessalegn, Muluken %A deVeber, Gabrielle A %A Dharmaratne, Samath D %A Dilmen, Uğur %A Ding, Eric L %A Dorrington, Rob E %A Driscoll, Tim R %A Ermakov, Sergei Petrovich %A Esteghamati, Alireza %A Faraon, Emerito Jose A %A Farzadfar, Farshad %A Felicio, Manuela Mendonca %A Fereshtehnejad, Seyed-Mohammad %A de Lima, Graça Maria Ferreira %A Forouzanfar, Mohammad H %A França, Elisabeth B %A Gaffikin, Lynne %A Gambashidze, Ketevan %A Gankpé, Fortuné Gbètoho %A Garcia, Ana C %A Geleijnse, Johanna M %A Gibney, Katherine B %A Giroud, Maurice %A Glaser, Elizabeth L %A Goginashvili, Ketevan %A Gona, Philimon %A González-Castell, Dinorah %A Goto, Atsushi %A Gouda, Hebe N %A Gugnani, Harish Chander %A Gupta, Rahul %A Gupta, Rajeev %A Hafezi-Nejad, Nima %A Hamadeh, Randah Ribhi %A Hammami, Mouhanad %A Hankey, Graeme J %A Harb, Hilda L %A Havmoeller, Rasmus %A Hay, Simon I %A Pi, Ileana B Heredia %A Hoek, Hans W %A Hosgood, H Dean %A Hoy, Damian G %A Husseini, Abdullatif %A Idrisov, Bulat T %A Innos, Kaire %A Inoue, Manami %A Jacobsen, Kathryn H %A Jahangir, Eiman %A Jee, Sun Ha %A Jensen, Paul N %A Jha, Vivekanand %A Jiang, Guohong %A Jonas, Jost B %A Juel, Knud %A Kabagambe, Edmond Kato %A Kan, Haidong %A Karam, Nadim E %A Karch, André %A Karema, Corine Kakizi %A Kaul, Anil %A Kawakami, Norito %A Kazanjan, Konstantin %A Kazi, Dhruv S %A Kemp, Andrew H %A Kengne, Andre Pascal %A Kereselidze, Maia %A Khader, Yousef Saleh %A Khalifa, Shams Eldin Ali Hassan %A Khan, Ejaz Ahmed %A Khang, Young-Ho %A Knibbs, Luke %A Kokubo, Yoshihiro %A Kosen, Soewarta %A Defo, Barthelemy Kuate %A Kulkarni, Chanda %A Kulkarni, Veena S %A Kumar, G Anil %A Kumar, Kaushalendra %A Kumar, Ravi B %A Kwan, Gene %A Lai, Taavi %A Lalloo, Ratilal %A Lam, Hilton %A Lansingh, Van C %A Larsson, Anders %A Lee, Jong-Tae %A Leigh, James %A Leinsalu, Mall %A Leung, Ricky %A Li, Xiaohong %A Li, Yichong %A Li, Yongmei %A Liang, Juan %A Liang, Xiaofeng %A Lim, Stephen S %A Lin, Hsien-Ho %A Lipshultz, Steven E %A Liu, Shiwei %A Liu, Yang %A Lloyd, Belinda K %A London, Stephanie J %A Lotufo, Paulo A %A Ma, Jixiang %A Ma, Stefan %A Machado, Vasco Manuel Pedro %A Mainoo, Nana Kwaku %A Majdan, Marek %A Mapoma, Christopher Chabila %A Marcenes, Wagner %A Marzan, Melvin Barrientos %A Mason-Jones, Amanda J %A Mehndiratta, Man Mohan %A Mejia-Rodriguez, Fabiola %A Memish, Ziad A %A Mendoza, Walter %A Miller, Ted R %A Mills, Edward J %A Mokdad, Ali H %A Mola, Glen Liddell %A Monasta, Lorenzo %A de la Cruz Monis, Jonathan %A Hernandez, Julio Cesar Montañez %A Moore, Ami R %A Moradi-Lakeh, Maziar %A Mori, Rintaro %A Mueller, Ulrich O %A Mukaigawara, Mitsuru %A Naheed, Aliya %A Naidoo, Kovin S %A Nand, Devina %A Nangia, Vinay %A Nash, Denis %A Nejjari, Chakib %A Nelson, Robert G %A Neupane, Sudan Prasad %A Newton, Charles R %A Ng, Marie %A Nieuwenhuijsen, Mark J %A Nisar, Muhammad Imran %A Nolte, Sandra %A Norheim, Ole F %A Nyakarahuka, Luke %A Oh, In-Hwan %A Ohkubo, Takayoshi %A Olusanya, Bolajoko O %A Omer, Saad B %A Opio, John Nelson %A Orisakwe, Orish Ebere %A Pandian, Jeyaraj D %A Papachristou, Christina %A Park, Jae-Hyun %A Caicedo, Angel J Paternina %A Patten, Scott B %A Paul, Vinod K %A Pavlin, Boris Igor %A Pearce, Neil %A Pereira, David M %A Pesudovs, Konrad %A Petzold, Max %A Poenaru, Dan %A Polanczyk, Guilherme V %A Polinder, Suzanne %A Pope, Dan %A Pourmalek, Farshad %A Qato, Dima %A Quistberg, D Alex %A Rafay, Anwar %A Rahimi, Kazem %A Rahimi-Movaghar, Vafa %A ur Rahman, Sajjad %A Raju, Murugesan %A Rana, Saleem M %A Refaat, Amany %A Ronfani, Luca %A Roy, Nobhojit %A Pimienta, Tania Georgina Sánchez %A Sahraian, Mohammad Ali %A Salomon, Joshua A %A Sampson, Uchechukwu %A Santos, Itamar S %A Sawhney, Monika %A Sayinzoga, Felix %A Schneider, Ione J C %A Schumacher, Austin %A Schwebel, David C %A Seedat, Soraya %A Sepanlou, Sadaf G %A Servan-Mori, Edson E %A Shakh-Nazarova, Marina %A Sheikhbahaei, Sara %A Shibuya, Kenji %A Shin, Hwashin Hyun %A Shiue, Ivy %A Sigfusdottir, Inga Dora %A Silberberg, Donald H %A Silva, Andrea P %A Singh, Jasvinder A %A Skirbekk, Vegard %A Sliwa, Karen %A Soshnikov, Sergey S %A Sposato, Luciano A %A Sreeramareddy, Chandrashekhar T %A Stroumpoulis, Konstantinos %A Sturua, Lela %A Sykes, Bryan L %A Tabb, Karen M %A Talongwa, Roberto Tchio %A Tan, Feng %A Teixeira, Carolina Maria %A Tenkorang, Eric Yeboah %A Terkawi, Abdullah Sulieman %A Thorne-Lyman, Andrew L %A Tirschwell, David L %A Towbin, Jeffrey A %A Tran, Bach X %A Tsilimbaris, Miltiadis %A Uchendu, Uche S %A Ukwaja, Kingsley N %A Undurraga, Eduardo A %A Uzun, Selen Begüm %A Vallely, Andrew J %A van Gool, Coen H %A Vasankari, Tommi J %A Vavilala, Monica S %A Venketasubramanian, N %A Villalpando, Salvador %A Violante, Francesco S %A Vlassov, Vasiliy Victorovich %A Vos, Theo %A Waller, Stephen %A Wang, Haidong %A Wang, Linhong %A Wang, XiaoRong %A Wang, Yanping %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Westerman, Ronny %A Wilkinson, James D %A Woldeyohannes, Solomon Meseret %A Wong, John Q %A Wordofa, Muluemebet Abera %A Xu, Gelin %A Yang, Yang C %A Yano, Yuichiro %A Yentur, Gokalp Kadri %A Yip, Paul %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa Z %A Yu, Chuanhua %A Jin, Kim Yun %A El Sayed Zaki, Maysaa %A Zhao, Yong %A Zheng, Yingfeng %A Zhou, Maigeng %A Zhu, Jun %A Zou, Xiao Nong %A Lopez, Alan D %A Naghavi, Mohsen %A Murray, Christopher J L %A Lozano, Rafael %K Age Distribution %K Cause of Death %K Female %K Global Health %K HIV Infections %K Humans %K Maternal Mortality %K Models, Statistical %K Organizational Objectives %K Pregnancy %K Pregnancy Complications, Infectious %K Risk Factors %K Socioeconomic Factors %K Time Factors %X

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.

METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.

FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.

INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 384 %P 980-1004 %8 2014 Sep 13 %G eng %N 9947 %1 http://www.ncbi.nlm.nih.gov/pubmed/24797575?dopt=Abstract %R 10.1016/S0140-6736(14)60696-6 %0 Journal Article %J Lancet %D 2014 %T Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Wang, Haidong %A Liddell, Chelsea A %A Coates, Matthew M %A Mooney, Meghan D %A Levitz, Carly E %A Schumacher, Austin E %A Apfel, Henry %A Iannarone, Marissa %A Phillips, Bryan %A Lofgren, Katherine T %A Sandar, Logan %A Dorrington, Rob E %A Rakovac, Ivo %A Jacobs, Troy A %A Liang, Xiaofeng %A Zhou, Maigeng %A Zhu, Jun %A Yang, Gonghuan %A Wang, Yanping %A Liu, Shiwei %A Li, Yichong %A Ozgoren, Ayse Abbasoglu %A Abera, Semaw Ferede %A Abubakar, Ibrahim %A Achoki, Tom %A Adelekan, Ademola %A Ademi, Zanfina %A Alemu, Zewdie Aderaw %A Allen, Peter J %A AlMazroa, Mohammad AbdulAziz %A Alvarez, Elena %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Ammar, Walid %A Anwari, Palwasha %A Cunningham, Solveig Argeseanu %A Asad, Majed Masoud %A Assadi, Reza %A Banerjee, Amitava %A Basu, Sanjay %A Bedi, Neeraj %A Bekele, Tolesa %A Bell, Michelle L %A Bhutta, Zulfiqar %A Blore, Jed D %A Basara, Berrak Bora %A Boufous, Soufiane %A Breitborde, Nicholas %A Bruce, Nigel G %A Bui, Linh Ngoc %A Carapetis, Jonathan R %A Cárdenas, Rosario %A Carpenter, David O %A Caso, Valeria %A Castro, Ruben Estanislao %A Catalá-López, Ferrán %A Cavlin, Alanur %A Che, Xuan %A Chiang, Peggy Pei-Chia %A Chowdhury, Rajiv %A Christophi, Costas A %A Chuang, Ting-Wu %A Cirillo, Massimo %A da Costa Leite, Iuri %A Courville, Karen J %A Dandona, Lalit %A Dandona, Rakhi %A Davis, Adrian %A Dayama, Anand %A Deribe, Kebede %A Dharmaratne, Samath D %A Dherani, Mukesh K %A Dilmen, Uğur %A Ding, Eric L %A Edmond, Karen M %A Ermakov, Sergei Petrovich %A Farzadfar, Farshad %A Fereshtehnejad, Seyed-Mohammad %A Fijabi, Daniel Obadare %A Foigt, Nataliya %A Forouzanfar, Mohammad H %A Garcia, Ana C %A Geleijnse, Johanna M %A Gessner, Bradford D %A Goginashvili, Ketevan %A Gona, Philimon %A Goto, Atsushi %A Gouda, Hebe N %A Green, Mark A %A Greenwell, Karen Fern %A Gugnani, Harish Chander %A Gupta, Rahul %A Hamadeh, Randah Ribhi %A Hammami, Mouhanad %A Harb, Hilda L %A Hay, Simon %A Hedayati, Mohammad T %A Hosgood, H Dean %A Hoy, Damian G %A Idrisov, Bulat T %A Islami, Farhad %A Ismayilova, Samaya %A Jha, Vivekanand %A Jiang, Guohong %A Jonas, Jost B %A Juel, Knud %A Kabagambe, Edmond Kato %A Kazi, Dhruv S %A Kengne, Andre Pascal %A Kereselidze, Maia %A Khader, Yousef Saleh %A Khalifa, Shams Eldin Ali Hassan %A Khang, Young-Ho %A Kim, Daniel %A Kinfu, Yohannes %A Kinge, Jonas M %A Kokubo, Yoshihiro %A Kosen, Soewarta %A Defo, Barthelemy Kuate %A Kumar, G Anil %A Kumar, Kaushalendra %A Kumar, Ravi B %A Lai, Taavi %A Lan, Qing %A Larsson, Anders %A Lee, Jong-Tae %A Leinsalu, Mall %A Lim, Stephen S %A Lipshultz, Steven E %A Logroscino, Giancarlo %A Lotufo, Paulo A %A Lunevicius, Raimundas %A Lyons, Ronan Anthony %A Ma, Stefan %A Mahdi, Abbas Ali %A Marzan, Melvin Barrientos %A Mashal, Mohammad Taufiq %A Mazorodze, Tasara T %A McGrath, John J %A Memish, Ziad A %A Mendoza, Walter %A Mensah, George A %A Meretoja, Atte %A Miller, Ted R %A Mills, Edward J %A Mohammad, Karzan Abdulmuhsin %A Mokdad, Ali H %A Monasta, Lorenzo %A Montico, Marcella %A Moore, Ami R %A Moschandreas, Joanna %A Msemburi, William T %A Mueller, Ulrich O %A Muszynska, Magdalena M %A Naghavi, Mohsen %A Naidoo, Kovin S %A Narayan, K M Venkat %A Nejjari, Chakib %A Ng, Marie %A de Dieu Ngirabega, Jean %A Nieuwenhuijsen, Mark J %A Nyakarahuka, Luke %A Ohkubo, Takayoshi %A Omer, Saad B %A Caicedo, Angel J Paternina %A Pillay-van Wyk, Victoria %A Pope, Dan %A Pourmalek, Farshad %A Prabhakaran, Dorairaj %A Rahman, Sajjad U R %A Rana, Saleem M %A Reilly, Robert Quentin %A Rojas-Rueda, David %A Ronfani, Luca %A Rushton, Lesley %A Saeedi, Mohammad Yahya %A Salomon, Joshua A %A Sampson, Uchechukwu %A Santos, Itamar S %A Sawhney, Monika %A Schmidt, Jürgen C %A Shakh-Nazarova, Marina %A She, Jun %A Sheikhbahaei, Sara %A Shibuya, Kenji %A Shin, Hwashin Hyun %A Shishani, Kawkab %A Shiue, Ivy %A Sigfusdottir, Inga Dora %A Singh, Jasvinder A %A Skirbekk, Vegard %A Sliwa, Karen %A Soshnikov, Sergey S %A Sposato, Luciano A %A Stathopoulou, Vasiliki Kalliopi %A Stroumpoulis, Konstantinos %A Tabb, Karen M %A Talongwa, Roberto Tchio %A Teixeira, Carolina Maria %A Terkawi, Abdullah Sulieman %A Thomson, Alan J %A Thorne-Lyman, Andrew L %A Toyoshima, Hideaki %A Dimbuene, Zacharie Tsala %A Uwaliraye, Parfait %A Uzun, Selen Begüm %A Vasankari, Tommi J %A Vasconcelos, Ana Maria Nogales %A Vlassov, Vasiliy Victorovich %A Vollset, Stein Emil %A Waller, Stephen %A Wan, Xia %A Weichenthal, Scott %A Weiderpass, Elisabete %A Weintraub, Robert G %A Westerman, Ronny %A Wilkinson, James D %A Williams, Hywel C %A Yang, Yang C %A Yentur, Gokalp Kadri %A Yip, Paul %A Yonemoto, Naohiro %A Younis, Mustafa %A Yu, Chuanhua %A Jin, Kim Yun %A El Sayed Zaki, Maysaa %A Zhu, Shankuan %A Vos, Theo %A Lopez, Alan D %A Murray, Christopher J L %K Child Mortality %K Child, Preschool %K Global Health %K Humans %K Infant %K Infant Mortality %K Infant, Newborn %K Organizational Objectives %K Risk Factors %K Socioeconomic Factors %X

BACKGROUND: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.

METHODS: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.

FINDINGS: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.

INTERPRETATION: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.

FUNDING: Bill & Melinda Gates Foundation, US Agency for International Development.

%B Lancet %V 384 %P 957-79 %8 2014 Sep 13 %G eng %N 9947 %1 http://www.ncbi.nlm.nih.gov/pubmed/24797572?dopt=Abstract %R 10.1016/S0140-6736(14)60497-9