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Author: Baune, Bernhard × Author: Patton, George × Author: Azzopardi, Peter × Author: Borschmann, Rohan × End date: 2021 × Type: Journal Article ×

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    Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019
    Ward, JL ; Azzopardi, PS ; Francis, KL ; Santelli, JS ; Skirbekk, V ; Sawyer, SM ; Kassebaum, NJ ; Mokdad, AH ; Hay, SI ; Abd-Allah, F ; Abdoli, A ; Abdollahi, M ; Abedi, A ; Abolhassani, H ; Abreu, LG ; Abrigo, MRM ; Abu-Gharbieh, E ; Abushouk, AI ; Adebayo, OM ; Adekanmbi, V ; Adham, D ; Advani, SM ; Afshari, K ; Agrawal, A ; Ahmad, T ; Ahmadi, K ; Ahmed, AE ; Aji, B ; Akombi-Inyang, B ; Alahdab, F ; Al-Aly, Z ; Alam, K ; Alanezi, FM ; Alanzi, TM ; Alcalde-Rabanal, JE ; Alemu, BW ; Al-Hajj, S ; Alhassan, RK ; Ali, S ; Alicandro, G ; Alijanzadeh, M ; Aljunid, SM ; Almasi-Hashiani, A ; Almasri, NA ; Al-Mekhlafi, HM ; Alonso, J ; Al-Raddadi, RM ; Altirkawi, KA ; Alvis-Guzman, N ; Amare, AT ; Amini, S ; Aminorroaya, A ; Amit, AML ; Amugsi, DA ; Ancuceanu, R ; Anderlini, D ; Andrei, CL ; Androudi, S ; Ansari, F ; Ansari, I ; Antonio, CAT ; Anvari, D ; Anwer, R ; Appiah, SCY ; Arabloo, J ; Arab-Zozani, M ; Arnlov, J ; Asaad, M ; Asadi-Aliabadi, M ; Asadi-Pooya, AA ; Atout, MMW ; Ausloos, M ; Avenyo, EK ; Avila-Burgos, L ; Quintanilla, BPA ; Ayano, G ; Aynalem, YA ; Azari, S ; Azene, ZN ; Bakhshaei, MH ; Bakkannavar, SM ; Banach, M ; Banik, PC ; Barboza, MA ; Barker-Collo, SL ; Baernighausen, TW ; Basu, S ; Baune, BT ; Bayati, M ; Bedi, N ; Beghi, E ; Bekuma, TT ; Bell, AW ; Bell, ML ; Benjet, C ; Bensenor, IM ; Berhe, AK ; Berhe, K ; Berman, AE ; Bhagavathula, AS ; Bhardwaj, N ; Bhardwaj, P ; Bhattacharyya, K ; Bhattarai, S ; Bhutta, ZA ; Bijani, A ; Bikbov, B ; Biondi, A ; Birhanu, TTM ; Biswas, RK ; Bohlouli, S ; Bolla, SR ; Boloor, A ; Borschmann, R ; Boufous, S ; Bragazzi, NL ; Braithwaite, D ; Breitborde, NJK ; Brenner, H ; Britton, GB ; Burns, RA ; Nagaraja, SB ; Butt, ZA ; dos Santos, FLC ; Camera, LA ; Campos-Nonato, IR ; Campuzano Rincon, JC ; Cardenas, R ; Carreras, G ; Carrero, JJ ; Carvalho, F ; Castaldelli-Maia, JM ; Castaneda-Orjuela, CA ; Castelpietra, G ; Catala-Lopez, F ; Cerin, E ; Chandan, JS ; Chang, H-Y ; Chang, J-C ; Charan, J ; Chattu, VK ; Chaturvedi, S ; Choi, J-YJ ; Chowdhury, MAK ; Christopher, DJ ; Dinh-Toi, C ; Chung, MT ; Chung, S-C ; Cicuttini, FM ; Constantin, TV ; Costa, VM ; Dahlawi, SMA ; Dai, H ; Dai, X ; Damiani, G ; Dandona, L ; Dandona, R ; Daneshpajouhnejad, P ; Darwesh, AM ; Alberto Davila-Cervantes, C ; Davletov, K ; De la Hoz, FP ; De Leo, D ; Dervenis, N ; Desai, R ; Desalew, A ; Deuba, K ; Dharmaratne, SD ; Dhungana, GP ; Dianatinasab, M ; da Silva, DD ; Diaz, D ; Didarloo, A ; Djalalinia, S ; Dorostkar, F ; Doshi, CP ; Doshmangir, L ; Doyle, KE ; Duraes, AR ; Kalan, ME ; Ebtehaj, S ; Edvardsson, D ; El Tantawi, M ; Elgendy, IY ; El-Jaafary, SI ; Elsharkawy, A ; Eshrati, B ; Eskandarieh, S ; Esmaeilnejad, S ; Esmaeilzadeh, F ; Esteghamati, S ; Faro, A ; Farzadfar, F ; Fattahi, N ; Feigin, VL ; Ferede, TY ; Fereshtehnejad, S-M ; Fernandes, E ; Ferrara, P ; Filip, I ; Fischer, F ; Fisher, JL ; Foigt, NA ; Folayan, MO ; Fomenkov, AA ; Foroutan, M ; Fukumoto, T ; Gad, MM ; Gaidhane, AM ; Gallus, S ; Gebre, T ; Gebremedhin, KB ; Gebremeskel, GG ; Gebremeskel, L ; Gebreslassie, AA ; Gesesew, HA ; Ghadiri, K ; Ghafourifard, M ; Ghamari, F ; Ghashghaee, A ; Gilani, SA ; Gnedovskaya, EV ; Godinho, MA ; Golechha, M ; Goli, S ; Gona, PN ; Gopalani, SV ; Gorini, G ; Grivna, M ; Gubari, MIM ; Gugnani, HC ; Guimaraes, RA ; Guo, Y ; Gupta, R ; Haagsma, JA ; Hafezi-Nejad, N ; Haile, TG ; Haj-Mirzaian, A ; Haj-Mirzaian, A ; Hall, BJ ; Hamadeh, RR ; Abdullah, KH ; Hamidi, S ; Handiso, DW ; Hanif, A ; Hankey, GJ ; Haririan, H ; Maria Haro, J ; Hasaballah, AI ; Hashi, A ; Hassan, A ; Hassanipour, S ; Hassankhani, H ; Hayat, K ; Heidari-Soureshjani, R ; Herteliu, C ; Heydarpour, F ; Ho, HC ; Hole, MK ; Holla, R ; Hoogar, P ; Hosseini, M ; Hosseinzadeh, M ; Hostiuc, M ; Hostiuc, S ; Househ, M ; Hsairi, M ; Huda, TM ; Humayun, A ; Hussain, R ; Hwang, B-F ; Iavicoli, I ; Ibitoye, SE ; Ilesanmi, OS ; Ilic, IM ; Ilic, MD ; Inbaraj, LR ; Intarut, N ; Iqbal, U ; Irvani, SSN ; Islam, MM ; Islam, SMS ; Iso, H ; Ivers, RQ ; Jahani, MA ; Jakovljevic, M ; Jalali, A ; Janodia, MD ; Javaheri, T ; Jeemon, P ; Jenabi, E ; Jha, RP ; Jha, V ; Ji, JS ; Jonas, JB ; Jones, KM ; Joukar, F ; Jozwiak, JJ ; Juliusson, PB ; Jurisson, M ; Kabir, A ; Kabir, Z ; Kalankesh, LR ; Kalhor, R ; Kamyari, N ; Kanchan, T ; Karch, A ; Karimi, SE ; Kaur, S ; Kayode, GA ; Keiyoro, PN ; Khalid, N ; Khammarnia, M ; Khan, M ; Khan, MN ; Khatab, K ; Khater, MM ; Khatib, MN ; Khayamzadeh, M ; Khazaie, H ; Khoja, AT ; Kieling, C ; Kim, Y-E ; Kim, YJ ; Kimokoti, RW ; Kisa, A ; Kisa, S ; Kivimaki, M ; Koolivand, A ; Kosen, S ; Koyanagi, A ; Krishan, K ; Kugbey, N ; Kumar, GA ; Kumar, M ; Kumar, N ; Kurmi, OP ; Kusuma, D ; La Vecchia, C ; Lacey, B ; Lal, DK ; Lalloo, R ; Lan, Q ; Landires, I ; Lansingh, VC ; Larsson, AO ; Lasrado, S ; Lassi, ZS ; Lauriola, P ; Lee, PH ; Lee, SWH ; Leigh, J ; Leonardi, M ; Leung, J ; Levi, M ; Lewycka, S ; Li, B ; Li, M-C ; Li, S ; Lim, L-L ; Lim, SS ; Liu, X ; Lorkowski, S ; Lotufo, PA ; Lunevicius, R ; Maddison, R ; Mahasha, PW ; Mahdavi, MM ; Mahmoudi, M ; Majeed, A ; Maleki, A ; Malekzadeh, R ; Malta, DC ; Mamun, AA ; Mansouri, B ; Mansournia, MA ; Martinez, G ; Martinez-Raga, J ; Martins-Melo, FR ; Mason-Jones, AJ ; Masoumi, SZ ; Mathur, MR ; Maulik, PK ; McGrath, JJ ; Mehndiratta, MM ; Mehri, F ; Memiah, PTN ; Mendoza, W ; Menezes, RG ; Mengesha, EW ; Meretoja, A ; Meretoja, TJ ; Mestrovic, T ; Miazgowski, B ; Miazgowski, T ; Michalek, IM ; Miller, TR ; Mini, GK ; Mirica, A ; Mirrakhimov, EM ; Mirzaei, H ; Mirzaei, M ; Moazen, B ; Mohammad, DK ; Mohammadi, S ; Mohammadian-Hafshejani, A ; Mohammadifard, N ; Mohammadpourhodki, R ; Mohammed, S ; Monasta, L ; Moradi, G ; Moradi-Lakeh, M ; Moradzadeh, R ; Moraga, P ; Morrison, SD ; Mosapour, A ; Khaneghah, AM ; Mueller, UO ; Muriithi, MK ; Murray, CJL ; Muthupandian, S ; Naderi, M ; Nagarajan, AJ ; Naghavi, M ; Naimzada, MD ; Nangia, V ; Nayak, VC ; Nazari, J ; Ndejjo, R ; Negoi, I ; Negoi, RI ; Netsere, HB ; Nguefack-Tsague, G ; Diep, NN ; Huong, LTN ; Nie, J ; Ningrum, DNA ; Nnaji, CA ; Nomura, S ; Noubiap, JJ ; Nowak, C ; Nunez-Samudio, V ; Ogbo, FA ; Oghenetega, OB ; Oh, I-H ; Oladnabi, M ; Olagunju, AT ; Olusanya, BO ; Olusanya, JO ; Bali, AO ; Omer, MO ; Onwujekwe, OE ; Ortiz, A ; Otoiu, A ; Otstavnov, N ; Otstavnov, SS ; Overland, S ; Owolabi, MO ; Mahesh, PA ; Padubidri, JR ; Pakshir, K ; Palladino, R ; Pana, A ; Panda-Jonas, S ; Pandey, A ; Able Panelo, CI ; Park, E-K ; Patten, SB ; Peden, AE ; Filipino Pepito, VC ; Peprah, EK ; Pereira, J ; Pesudovs, K ; Hai, QP ; Phillips, MR ; Piradov, MA ; Pirsaheb, M ; Postma, MJ ; Pottoo, FH ; Pourjafar, H ; Pourshams, A ; Prada, SI ; Pupillo, E ; Syed, ZQ ; Rabiee, MH ; Rabiee, N ; Radfar, A ; Rafiee, A ; Raggi, A ; Rahim, F ; Rahimi-Movaghar, V ; Rahman, MHU ; Rahman, MA ; Ramezanzadeh, K ; Ranabhat, CL ; Rao, SJ ; Rashedi, V ; Rastogi, P ; Rathi, P ; Rawaf, DL ; Rawaf, S ; Rawal, L ; Rawassizadeh, R ; Renzaho, AMN ; Rezaei, N ; Rezaei, N ; Rezai, MS ; Riahi, SM ; Rickard, J ; Roever, L ; Ronfani, L ; Roth, GA ; Rubagotti, E ; Rumisha, SF ; Rwegerera, GM ; Sabour, S ; Sachdev, PS ; Saddik, B ; Sadeghi, E ; Moghaddam, SS ; Sagar, R ; Sahebkar, A ; Sahraian, MA ; Sajadi, SM ; Salem, MR ; Salimzadeh, H ; Samy, AM ; Sanabria, J ; Santric-Milicevic, MM ; Saraswathy, SYI ; Sarrafzadegan, N ; Sarveazad, A ; Sathish, T ; Sattin, D ; Saxena, D ; Saxena, S ; Schiavolin, S ; Schwebel, DC ; Schwendicke, F ; Senthilkumaran, S ; Sepanlou, SG ; Sha, F ; Shafaat, O ; Shahabi, S ; Shaheen, AA ; Shaikh, MA ; Shakiba, S ; Shamsi, MB ; Shannawaz, M ; Sharafi, K ; Sheikh, A ; Sheikhbahaei, S ; Shetty, BSK ; Shi, P ; Shigematsu, M ; Shin, JI ; Shiri, R ; Shuval, K ; Siabani, S ; Sigfusdottir, ID ; Sigurvinsdottir, R ; Santos Silva, DA ; Silva, JP ; Simonetti, B ; Singh, JA ; Singh, V ; Sinke, AH ; Skryabin, VY ; Slater, H ; Smith, EUR ; Sobhiyeh, MR ; Sobngwi, E ; Soheili, A ; Somefun, OD ; Sorrie, MB ; Soyiri, IN ; Sreeramareddy, CT ; Stein, DJ ; Stokes, MA ; Sudaryanto, A ; Sultan, I ; Tabares-Seisdedos, R ; Tabuchi, T ; Tadakamadla, SK ; Taherkhani, A ; Tamiru, AT ; Tareque, MI ; Thankappan, KR ; Thapar, R ; Thomas, N ; Titova, MV ; Tonelli, M ; Tovani-Palone, MR ; Bach, XT ; Travillian, RS ; Tsai, AC ; Tsatsakis, A ; Car, LT ; Uddin, R ; Unim, B ; Unnikrishnan, B ; Upadhyay, E ; Vacante, M ; Tahbaz, SV ; Valdez, PR ; Varughese, S ; Vasankari, TJ ; Venketasubramanian, N ; Villeneuve, PJ ; Violante, FS ; Vlassov, V ; Vos, T ; Giang, TV ; Waheed, Y ; Wamai, RG ; Wang, Y ; Wang, Y ; Wang, Y-P ; Westerman, R ; Wickramasinghe, ND ; Wu, A-M ; Wu, C ; Jabbari, SHY ; Yamagishi, K ; Yano, Y ; Yaya, S ; Yazdi-Feyzabadi, V ; Yeshitila, YG ; Yip, P ; Yonemoto, N ; Yoon, S-J ; Younis, MZ ; Yousefinezhadi, T ; Yu, C ; Yu, Y ; Yuce, D ; Zaidi, SS ; Bin Zaman, S ; Zamani, M ; Zamanian, M ; Zarafshan, H ; Zarei, A ; Zastrozhin, MS ; Zhang, Y ; Zhang, Z-J ; Zhao, X-JG ; Zhu, C ; Patton, GC ; Viner, RM (ELSEVIER SCIENCE INC, 2021-10-30)
    BACKGROUND: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS: We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). FINDINGS: In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39-1·59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1-4 years (2·4%), and around a third less than in females aged 1-4 years (2·5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. INTERPRETATION: Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. FUNDING: Bill & Melinda Gates Foundation.
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    Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017
    Roth, GA ; Abate, D ; Abate, KH ; Abay, SM ; Abbafati, C ; Abbasi, N ; Abbastabar, H ; Abd-Allah, L ; Abdela, J ; Abdelalim, A ; Abdollahpour, I ; Abdulkader, RS ; Abebe, HT ; Abebe, M ; Abebe, Z ; Abejie, AN ; Abera, SF ; Abil, OZ ; Abraha, HN ; Abrham, AR ; Abu-Raddad, LJ ; Accrombessi, MMK ; Acharya, D ; Adamu, AA ; Adebayo, O ; Adedoyin, RA ; Adekanmbi, V ; Adookunboh, O ; Adhena, BM ; Adib, MG ; Admasie, A ; Afshin, A ; Agarwal, G ; Agesa, KM ; Agrawal, A ; Agrawal, S ; Ahmadi, A ; Ahmadi, M ; Ahmed, MB ; Ahmed, S ; Aichour, AN ; Aichour, I ; Aichour, MTF ; Akbari, ME ; Akinyeniti, RO ; Akseer, N ; Al-Aly, Z ; Al-Eyadhy, A ; Al-Raddadi, RM ; Alandab, F ; Alam, K ; Alam, T ; Alebel, A ; Alene, KA ; Alijanzadeh, M ; Alizadeh-Navaei, R ; Aljunid, SM ; Alkerwi, A ; Alla, F ; Allebeck, P ; Alonso, J ; Altirkawi, K ; Alvis-Guzman, N ; Amare, AT ; Aminde, LN ; Amini, E ; Ammar, W ; Amoako, YA ; Anber, NH ; Andrei, CL ; Androudi, S ; Animut, MD ; Anjomshoa, M ; Ansari, H ; Aniha, MG ; Antonio, CAT ; Anwari, P ; Aremu, O ; Arnlov, J ; Arora, A ; Arora, M ; Artaman, A ; Aryal, KK ; Asayesh, H ; Asfaw, ET ; Ataro, Z ; Atique, S ; Atre, SR ; Ausloos, M ; Avokpaho, EFGA ; Awasthi, A ; Quintattilla, BPA ; Ayele, Y ; Ayer, R ; Azzopardi, PS ; Babazadeh, A ; Bacha, U ; Badali, H ; Badawi, A ; Bali, AG ; Ballesteros, KE ; Banach, M ; Banerjee, K ; Bannick, MS ; Banoub, JAM ; Barboza, MA ; Barker-Collo, SL ; Barnighausen, TW ; Barquera, S ; Barrero, L ; Bassat, Q ; Base, S ; Baune, BT ; Baynes, HW ; Bazargan-Hejazi, S ; Beth, N ; Beghi, E ; Behzadifar, M ; Behzadifar, M ; Bejot, Y ; Bekele, BB ; Belacliew, AB ; Belay, E ; Belay, YA ; Bell, ML ; Bello, AK ; Bennett, DA ; Bensenor, IM ; Berman, AF ; Bernabe, E ; Bernstein, RS ; Bertolacci, GJ ; Beuran, M ; Beyranvand, T ; Bhalla, A ; Bhattarai, S ; Bhaumik, S ; Bhutta, ZA ; Biadgo, B ; Biehl, MH ; Bijani, A ; Bikbov, B ; Bilano, V ; Bililign, N ; Bin Sayeed, MS ; Bisanzio, D ; Biswas, T ; Blacker, BF ; Basara, BB ; Borschmann, R ; Bosetti, C ; Bozorgmehr, K ; Brady, OJ ; Brant, LC ; Brayne, C ; Brazinova, A ; Breitborde, NJK ; Brenner, H ; Briant, PS ; Britton, G ; Brugha, T ; Busse, R ; Butt, ZA ; Callender, CSKH ; Campos-Nonato, IR ; Rincon, JCC ; Cano, J ; Car, M ; Cardenas, R ; Carreras, G ; Carrero, JJ ; Carter, A ; Carvalho, F ; Castaneda-Orjuela, CA ; Rivas, JC ; Castle, CD ; Castro, C ; Castro, F ; Catala-Lopez, F ; Cerin, E ; Chaiah, Y ; Chang, J-C ; Chanson, FJ ; Chaturvedi, P ; Chiang, PP-C ; Chimed-Ochir, O ; Chisumpa, VH ; Chitheet, A ; Chowdhury, R ; Christensen, H ; Christopher, DJ ; Chiang, S-C ; Cicuttini, FM ; Ciobanu, LG ; Cirillo, M ; Cohen, AJ ; Cooper, LT ; Cortesi, PA ; Cortinovis, M ; Cousin, E ; Cowie, BC ; Criqui, MH ; Cromwell, EA ; Crowe, CS ; Crump, JA ; Cunningham, M ; Daba, AK ; Dadi, AF ; Dandona, L ; Dandona, R ; Dang, AK ; Dargan, PI ; Daryani, A ; Das, SK ; Das Gupta, R ; Das Neves, J ; Dasa, TT ; Dash, AP ; Davis, AC ; Weaver, ND ; Davitoiu, DV ; Davletov, K ; De La Hoz, FP ; De Neve, J-W ; Degefa, MG ; Degenhardt, L ; Degfie, TT ; Deiparine, S ; Demoz, GT ; Demtsu, BB ; Denova-Gutierrez, E ; Deribe, K ; Dervenis, N ; Jarlais, DCD ; Dessie, GA ; Dey, S ; Dhannaratne, SD ; Dicker, D ; Dinberu, MT ; Ding, EL ; Dirac, MA ; Djalalinia, S ; Dokova, K ; Ter Doku, D ; Donnelly, CA ; Dorsey, ER ; Doshi, PP ; Douwes-Schultz, D ; Doyle, KE ; Driscoll, TR ; Dubey, M ; Dubljanin, E ; Duken, EE ; Duncan, BB ; Duraes, AR ; Ebrahimi, H ; Ebrahimpour, S ; Edessa, D ; Edvardsson, D ; Eggen, AE ; El Bcheraoui, C ; Zaki, MES ; El-Khatib, Z ; Elkout, H ; Eltinsel, CL ; Endres, M ; Endries, AY ; Er, B ; Erskine, HE ; Eshrati, B ; Eskandarieh, S ; Esmaeili, R ; Esteghamati, A ; Fakhar, M ; Fakhim, H ; Faramarzi, M ; Fareed, M ; Farhadi, F ; Faninha, CSES ; Faro, A ; Farvid, MS ; Farzadfar, F ; Farzaei, MH ; Feign, VL ; Feigl, AB ; Fentahun, N ; Eereshtehnejad, S-M ; Fernandes, E ; Fernandes, JC ; Ferrari, AJ ; Feyissa, GT ; Filip, I ; Finegold, S ; Fischer, F ; Eitzmaurice, C ; Foigt, NA ; Foreman, KJ ; Fornari, C ; Frank, TD ; Fukumoto, T ; Fuller, JE ; Fullman, N ; Furst, T ; Furtado, JM ; Futran, ND ; Gallus, S ; Garcia-Basteiro, AL ; Garcia-Gordillo, MA ; Gardner, WM ; Gebre, AK ; Gebrehiwol, TT ; Gebremedhin, AT ; Gebremichael, B ; Gebremichael, TG ; Gelano, TF ; Geleijinse, JM ; Genova-Maleras, R ; Geramo, YCD ; Gething, PW ; Gezae, KE ; Ghadami, MR ; Ghadimi, R ; Falavarjani, KG ; Ghasemi-Kasman, M ; Ghimire, M ; Gibney, KB ; Gill, PS ; Gill, TK ; Gillum, RF ; Ginawi, IA ; Giroud, M ; Giussani, G ; Goenka, S ; Goldberg, EM ; Goli, S ; Gomez-Dantes, H ; Gona, PN ; Gopalani, SV ; Gorman, TM ; Goto, A ; Goulart, AC ; Gnedovskaya, EV ; Grada, A ; Grosso, G ; Gugnani, HC ; Guimaraes, ALS ; Gun, N ; Gupta, PC ; Gupta, R ; Gupta, R ; Gupta, T ; Gutierrez, RA ; Gyawali, B ; Haagsma, JA ; Hafezi-Nejad, N ; Hagos, TB ; Hailegiyorgis, TT ; Hailu, GB ; Haj-Mirzaian, A ; Haj-Mirzaian, A ; Hamadeh, RR ; Hamidi, S ; Handal, MJ ; Hankey, GJ ; Harb, HL ; Harikrishnan, S ; 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Kassa, TD ; Kassebaum, NJ ; Katikireddi, SV ; Kaul, A ; Kazemi, Z ; Karyani, AK ; Kazi, DS ; Kefale, AT ; Keiyoro, PN ; Kemp, GR ; Kengne, AP ; Keren, A ; Kesavachandran, CN ; Khader, YS ; Khafaei, B ; Khafaie, MA ; Khajavi, A ; Khalid, N ; Khalil, IA ; Khan, EA ; Khan, MS ; Khan, MA ; Khang, Y-H ; Khater, MM ; Khoja, AT ; Khosravi, A ; Khosravi, MH ; Khubchandani, J ; Kiadaliri, AA ; Kibret, GD ; Kidanemariam, ZT ; Kiirithio, DN ; Kim, D ; Kim, Y-E ; Kim, YJ ; Kimokoti, RW ; Kinfu, Y ; Kisa, A ; Kissimova-Skarbek, K ; Kivimaki, M ; Knudsen, AKS ; Kocarnik, JM ; Kochhar, S ; Kokubo, Y ; Kolola, T ; Kopec, JA ; Koul, PA ; Koyanagi, A ; Kravchenko, MA ; Krishan, K ; Defo, BK ; Bicer, BK ; Kumar, GA ; Kumar, M ; Kumar, P ; Kutz, MJ ; Kuzin, I ; Kyu, HH ; Lad, DP ; Lad, SD ; Lafranconi, A ; Lal, DK ; Lalloo, R ; Lallukka, T ; Lam, JO ; Lami, FH ; Lansingh, VC ; Lansky, S ; Larson, HJ ; Latifi, A ; Lau, KM-M ; Lazarus, JV ; Lebedev, G ; Lee, PH ; Leigh, J ; Leili, M ; Leshargie, CT ; Li, S ; 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    BACKGROUND: Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS: The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. FINDINGS: At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. INTERPRETATION: Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. FUNDING: Bill & Melinda Gates Foundation.
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    Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
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    BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations. METHODS: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. FINDINGS: In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. INTERPRETATION: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. FUNDING: Bill & Melinda Gates Foundation.