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    Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016
    Fullman, N ; Barber, RM ; Abajobir, AA ; Abate, KH ; Abbafati, C ; Abbas, KM ; Abd-Allah, F ; Abdulle, AM ; Abera, SF ; Aboyans, V ; Abu-Raddad, LJ ; Abu-Rmeileh, NME ; Adedeji, IA ; Adetokunboh, O ; Afshin, A ; Agrawal, A ; Agrawal, S ; Kiadaliri, AA ; Ahmadieh, H ; Ahmed, MB ; Aichour, AN ; Aichour, I ; Aichour, MTE ; Aiyar, S ; Akinyemi, RO ; Akseer, N ; Al-Aly, Z ; Alam, K ; Alam, N ; Alasfoor, D ; Alene, KA ; Alizadeh-Navaei, R ; Alkerwi, A ; Alla, F ; Allebeck, P ; Allen, C ; Al-Raddadi, R ; Alsharif, U ; Altirkawi, KA ; Alvis-Guzman, N ; Amare, AT ; Amini, E ; Ammar, W ; Antonio, CAT ; Ansari, H ; Anwari, P ; Arora, M ; Artaman, A ; Aryal, KK ; Asayesh, H ; Asgedom, SW ; Assadi, R ; Atey, TM ; Atre, SR ; Avila-Burgos, L ; Avokpaho, EFGA ; Awasthi, A ; Azzopardi, P ; Bacha, U ; Badawi, A ; Balakrishnan, K ; Bannick, MS ; Barac, A ; Barker-Collo, SL ; Barnighausen, T ; Barrero, LH ; Basu, S ; Battle, KE ; Baune, BT ; Beardsley, J ; Bedi, N ; Bejot, Y ; Bell, ML ; Bennett, DA ; Bennett, JR ; Bensenor, IM ; Berhane, A ; Berhe, DF ; Bernabe, E ; Betsu, BD ; Beuran, M ; Beyene, AS ; Bhansali, A ; Bhatt, S ; Bhutta, ZA ; Bikbov, B ; Bilal, AI ; Birungi, C ; Biryukov, S ; Bizuayehu, HM ; Blosser, CD ; Boneya, DJ ; Bose, D ; Bou-Orm, IR ; Brauer, M ; Breitborde, NJK ; Brugha, TS ; Bulto, LNB ; Butt, ZA ; Cahuana-Hurtado, L ; Cameron, E ; Cesar Campuzano, J ; Cardenas, R ; Carrero, JJ ; Carter, A ; Casey, DC ; Castaneda-Orjuela, CA ; Castillo Rivas, J ; Estanislao Castro, R ; Catala-Lopez, F ; Cercy, K ; Chang, H-Y ; Chang, J-C ; Charlson, FJ ; Chew, A ; Chisumpa, VH ; Chitheer, AA ; Christensen, H ; Christopher, DJ ; Cirillo, M ; Cooper, C ; Criqui, MH ; Cromwell, EA ; Crump, JA ; Dandona, L ; Dandona, R ; Dargan, PI ; das Neves, J ; Davitoiu, DV ; de Courten, B ; De Steur, H ; Degenhardt, L ; Deiparine, S ; Deribe, K ; deveber, GA ; Ding, EL ; Djalalinia, S ; Huyen, PD ; Dokova, K ; Doku, DT ; Dorsey, ER ; Driscoll, TR ; Dubey, M ; Duncan, BB ; Ebel, BE ; Ebrahimi, H ; El-Khatib, ZZ ; Enayati, A ; Endries, AY ; Ermakov, SP ; Erskine, HE ; Eshrati, B ; Eskandarieh, S ; Esteghamati, A ; Estep, K ; Faraon, EJA ; E Sa Farinha, CS ; Faro, A ; Farzadfar, F ; Fazeli, MS ; Feigin, VL ; Feigl, AB ; Fereshtehnejad, S-M ; Fernandes, JC ; Ferrari, AJ ; Feyissa, TR ; Filip, I ; Fischer, F ; Fitzmaurice, C ; Flaxman, AD ; Foigt, N ; Foreman, KJ ; Frank, T ; Franklin, RC ; Friedman, J ; Frostad, JJ ; Furst, T ; Furtado, JM ; Gakidou, E ; Garcia-Basteiro, AL ; Gebrehiwot, TT ; Geleijnse, JM ; Geleto, A ; Gemechu, BL ; Gething, PW ; Gibney, KB ; Gill, PS ; Gillum, RF ; Giref, AZ ; Gishu, MD ; Giussani, G ; Glenn, SD ; Godwin, WW ; Goldberg, EM ; Gona, PN ; Goodridge, A ; Gopalani, SV ; Goryakin, Y ; Griswold, M ; Gugnani, HC ; Gupta, R ; Gupta, T ; Gupta, V ; Hafezi-Nejad, N ; Bidgoli, HH ; Hailu, GB ; Hamadeh, RR ; Hammami, M ; Hankey, GJ ; Harb, HL ; Hareri, HA ; Hassanvand, MS ; Havmoeller, R ; Hawley, C ; Hay, SI ; He, J ; Hendrie, D ; Henry, NJ ; Beatriz Heredia-Pi, I ; Hoek, HW ; Holmberg, M ; Horita, N ; Hosgood, HD ; Hostiuc, S ; Hoy, DG ; Hsairi, M ; Htet, AS ; Huang, H ; Huang, JJ ; Huynh, C ; Iburg, KM ; Ikeda, C ; Inoue, M ; Irvine, CMS ; Jacobsen, KH ; Jahanmehr, N ; Jakovljevic, MB ; Jauregui, A ; Javanbakht, M ; Jeemon, P ; Jha, V ; John, D ; Johnson, CO ; Johnson, SC ; Jonas, JB ; Jurisson, M ; Kabir, Z ; Kadel, R ; Kahsay, A ; Kamal, R ; Karch, A ; Karema, CK ; Kasaeian, A ; Kasaeian, A ; Kassebaum, NJ ; Kastor, A ; Katikireddi, SV ; Kawakami, N ; Keiyoro, PN ; Kelbore, SG ; Kemmer, L ; Kengne, AP ; Kesavachandran, CN ; Khader, YS ; Khalil, IA ; Khan, EA ; Khang, Y-H ; Khosravi, A ; Khubchandani, J ; Kieling, C ; Kim, D ; Kim, JY ; Kim, YJ ; Kimokoti, RW ; Kinfu, Y ; Kisa, A ; Kissimova-Skarbek, KA ; Kivimaki, M ; Kokubo, Y ; Kopec, JA ; Kosen, S ; Koul, PA ; Koyanagi, A ; Kravchenko, M ; Krohn, KJ ; Defo, BK ; Bicer, BK ; Kulikoff, XR ; Kumar, GA ; Kutz, MJ ; Kyu, HH ; Lal, DK ; Lalloo, R ; Lansingh, VC ; Larsson, A ; Lazarus, JV ; Lee, PH ; Leigh, J ; Leung, J ; Leung, R ; Levi, M ; Li, Y ; Liben, ML ; Linn, S ; Liu, PY ; Liu, S ; Lodha, R ; Looker, KJ ; Lopez, AD ; Lorkowski, S ; Lotufo, PA ; Lozano, R ; Lucas, TCD ; Mackay, MT ; Maddison, ER ; Abd el Razek, HM ; Abd el Razek, MM ; Majdan, M ; Majdzadeh, R ; Majeed, A ; Malekzadeh, R ; Malhotra, R ; Malta, DC ; Mamun, AA ; Manguerra, H ; Mantovani, LG ; Manyazewal, T ; Mapoma, CC ; Marks, GB ; Martin, RV ; Martins-Melo, FR ; Martopullo, I ; Mathur, MR ; Mazidi, M ; McAlinden, C ; McGaughey, M ; McGrath, JJ ; Mckee, M ; Mehata, S ; Mehndiratta, MM ; Meier, T ; Meles, KG ; Memish, ZA ; Mendoza, W ; Mengesha, MM ; Mengistie, MA ; Mensah, GA ; Mensink, GBM ; Mereta, ST ; Meretoja, A ; Meretoja, TJ ; Mezgebe, HB ; Micha, R ; Millear, A ; Miller, TR ; Minnig, S ; Mirarefin, M ; Mirrakhimov, EM ; Misganaw, A ; Mishra, SR ; Mitchell, PB ; Mohammad, KA ; Mohammed, KE ; Mohammed, S ; Mohan, MBV ; Mokdad, AH ; Mollenkopf, SK ; Monasta, L ; Montanez Hernandez, JC ; Montico, M ; Moradi-Lakeh, M ; Moraga, P ; Morawska, L ; Morrison, SD ; Moses, MW ; Mountjoy-Venning, C ; Mueller, UO ; Muller, K ; Murthy, GVS ; Musa, KI ; Naghavi, M ; Naheed, A ; Naidoo, KS ; Nangia, V ; Natarajan, G ; Negoi, I ; Negoi, RI ; Cuong, TN ; Grant, N ; Minh, N ; Quyen, LN ; Trang, HN ; Nichols, E ; Ningrum, DNA ; Nomura, M ; Vuong, MN ; Norheim, OF ; Noubiap, JJN ; Obermeyer, CM ; Ogbo, FA ; Oh, I-H ; Oladimeji, O ; Olagunju, AT ; Olagunju, TO ; Olivares, PR ; Olsen, HE ; Olusanya, BO ; Olusanya, JO ; Ong, K ; Oren, E ; Ortiz, A ; Owolabi, MO ; Pa, M ; Pana, A ; Panda, BK ; Panda-Jonas, S ; Papachristou, C ; Park, E-K ; Patton, GC ; Paulson, K ; Pereira, DM ; Perico, DN ; Pesudovs, K ; Petzold, M ; Phillips, MR ; Pigott, DM ; Pillay, JD ; Pinho, C ; Piradov, MA ; Pishgar, F ; Poulton, RG ; Pourmalek, F ; Qorbani, M ; Radfar, A ; Rafay, A ; Rao, PC ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MHU ; Rahman, MA ; Rai, RK ; Rajsic, S ; Ram, U ; Ranabhat, CL ; Rawaf, S ; Reidy, P ; Reiner, RC ; Reinig, N ; Reitsma, MB ; Remuzzi, G ; Renzaho, AMN ; Resnikoff, S ; Rezaei, S ; Rios Blancas, MJ ; Roba, KT ; Rojas-Rueda, D ; Rokni, MB ; Roshandel, G ; Roth, GA ; Roy, A ; Rubagotti, E ; Sadat, N ; Safdarian, M ; Safi, S ; Safiri, S ; Sagar, R ; Salama, J ; Salomon, JA ; Samy, AM ; Ramon Sanabria, J ; Santomauro, D ; Santos, IS ; Santos, JV ; Milicevic, MMS ; Sartorius, B ; Satpathy, M ; Sawhney, M ; Saxena, S ; Saylan, MI ; Shirude, S ; Schmidt, MI ; Schneider, IJC ; Schneider, MT ; Schottker, B ; Schutte, AE ; Schwebel, DC ; Schwendicke, F ; Seedat, S ; Sepanlou, SG ; Servan-Mori, EE ; Shackelford, KA ; Shaheen, A ; Shahraz, S ; Shaikh, MA ; Shamsipour, M ; Shamsizadeh, M ; Islam, SMS ; Sharma, J ; Sharma, R ; She, J ; Shi, P ; Shibuya, K ; Shields, C ; Shiferaw, MS ; Shigematsu, M ; Shin, M-J ; Shiri, R ; Shirkoohi, R ; Shishani, K ; Shoman, H ; Shrime, MG ; Santos Silva, DA ; Silva, JP ; Alves Silveira, DG ; Singh, JA ; Singh, V ; Sinha, DN ; Skiadaresi, E ; Slepak, EL ; Sligar, A ; Smith, A ; Smith, DL ; Smith, M ; Sobaih, BHA ; Sobngwi, E ; Soljak, M ; Soneji, S ; Sorensen, RJD ; Sposato, LA ; Sreeramareddy, CT ; Srinivasan, V ; Stanaway, JD ; Stein, DJ ; Steinke, S ; Stokes, MA ; Strub, B ; Sufiyan, MB ; Abdulkader, RS ; Sunguya, BF ; Sur, PJ ; Swaminathan, S ; Sykes, BL ; Sylte, DO ; Szoeke, CEI ; Tabares-Seisdedos, R ; Tadakamadla, SK ; Tandon, N ; Tao, T ; Tarekegn, YL ; Tavakkoli, M ; Taveira, N ; Tegegne, TK ; Shifa, GT ; Terkawi, AS ; Tessema, GA ; Thakur, JS ; Thankappan, KR ; Thrift, AG ; Tiruye, TY ; Tobe-Gai, R ; Topor-Madry, R ; Torre, A ; Tortajada, M ; Tran, BX ; Troeger, C ; Truelsen, T ; Tsoi, D ; Tuem, KB ; Tuzcu, EM ; Tyrovolas, S ; Ukwaja, KN ; Uneke, CJ ; Updike, R ; Uthman, OA ; van Boven, JFM ; van Donkelaar, A ; Varughese, S ; Vasankari, T ; Venketasubramanian, N ; Vidavalur, R ; Violante, FS ; Vladimirov, SK ; Vlassov, VV ; Vollset, SE ; Vos, T ; Wadilo, F ; Wakayo, T ; Wallin, MT ; Wang, Y-P ; Weichenthal, S ; Weiderpass, E ; Weintraub, RG ; Weiss, DJ ; Werdecker, A ; Westerman, R ; Whiteford, HA ; Wijeratne, T ; Wiysonge, CS ; Woldeyes, BG ; Wolfe, CDA ; Woodbrook, R ; Xavier, D ; Xu, G ; Yadgir, S ; Yakob, B ; Yan, LL ; Yano, Y ; Yaseri, M ; Ye, P ; Yimam, HH ; Yip, P ; Yonemoto, N ; Yoon, S-J ; Yotebieng, M ; Younis, MZ ; Zaidi, Z ; Zaki, MES ; Zavala-Arciniega, L ; Zhang, X ; Zipkin, B ; Zodpey, S ; Lim, SS ; Murray, CJL (ELSEVIER SCIENCE INC, 2017-09-16)
    BACKGROUND: The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. METHODS: We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment. FINDINGS: Globally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past. INTERPRETATION: GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations. FUNDING: Bill & Melinda Gates Foundation.
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    Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
    Hay, SI ; Abajobir, AA ; Abate, KH ; Abbafati, C ; Abbas, KM ; Abd-Allah, F ; Abdulle, AM ; Abebo, TA ; Abera, SF ; Aboyans, V ; Abu-Raddad, LJ ; Ackerman, IN ; Adedeji, IA ; Adetokunboh, O ; Afshin, A ; Aggarwal, R ; Agrawal, S ; Agrawal, A ; Kiadaliri, AA ; Ahmed, MB ; Aichour, AN ; Aichour, I ; Aichour, MTE ; Aiyar, S ; Akinyemiju, TF ; Akseer, N ; Al Lami, FH ; Alahdab, F ; Al-Aly, Z ; Alam, K ; Alam, N ; Alam, T ; Alasfoor, D ; Alene, KA ; Ali, R ; Alizadeh-Navaei, R ; Alkaabi, JM ; Alkerwi, A ; Alla, F ; Allebeck, P ; Allen, C ; Al-Maskari, F ; AlMazroa, MA ; Al-Raddadi, R ; Alsharif, U ; Alsowaidi, S ; Althouse, BM ; Altirkawi, KA ; Alvis-Guzman, N ; Amare, AT ; Amini, E ; Ammar, W ; Ampem, YA ; Ansha, MG ; Antonio, CAT ; Anwari, P ; Arnlov, J ; Arora, M ; Al, A ; Aryal, KK ; Asgedom, SW ; Atey, TM ; Atnafu, NT ; Avila-Burgos, L ; Avokpaho, EFGA ; Awasthi, A ; Awasthi, S ; Quintanilla, BPA ; Azarpazhooh, MR ; Azzopardi, P ; Babalola, TK ; Bacha, U ; Badawi, A ; Balakrishnan, K ; Bannick, MS ; Barac, A ; Barker-Collo, SL ; Barnighausen, T ; Barquera, S ; Barrero, LH ; Basu, S ; Battista, R ; Battle, KE ; Baune, BT ; Bazargan-Hejazi, S ; Beardsley, J ; Bedi, N ; Bejot, Y ; Bekele, BB ; Bell, ML ; Bennett, DA ; Bennett, JR ; Bensenor, IM ; Benson, J ; Berhane, A ; Berhe, DF ; Bernabe, E ; Betsu, BD ; Beuran, M ; Beyene, AS ; Bhansali, A ; Bhatt, S ; Bhutta, ZA ; Biadgilign, S ; Bienhoff, K ; Bikbov, B ; Birungi, C ; Biryukov, S ; Bisanzio, D ; Bizuayehu, HM ; Blyth, FM ; Boneya, DJ ; Bose, D ; Bou-Orm, IR ; Bourne, RRA ; Brainin, M ; Brayne, CEG ; Brazinova, A ; Breitborde, NJK ; Briant, PS ; Britton, G ; Brugha, TS ; Buchbinder, R ; Bulto, LNB ; Bumgarner, B ; Butt, ZA ; Cahuana-Hurtado, L ; Cameron, E ; Ricardo Campos-Nonato, I ; Carabin, H ; Cardenas, R ; Carpenter, DO ; Carrero, JJ ; Carter, A ; Carvalho, F ; Casey, D ; Castaneda-Orjuela, CA ; Rivas, JC ; Castle, CD ; Catala-Lopez, F ; Chang, J-C ; Charlson, FJ ; Chaturvedi, P ; Chen, H ; Chibalabala, M ; Chibueze, CE ; Chisumpa, VH ; Chitheer, AA ; Chowdhury, R ; Christopher, DJ ; Ciobanu, LG ; Cirillo, M ; Colombara, D ; Cooper, LT ; Cooper, C ; Cortesi, PA ; Cortinovis, M ; Criqui, MH ; Cromwell, EA ; Cross, M ; Crump, JA ; Dadi, AF ; Dalal, K ; Damasceno, A ; Dandona, L ; Dandona, R ; das Neves, J ; Davitoiu, DV ; Davletov, K ; de Courten, B ; de Leo, D ; De Steur, H ; Degenhardt, L ; Deiparine, S ; Dellavalle, RP ; Deribe, K ; Deribew, A ; Des Jarlais, DC ; Dey, S ; Dharmaratne, SD ; Dhillon, PK ; Dicker, D ; Djalalinia, S ; Huyen, PD ; Dokova, K ; Doku, DT ; Dorsey, ER ; Bender dos Santos, KP ; Driscoll, TR ; Dubey, M ; Duncan, BB ; Ebel, BE ; Echko, M ; El-Khatib, ZZ ; Enayati, A ; Endries, AY ; Ermakov, SP ; Erskine, HE ; Eshetie, S ; Eshrati, B ; Esteghamati, A ; Estep, K ; Fanuel, FBB ; Farag, T ; Sofia, C ; Farinha, S ; Faro, A ; Farzadfar, F ; Fazeli, MS ; Feigin, VL ; Feigl, AB ; Fereshtehnejad, S-M ; Fernandes, JC ; Ferrari, AJ ; Feyissa, TR ; Filip, I ; Fischer, F ; Fitzmaurice, C ; Flaxman, AD ; Foigt, N ; Foreman, KJ ; Franklin, RC ; Frostad, JJ ; Fullman, N ; Furst, T ; Furtado, JM ; Futran, ND ; Gakidou, E ; Garcia-Basteiro, AL ; Gebre, T ; Gebregergs, GB ; Gebrehiwot, TT ; Geleijnse, JM ; Geleto, A ; Gemechu, BL ; Gesesew, HA ; Gething, PW ; Ghajar, A ; Gibney, KB ; Gillum, RF ; Ginawi, IAM ; Gishu, MD ; Giussani, G ; Godwin, WW ; Goel, K ; Goenka, S ; Goldberg, EM ; Gona, PN ; Goodridge, A ; Gopalani, SV ; Gosselin, RA ; Gotay, CC ; Goto, A ; Goulart, AC ; Graetz, N ; Gugnani, HC ; Gupta, R ; Gupta, PC ; Gupta, T ; Gupta, V ; Gupta, R ; Gutierrez, RA ; Hachinski, V ; Hafezi-Nejad, N ; Hailu, AD ; Hailu, GB ; Hamadeh, RR ; Hamidi, S ; Hammami, M ; Handal, AJ ; Hankey, GJ ; Hao, Y ; Harb, HL ; Hareri, HA ; Haro, JM ; Harun, KM ; Harvey, J ; Hassanvand, MS ; Havmoeller, R ; Hay, RJ ; Hedayati, MT ; Hendrie, D ; Henry, NJ ; Heredia-Pi, IB ; Heydarpour, P ; Hoek, HW ; Hoffman, HJ ; Horino, M ; Horita, N ; Hosgood, HD ; Hostiuc, S ; Hotez, PJ ; Hoy, DG ; Htet, AS ; Hu, G ; Huang, JJ ; Huynh, C ; Iburg, KM ; Igumbor, EU ; Ikeda, C ; Irvine, CMS ; Jacobsen, KH ; Jahanmehr, N ; Jakovljevic, MB ; James, P ; Jassal, SK ; Javanbakht, M ; Jayaraman, SP ; Jeemon, P ; Jensen, PN ; Jha, V ; Jiang, G ; John, D ; Johnson, CO ; Johnson, SC ; Jonas, JB ; Jurisson, M ; Kabir, Z ; Kadel, R ; Kahsay, A ; Kamal, R ; Kar, C ; Karam, NE ; Karch, A ; Karema, CK ; Karimi, SM ; Karimkhani, C ; Kasaeian, A ; Kassa, GM ; Kassebaum, NJ ; Kassaw, NA ; Kastor, A ; Katikireddi, SV ; Kaul, A ; Kawakami, N ; Keiyoro, PN ; Kemmer, L ; Kengne, AP ; Keren, A ; Kesavachandran, CN ; Khader, YS ; Khalil, IA ; Khan, EA ; Khang, Y-H ; Khoja, AT ; Khosravi, A ; Khubchandani, J ; Kieling, C ; Kim, YJ ; Kim, D ; Kimokoti, RW ; Kinfu, Y ; Kisa, A ; Kissimova-Skarbek, KA ; Kissoon, N ; Kivimaki, M ; Knudsen, AK ; Kokubo, Y ; Kolte, D ; Kopec, JA ; Kosen, S ; Kotsakis, GA ; Koul, PA ; Koyanagi, A ; Kravchenko, M ; Krohn, KJ ; Defo, BK ; Bicer, BK ; Kumar, GA ; Kumar, P ; Kyu, HH ; Lager, ACJ ; Lal, DK ; Lalloo, R ; Lallukka, T ; Lambert, N ; Lan, Q ; Lansingh, VC ; Larsson, A ; Leasher, JL ; Lee, PH ; Leigh, J ; Leshargie, CT ; Leung, J ; Leung, R ; Levi, M ; Li, Y ; Li, Y ; Liang, X ; Liben, ML ; Lim, SS ; Linn, S ; Liu, A ; Liu, PY ; Liu, S ; Liu, Y ; Lodha, R ; Logroscino, G ; Looker, KJ ; Lopez, AD ; Lorkowski, S ; Lotufo, PA ; Lozano, R ; Lucas, TCD ; Lunevicius, R ; Lyons, RA ; Macarayan, ERK ; Maddison, ER ; Abd el Razek, HM ; Magis-Rodriguez, C ; Mahdavi, M ; Majdan, M ; Majdzadeh, R ; Majeed, A ; Malekzadeh, R ; Malhotra, R ; Malta, DC ; Mamun, AA ; Manguerra, H ; Manhertz, T ; Mantovani, LG ; Mapoma, CC ; March, LM ; Marczak, LB ; Martinez-Raga, J ; Henrique, P ; Martins, V ; Martins-Melo, FR ; Martopullo, I ; Marz, W ; Mathur, MR ; Mazidi, M ; McAlinden, C ; McGaughey, M ; McGrath, JJ ; Mckee, M ; Mehata, S ; Meier, T ; Meles, KG ; Memiah, P ; Memish, ZA ; Mendoza, W ; Mengesha, MM ; Mengistie, MA ; Mengistu, DT ; Mensah, GA ; Meretoja, A ; Meretoja, TJ ; Mezgebe, HB ; Micha, R ; Millear, A ; Miller, TR ; Minnig, S ; Mirarefin, M ; Mirrakhimov, EM ; Misganaw, A ; Mishra, SR ; Mitchell, PB ; Mohammad, KA ; Mohammadi, A ; Mohammed, S ; Mohammed, KE ; Mohammed, MSK ; Mohan, MBV ; Mokdad, AH ; Mollenkopf, SK ; Monasta, L ; Montanez Hernandez, JC ; Montico, M ; Moradi-Lakeh, M ; Moraga, P ; Morawska, L ; Mori, R ; Morrison, SD ; Moses, M ; Mountjoy-Venning, C ; Mruts, KB ; Mueller, UO ; Muller, K ; Mudoch, ME ; Murthy, S ; Murthy, GVS ; Musa, KI ; Nachega, JB ; Nagel, G ; Naghavi, M ; Naheed, A ; Naidoo, KS ; Nangia, V ; Nasher, JT ; Natarajan, G ; Negasa, DE ; Negoi, I ; Negoi, RI ; Newton, CR ; Ngunjiri, JW ; Cuong, TN ; Quyen, LN ; Grant, N ; Trang, HN ; Minh, N ; Nichols, E ; Ningrum, DNA ; Vuong, MN ; Norheim, OF ; Norrving, B ; Noubiap, JJN ; Nyandwi, A ; Obermeyer, CM ; O'Donnell, MJ ; Ogbo, FA ; Oh, I-H ; Okoro, A ; Oladimeji, O ; Olagunju, AT ; Olagunju, TO ; Olsen, HE ; Olusanya, BO ; Olusanya, JO ; Ong, K ; Opio, JN ; Oren, E ; Ortiz, A ; Osborne, RH ; Osgood-Zimmerman, A ; Osman, M ; Ota, E ; Owolabi, MO ; Pa, M ; Pacella, RE ; Panda, BK ; Pandian, JD ; Papachristou, C ; Park, E-K ; Parry, CD ; Parsaeian, M ; Patil, ST ; Patten, SB ; Patton, GC ; Paudel, D ; Paulson, K ; Pearce, N ; Pereira, DM ; Perez, KM ; Perico, N ; Pesudovs, K ; Peterson, CB ; Petri, WA ; Petzold, M ; Phillips, MR ; Phipps, G ; Pigott, DM ; Pillay, JD ; Pinho, C ; Piradov, MA ; Plass, D ; Pletcher, MA ; Popova, S ; Poulton, RG ; Pourmalek, F ; Prabhakaran, D ; Prasad, N ; Purcell, C ; Purwar, M ; Qorbani, M ; Rabiee, RHS ; Radfar, A ; Rafay, A ; Rahimi, K ; Rahimi-Movaghar, A ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MA ; Rahman, MHU ; Rai, RK ; Rajsic, S ; Ram, U ; Ranabhat, CL ; Rangaswamy, T ; Rankin, Z ; Rao, PV ; Rao, PC ; Rawaf, S ; Ray, SE ; Reiner, RC ; Reinig, N ; Reitsma, M ; Remuzzi, G ; Renzaho, AMN ; Resnikoff, S ; Rezaei, S ; Ribeiro, AL ; Roba, HS ; Robinson, SR ; Rojas-Rueda, D ; Rokni, MB ; Ronfani, L ; Roshandel, G ; Roth, GA ; Rothenbacher, D ; Roy, A ; Rubagotti, E ; Ruhago, GM ; Saadat, S ; Safdarian, M ; Safiri, S ; Sagar, R ; Sahathevan, R ; Sahraian, MA ; Salama, J ; Saleh, MM ; Salomon, JA ; Salvi, SS ; Samy, AM ; Sanabria, JR ; Dolores Sanchez-Nino, M ; Santomauro, D ; Santos, JV ; Santos, IS ; Milicevic, MMS ; Sartorius, B ; Satpathy, M ; Sawhney, M ; Saxena, S ; Schelonka, K ; Schmidt, MI ; Schneider, IJC ; Ben, S ; Schutte, AE ; Schwebel, DC ; Schwendicke, F ; Seedat, S ; Sepanlou, SG ; Servan-Mori, EE ; Shaheen, A ; Shaikh, MA ; Shamsipour, M ; Islam, SMS ; Sharma, R ; Sharma, J ; She, J ; Shi, P ; Shibuya, K ; Shields, C ; Shiferaw, MS ; Shigematsu, M ; Shiri, R ; Shirkoohi, R ; Shirude, S ; Shishani, K ; Shoman, H ; Siabani, S ; Sibai, AM ; Sigfusdottir, ID ; Silberberg, DH ; Silva, JP ; Santos Silva, DA ; Alves Silveira, DG ; Singh, JA ; Singh, V ; Singh, OP ; Singh, NP ; Sinha, DN ; Skiadaresi, E ; Skirbekk, V ; Slepak, EL ; Smith, DL ; Smith, M ; Sobaih, BHA ; Sobngwi, E ; Soljak, M ; Sorensen, RJD ; Moraes Sousa, TC ; Sposato, LA ; Sufiyan, MB ; Abdulkader, RS ; Sunguya, BF ; Sur, PJ ; Swaminathan, S ; Sykes, BL ; Sylte, D ; Szoeke, CEI ; Tabares-Seisdedos, R ; Tadakamadla, SK ; Taffere, GR ; Takala, JS ; Tandon, N ; Tanne, D ; Tarekegn, YL ; Tavakkoli, M ; Taveira, N ; Taylor, HR ; Tegegne, TK ; Tehrani-Banihashemi, A ; Tekelab, T ; Shifa, GT ; Terkawi, AS ; Tesfaye, DJ ; Tesssema, B ; Thakur, JS ; Thamsuwan, O ; Theadom, AM ; Theis, AM ; Thomas, KE ; Thomas, N ; Thompson, R ; Thrift, AG ; Tobe-Gai, R ; Tobollik, M ; Tonelli, M ; Topor-Madry, R ; Tortajada, M ; Touvier, M ; Traebert, J ; Tran, BX ; Troeger, C ; Truelsen, T ; Tsoi, D ; Tuzcu, EM ; Tymeson, H ; Tyrovolas, S ; Ukwaja, KN ; Undurraga, EA ; Uneke, CJ ; Updike, R ; Uthman, OA ; Uzochukwu, BSC ; van Boven, JFM ; Varughese, S ; Vasankari, T ; Veerman, LJ ; Venkatesh, S ; Venketasubramanian, N ; Vidavalur, R ; Vijayakumar, L ; Violante, FS ; Vishnu, A ; Vladimirov, SK ; Vlassov, VV ; Vollset, SE ; Vos, T ; Wadilo, F ; Wakayo, T ; Wallin, MT ; Wang, Y-P ; Weichenthal, S ; Weiderpass, E ; Weintraub, RG ; Weiss, DJ ; Werdecker, A ; Westerman, R ; Whiteford, HA ; Wijeratne, T ; Williams, HC ; Wiysonge, CS ; Woldeyes, BG ; Wolfe, CDA ; Woodbrook, R ; Woolf, AD ; Workicho, A ; Xavier, D ; Xu, G ; Yadgir, S ; Yaghoubi, M ; Yakob, B ; Yan, LL ; Yano, Y ; Ye, P ; Yihdego, MG ; Yimam, HH ; Yip, P ; Yonemoto, N ; Yoon, S-J ; Yotebieng, M ; Younis, MZ ; Yu, C ; Zaidi, Z ; Zaki, MES ; Zegeye, EA ; Zenebe, ZM ; Zhang, X ; Zheng, Y ; Zhou, M ; Zipkin, B ; Zodpey, S ; Zoeckler, L ; Zuhlke, LJ ; Murray, CJL (ELSEVIER SCIENCE INC, 2017-09-16)
    BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation.
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    Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015
    Barber, RM ; Fullman, N ; Sorensen, RJD ; Bollyky, T ; McKee, M ; Nolte, E ; Abajobir, AA ; Abate, KH ; Abbafati, C ; Abbas, KM ; Abd-Allah, F ; Abdulle, AM ; Abdurahman, AA ; Abera, SF ; Abraham, B ; Abreha, GF ; Adane, K ; Adelekan, AL ; Adetifa, IMO ; Afshin, A ; Agarwal, A ; Agarwal, SK ; Agarwal, S ; Agrawal, A ; Kiadaliri, AA ; Ahmadi, A ; Ahmed, KY ; Ahmed, MB ; Akinyemi, RO ; Akinyemiju, TF ; Akseer, N ; Al-Aly, Z ; Alam, K ; Alam, N ; Alam, SS ; Alemu, ZA ; Alene, KA ; Alexander, L ; Ali, R ; Ali, SD ; Alizadeh-Navaei, R ; Alkerwi, A ; Alla, F ; Allebeck, P ; Allen, C ; Al-Raddadi, R ; Alsharif, U ; Altirkawi, KA ; Martin, EA ; Alvis-Guzman, N ; Amare, AT ; Amini, E ; Ammar, W ; Amo-Adjei, J ; Amoako, YA ; Anderson, BO ; Androudi, S ; Ansari, H ; Ansha, MG ; Antonio, CAT ; Aernloev, J ; Artaman, A ; Asayesh, H ; Assadi, R ; Astatkie, A ; Atey, TM ; Atique, S ; Atnafu, NT ; Atre, SR ; Avila-Burgos, L ; Avokpaho, EFGA ; Quintanilla, BPA ; Awasthi, A ; Ayele, NN ; Azzopardi, P ; Saleem, HOB ; Baernighausen, T ; Bacha, U ; Badawi, A ; Banerjee, A ; Barac, A ; Barboza, MA ; Barker-Collo, SL ; Barrero, LH ; Basu, S ; Baune, BT ; Baye, K ; Bayou, YT ; Bazargan-Hejazi, S ; Bedi, N ; Beghi, E ; Bejot, Y ; Bello, AK ; Bennett, DA ; Bensenor, IM ; Berhane, A ; Bernabe, E ; Bernal, OA ; Beyene, AS ; Beyene, TJ ; Bhutta, ZA ; Biadgilign, S ; Bikbov, B ; Birlik, SM ; Birungi, C ; Biryukov, S ; Bisanzio, D ; Bizuayehu, HM ; Bose, D ; Brainin, M ; Brauer, M ; Brazinova, A ; Breitborde, NJK ; Brenner, H ; Butt, ZA ; Cardenas, R ; Cahuana-Hurtado, L ; Campos-Nonato, IR ; Car, J ; Carrero, JJ ; Casey, D ; Caso, V ; Castaneda-Orjuela, CA ; Rivas, JC ; Catala-Lopez, F ; Cecilio, P ; Cercy, K ; Charlson, FJ ; Chen, AZ ; Chew, A ; Chibalabala, M ; Chibueze, CE ; Chisumpa, VH ; Chitheer, AA ; Chowdhury, R ; Christensen, H ; Christopher, DJ ; Ciobanu, LG ; Cirillo, M ; Coggeshall, MS ; Cooper, LT ; Cortinovis, M ; Crump, JA ; Dalal, K ; Dandona, L ; Dandona, R ; Dargan, PI ; das Neves, J ; Davey, G ; Davitoiu, DV ; Davletov, K ; De Leo, D ; Del Gobbo, LC ; del Pozo-Cruz, B ; Dellavalle, RP ; Deribe, K ; Deribew, A ; Jarlais, DCD ; Dey, S ; Dharmaratne, SD ; Dicker, D ; Ding, EL ; Dokova, K ; Dorsey, ER ; Doyle, KE ; Dubey, M ; Ehrenkranz, R ; Ehrenkranz, R ; Ellingsen, CL ; Elyazar, I ; Enayati, A ; Ermakov, SP ; Eshrati, B ; Esteghamati, A ; Estep, K ; Fuerst, T ; Faghmous, IDA ; Fanuel, FBB ; Faraon, EJA ; Farid, TA ; Farinha, CSES ; Faro, A ; Farvid, MS ; Farzadfar, F ; Feigin, VL ; Feigl, AB ; Fereshtehnejad, S-M ; Fernandes, JG ; Fernandes, JC ; Feyissa, TR ; Fischer, F ; Fitzmaurice, C ; Fleming, TD ; Foigt, N ; Foreman, KJ ; Forouzanfar, MH ; Franklin, RC ; Frostad, J ; hiwot, TTG ; Gakidou, E ; Gambashidze, K ; Gamkrelidze, A ; Gao, W ; Garcia-Basteiro, AL ; Gebre, T ; Gebremedhin, AT ; Gebremichael, MW ; Gebru, AA ; Gelaye, AA ; Geleijnse, JM ; Genova-Maleras, R ; Gibney, KB ; Giref, AZ ; Gishu, MD ; Giussani, G ; Godwin, WW ; Gold, A ; Goldberg, EM ; Gona, PN ; Goodridge, A ; Gopalani, SV ; Goto, A ; Graetz, N ; Greaves, F ; Griswold, M ; Guban, PI ; Gugnani, HC ; Gupta, PC ; Gupta, R ; Gupta, R ; Gupta, T ; Gupta, V ; Habtewold, TD ; Hafezi-Nejad, N ; Haile, D ; Hailu, AD ; Hailu, GB ; Hakuzimana, A ; Hamadeh, RR ; Hambisa, MT ; Hamidi, S ; Hammami, M ; Hankey, GJ ; Hao, Y ; Harb, HL ; Hareri, HA ; Haro, JM ; Hassanvand, MS ; Havmoeller, R ; Hay, RJ ; Hay, SI ; Hendrie, D ; Heredia-Pi, IB ; Hoek, HW ; Horino, M ; Horita, N ; Hosgood, HD ; Htet, AS ; Hu, G ; Huang, H ; Huang, JJ ; Huntley, BM ; Huynh, C ; Iburg, KM ; Ileanu, BV ; Innos, K ; Irenso, AA ; Jahanmehr, N ; Jakovljevic, MB ; James, P ; James, SL ; Javanbakht, M ; Jayaraman, SP ; Jayatilleke, AU ; Jeemon, P ; Jha, V ; John, D ; Johnson, C ; Johnson, SC ; Jonas, JB ; Juel, K ; Kabir, Z ; Kalkonde, Y ; Kamal, R ; Kan, H ; Karch, A ; Karema, CK ; Karimi, SM ; Kasaeian, A ; Kassebaum, NJ ; Kastor, A ; Katikireddi, SV ; Kazanjan, K ; Keiyoro, PN ; Kemmer, L ; Kemp, AH ; Kengne, AP ; Kerbo, AA ; Kereselidze, M ; Kesavachandran, CN ; Khader, YS ; Khalil, I ; Khan, AR ; Khan, EA ; Khan, G ; Khang, Y-H ; Khoja, ATA ; Khonelidze, I ; Khubchandani, J ; Kibret, GD ; Kim, D ; Kim, P ; Kim, YJ ; Kimokoti, RW ; Kinfu, Y ; Kissoon, N ; Kivipelto, M ; Kokubo, Y ; Kolk, A ; Kolte, D ; Kopec, JA ; Kosen, S ; Koul, PA ; Koyanagi, A ; Kravchenko, M ; Krishnaswami, S ; Krohn, KJ ; Defo, BK ; Bicer, BK ; Kuipers, EJ ; Kulkarni, VS ; Kumar, GA ; Kumsa, FA ; Kutz, M ; Kyu, HH ; Lager, ACJ ; Lal, A ; Lal, DK ; Lalloo, R ; Lallukka, T ; Lan, Q ; Langan, SM ; Lansingh, VC ; Larson, HJ ; Larsson, A ; Laryea, DO ; Latif, AA ; Lawrynowicz, AEB ; Leasher, JL ; Leigh, J ; Leinsalu, M ; Leshargie, CT ; Leung, J ; Leung, R ; Levi, M ; Liang, X ; Lim, SS ; Lind, M ; Linn, S ; Lipshultz, SE ; Liu, P ; Liu, Y ; Lo, L-T ; Logroscino, G ; Lopez, AD ; Lorch, SA ; Lotufo, PA ; Lozano, R ; Lunevicius, R ; Lyons, RA ; Macarayan, ERK ; Mackay, MT ; El Razek, HMA ; El Razek, MMA ; Mahdavi, M ; Majeed, A ; Malekzadeh, R ; Malta, DC ; Mantovani, LG ; Manyazewal, T ; Mapoma, CC ; Marcenes, W ; Marks, GB ; Marquez, N ; Martinez-Raga, J ; Marzan, MB ; Massano, J ; Mathur, MR ; Maulik, PK ; Mazidi, M ; McAlinden, C ; McGrath, JJ ; McNellan, C ; Meaney, PA ; Mehari, A ; Mehndiratta, MM ; Meier, T ; Mekonnen, AB ; Meles, KG ; Memish, ZA ; Mengesha, MM ; Mengiste, DT ; Mengistie, MA ; Menota, BG ; Mensah, GA ; Mereta, ST ; Meretoja, A ; Meretoja, TJ ; Mezgebe, HB ; Micha, R ; Millear, A ; Mills, EJ ; Minnig, S ; Mirarefin, M ; Mirrakhimov, EM ; Mock, CN ; Mohammad, KA ; Mohammed, S ; Mohanty, SK ; Mokdad, AH ; Mola, GLD ; Molokhia, M ; Monasta, L ; Montico, M ; Moradi-Lakeh, M ; Moraga, P ; Morawska, L ; Mori, R ; Moses, M ; Mueller, UO ; Murthy, S ; Musa, KI ; Nachega, JB ; Nagata, C ; Nagel, G ; Naghavi, M ; Naheed, A ; Naldi, L ; Nangia, V ; Nascimento, BR ; Negoi, I ; Neupane, SP ; Newton, CR ; Ng, M ; Ngalesoni, FN ; Ngunjiri, JW ; Nguyen, G ; Ningrum, DNA ; Nolte, S ; Nomura, M ; Norheim, OF ; Norrving, B ; Noubiap, JJN ; Obermeyer, CM ; Ogbo, FA ; Oh, I-H ; Okoro, A ; Oladimeji, O ; Olagunju, AT ; Olivares, PR ; Olsen, HE ; Olusanya, BO ; Olusanya, JO ; Opio, JN ; Oren, E ; Ortiz, A ; Osborne, RH ; Osman, M ; Owolabi, MO ; Mahesh, PA ; Pain, AW ; Pakhale, S ; Castillo, EP ; Pana, A ; Papachristou, C ; Parsaeian, M ; Patel, T ; Patton, GC ; Paudel, D ; Paul, VK ; Pearce, N ; Pereira, DM ; Perez-Padilla, R ; Perez-Ruiz, F ; Perico, N ; Pesudovs, K ; Petzold, M ; Phillips, MR ; Pigott, DM ; Pillay, JD ; Pinho, C ; Polinder, S ; Pond, CD ; Prakash, V ; Purwar, M ; Qorbani, M ; Quistberg, DA ; Radfar, A ; Rafay, A ; Rahimi, K ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MHU ; Rai, RK ; Ram, U ; Rana, SM ; Rankin, Z ; Rao, PV ; Rao, PC ; Rawaf, S ; Rego, MAS ; Reitsma, M ; Remuzzi, G ; Renzaho, AMNN ; Resnikoff, S ; Rezaei, S ; Rezai, MS ; Ribeiro, AL ; Roba, HS ; Rokni, MB ; Ronfani, L ; Roshandel, G ; Roth, GA ; Rothenbacher, D ; Roy, NK ; Sachdev, PS ; Sackey, BB ; Saeedi, MY ; Safiri, S ; Sagar, R ; Sahraian, MA ; Saleh, MM ; Salomon, JA ; Samy, AM ; Sanabria, JR ; Sanchez-Nino, MD ; Sandar, L ; Santos, IS ; Santos, JV ; Milicevic, MMS ; Sarmiento-Suarez, R ; Sartorius, B ; Satpathy, M ; Savic, M ; Sawhney, M ; Saylan, MI ; Schoettker, B ; Schutte, AE ; Schwebel, DC ; Seedat, S ; Seid, AM ; Seifu, CN ; Sepanlou, SG ; Serdar, B ; Servan-Mori, EE ; Setegn, T ; Shackelford, KA ; Shaheen, A ; Shahraz, S ; Shaikh, MA ; Shakh-Nazarova, M ; Shamsipour, M ; Islam, SMS ; Sharma, J ; Sharma, R ; She, J ; Sheikhbahaei, S ; Shen, J ; Shi, P ; Shigematsu, M ; Shin, M-J ; Shiri, R ; Shoman, H ; Shrime, MG ; Sibamo, ELS ; Sigfusdottir, ID ; Silva, DAS ; Silveira, DGA ; Sindi, S ; Singh, A ; Singh, JA ; Singh, OP ; Singh, PK ; Singh, V ; Sinke, AH ; Sinshaw, AE ; Skirbekk, V ; Sliwa, K ; Smith, A ; Sobngwi, E ; Soneji, S ; Soriano, JB ; Sousa, TCM ; Sposato, LA ; Sreeramareddy, CT ; Stathopoulou, V ; Steel, N ; Steiner, C ; Steinke, S ; Stokes, MA ; Stranges, S ; Strong, M ; Stroumpoulis, K ; Sturua, L ; Sufiyan, MB ; Suliankatchi, RA ; Sun, J ; Sur, P ; Swaminathan, S ; Sykes, BL ; Tabares-Seisdedos, R ; Tabb, KM ; Taffere, GR ; Talongwa, RT ; Tarajia, M ; Tavakkoli, M ; Taveira, N ; Teeple, S ; Tegegne, TK ; Tehrani-Banihashemi, A ; Tekelab, T ; Tekle, DY ; Shifa, GT ; Terkawi, AS ; Tesema, AG ; Thakur, JS ; Thomson, AJ ; Tillmann, T ; Tiruye, TY ; Tobe-Gai, R ; Tonelli, M ; Topor-Madry, R ; Tortajada, M ; Troeger, C ; Truelsen, T ; Tura, AK ; Uchendu, US ; Ukwaja, KN ; Undurraga, EA ; Uneke, CJ ; Uthman, OA ; van Boven, JFM ; Van Dingenen, R ; Varughese, S ; Vasankari, T ; Venketasubramanian, N ; Violante, FS ; Vladimirov, SK ; Vlassov, VV ; Vollset, SE ; Vos, T ; Wagner, JA ; Wakayo, T ; Waller, SG ; Walson, JL ; Wang, H ; Wang, Y-P ; Watkins, DA ; Weiderpass, E ; Weintraub, RG ; Wen, C-P ; Werdecker, A ; Wesana, J ; Westerman, R ; Whiteford, HA ; Wilkinson, JD ; Wiysonge, CS ; Woldeyes, BG ; Wolfe, CDA ; Won, S ; Workicho, A ; Workie, SB ; Wubshet, M ; Xavier, D ; Xu, G ; Yadav, AK ; Yaghoubi, M ; Yakob, B ; Yan, LL ; Yano, Y ; Yaseri, M ; Yimam, HH ; Yip, P ; Yonemoto, N ; Yoon, S-J ; Younis, MZ ; Yu, C ; Zaidi, Z ; Zaki, MES ; Zambrana-Torrelio, C ; Zapata, T ; Zenebe, ZM ; Zodpey, S ; Zoeckler, L ; Zuhlke, LJ ; Murray, CJL (ELSEVIER SCIENCE INC, 2017-07-15)
    BACKGROUND: National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. METHODS: We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. FINDINGS: Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. INTERPRETATION: This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. FUNDING: Bill & Melinda Gates Foundation.
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    Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016
    Fullman, N ; Yearwood, J ; Abay, SM ; Abbafati, C ; Abd-Allah, F ; Abdela, J ; Abdelalim, A ; Abebe, Z ; Abebo, TA ; Aboyans, V ; Abraha, HN ; Abreu, DMX ; Abu-Raddad, LJ ; Adane, AA ; Adedoyin, RA ; Adetokunboh, O ; Adhikari, TB ; Afarideh, M ; Afshin, A ; Agarwal, G ; Agius, D ; Agrawal, A ; Agrawal, S ; Kiadaliri, AA ; Aichour, MTE ; Akibu, M ; Akinyemi, RO ; Akinyemiju, TF ; Akseer, N ; Al Lami, FH ; Alahdab, F ; Al-Aly, Z ; Alam, K ; Alam, T ; Alasfoor, D ; Albittar, MI ; Alene, KA ; Al-Eyadhy, A ; Ali, SD ; Alijanzadeh, M ; Aljunid, SM ; Alkerwi, A ; Alla, F ; Allebeck, P ; Allen, C ; Alomari, MA ; Al-Raddadi, R ; Alsharif, U ; Altirkawi, KA ; Alvis-Guzman, N ; Amare, AT ; Amenu, K ; Ammar, W ; Amoako, YA ; Anber, N ; Andrei, CL ; Androudi, S ; Antonio, CAT ; Araujo, VEM ; Aremu, O ; Arnlov, J ; Artaman, A ; Aryal, KK ; Asayesh, H ; Asfaw, ET ; Asgedom, SW ; Asghar, RJ ; Ashebir, MM ; Asseffa, NA ; Atey, TM ; Atre, SR ; Atteraya, MS ; Avila-Burgos, L ; Avokpaho, EFGA ; Awasthi, A ; Quintanilla, BPA ; Ayalew, AA ; Ayele, HT ; Ayer, R ; Ayuk, TB ; Azzopardi, P ; Azzopardi-Muscat, N ; Babalola, TK ; Badali, H ; Badawi, A ; Banach, M ; Banerjee, A ; Banstola, A ; Barber, RM ; Barboza, MA ; Barker-Collo, SL ; Baernighausen, T ; Barquera, S ; Barrero, LH ; Bassat, Q ; Basu, S ; Baune, BT ; Bazargan-Hejazi, S ; Bedi, N ; Beghi, E ; Behzadifar, M ; Behzadifar, M ; Bekele, BB ; Belachew, AB ; Belay, SA ; Belay, YA ; Bell, ML ; Bello, AK ; Bennett, DA ; Bennett, JR ; Bensenor, IM ; Berhe, DF ; Bernabe, E ; Bernstein, RS ; Beuran, M ; Bhalla, A ; Bhatt, P ; Bhaumik, S ; Bhutta, ZA ; Biadgo, B ; Bijani, A ; Bikbov, B ; Birungi, C ; Biryukov, S ; Bizuneh, H ; Bolliger, IW ; Bolt, K ; Bou-Orm, IR ; Bozorgmehr, K ; Brady, OJ ; Brazinova, A ; Breitborde, NJK ; Brenner, H ; Britton, G ; Brugha, TS ; Butt, ZA ; Cahuana-Hurtado, L ; Campos-Nonato, IR ; Campuzano, JC ; Car, J ; Car, M ; Cardenas, R ; Carrero, JJ ; Carvalho, F ; Castaneda-Orjuela, CA ; Rivas, JC ; Catala-Lopez, F ; Cercy, K ; Chalek, J ; Chang, H-Y ; Chang, J-C ; Chattopadhyay, A ; Chaturvedi, P ; Chiang, PP-C ; Chisumpa, VH ; Choi, J-YJ ; Christensen, H ; Christopher, DJ ; Chung, S-C ; Ciobanu, LG ; Cirillo, M ; Colombara, D ; Conti, S ; Cooper, C ; Cornaby, L ; Cortesi, PA ; Cortinovis, M ; Pereira, AC ; Cousin, E ; Criqui, MH ; Cromwell, EA ; Crowe, CS ; Crump, JA ; Daba, AK ; Dachew, BA ; Dadi, AF ; Dandona, L ; Dandona, R ; Dargan, PI ; Daryani, A ; Daryani, M ; Das, J ; Das, SK ; das Neves, J ; Weaver, ND ; Davletov, K ; de Courten, B ; De Leo, D ; De Neve, J-W ; Dellavalle, RP ; Demoz, G ; Deribe, K ; Des Jarlais, DC ; Dey, S ; Dharmaratne, SD ; Dhimal, M ; Djalalinia, S ; Doku, DT ; Dolan, K ; Dorsey, ER ; Bender dos Santos, KP ; Doyle, KE ; Driscoll, TR ; Dubey, M ; Dubljanin, E ; Duncan, BB ; Echko, M ; Edessa, D ; Edvardsson, D ; Ehrlich, JR ; Eldrenkamp, E ; El-Khatib, Z ; Endres, M ; Endries, AY ; Eshrati, B ; Eskandarieh, S ; Esteghamati, A ; Fakhar, M ; Farag, T ; Faramarzi, M ; Faraon, EJA ; Faro, A ; Farzadfar, F ; Fatusi, A ; Fazeli, MS ; Feigin, VL ; Feigl, AB ; Fentahun, N ; Fereshtehnejad, S-M ; Fernandes, E ; Fernandes, JC ; Fijabi, DO ; Filip, I ; Fischer, F ; Fitzmaurice, C ; Flaxman, AD ; Flor, LS ; Foigt, N ; Foreman, KJ ; Frostad, JJ ; Fuerst, T ; Futran, ND ; Gakidou, E ; Gallus, S ; Gambashidze, K ; Gamkrelidze, A ; Ganji, M ; Gebre, AK ; Gebrehiwot, TT ; Gebremedhin, AT ; Gelaw, YA ; Geleijnse, JM ; Geremew, D ; Gething, PW ; Ghadimi, R ; Falavarjani, KG ; Ghasemi-Kasman, M ; Gill, PS ; Giref, AZ ; Giroud, M ; Gishu, MD ; Giussani, G ; Godwin, WW ; Goli, S ; Gomez-Dantes, H ; Gona, PN ; Goodridge, A ; Gopalani, SV ; Goryakin, Y ; Goulart, AC ; Grada, A ; Griswold, M ; Grosso, G ; Gugnani, HC ; Guo, Y ; Gupta, R ; Gupta, R ; Gupta, T ; Gupta, T ; Gupta, V ; Haagsma, JA ; Hachinski, V ; Hafezi-Nejad, N ; Hailu, GB ; Hamadeh, RR ; Hamidi, S ; Hankey, GJ ; Harb, HL ; Harewood, HC ; Harikrishnan, S ; Haro, JM ; Hassen, HY ; Havmoeller, R ; Hawley, C ; Hay, SI ; He, J ; Hearps, SJC ; Hegazy, MI ; Heibati, B ; Heidari, M ; Hendrie, D ; Henry, NJ ; Herrera Ballesteros, VH ; Herteliu, C ; Hibstu, DT ; Hiluf, MK ; Hoek, HW ; Rad, EH ; Horita, N ; Hosgood, HD ; Hosseini, M ; Hosseini, SR ; Hostiuc, M ; Hostiuc, S ; Hoy, DG ; Hsairi, M ; Htet, AS ; Hu, G ; Huang, JJ ; Iburg, KM ; Idris, F ; Igumbor, EU ; Ikeda, C ; Ileanu, BV ; Ilesanmi, OS ; Innos, K ; Irvani, SSN ; Irvine, CMS ; Islami, F ; Jacobs, TA ; Jacobsen, KH ; Jahanmehr, N ; Jain, R ; Jain, SK ; Jakovljevic, MM ; Jalu, MT ; Jamal, AA ; Javanbakht, M ; Jayatilleke, AU ; Jeemon, P ; Jha, RP ; Jha, V ; Jozwiak, J ; John, O ; Johnson, SC ; Jonas, JB ; Joshua, V ; Juerisson, M ; Kabir, Z ; Kadel, R ; Kahsay, A ; Kalani, R ; Kar, C ; Karanikolos, M ; Karch, A ; Karema, CK ; Karimi, SM ; Kasaeian, A ; Kassa, DH ; Kassa, GM ; Kassa, TD ; Kassebaum, NJ ; Katikireddi, SV ; Kaul, A ; Kawakami, N ; Kazanjan, K ; Kebede, S ; Keiyoro, PN ; Kemp, GR ; Kengne, AP ; Kereselidze, M ; Ketema, EB ; Khader, YS ; Khafaie, MA ; Khajavi, A ; Khalil, IA ; Khan, EA ; Khan, G ; Khan, MN ; Khan, MA ; Khanal, MN ; Khang, Y-H ; Khater, MM ; Khoja, ATA ; Khosravi, A ; Khubchandani, J ; Kibret, GD ; Kiirithio, DN ; Kim, D ; Kim, YJ ; Kimokoti, RW ; Kinfu, Y ; Kinra, S ; Kisa, A ; Kissoon, N ; Kochhar, S ; Kokubo, Y ; Kopec, JA ; Kosen, S ; Koul, PA ; Koyanagi, A ; Kravchenko, M ; Krishan, K ; Krohn, KJ ; Defo, BK ; Kumar, GA ; Kumar, P ; Kutz, M ; Kuzin, I ; Kyu, HH ; Lad, DP ; Lafranconi, A ; Lal, DK ; Lalloo, R ; Lam, H ; Lan, Q ; Lang, JJ ; Lansingh, VC ; Lansky, S ; Larsson, A ; Latifi, A ; Lazarus, JV ; Leasher, JL ; Lee, PH ; Legesse, Y ; Leigh, J ; Leshargie, CT ; Leta, S ; Leung, J ; Leung, R ; Levi, M ; Li, Y ; Liang, J ; Liben, ML ; Lim, L-L ; Lim, SS ; Lind, M ; Linn, S ; Listl, S ; Liu, PY ; Liu, S ; Lodha, R ; Lopez, AD ; Lorch, SA ; Lorkowski, S ; Lotufo, PA ; Lucas, TCD ; Lunevicius, R ; Lurton, G ; Lyons, RA ; Maalouf, F ; Macarayan, ERK ; Mackay, MT ; Maddison, ER ; Madotto, F ; Abd El Razek, HM ; Abd El Razek, MM ; Majdan, M ; Majdzadeh, R ; Majeed, A ; Malekzadeh, R ; Malhotra, R ; Malta, DC ; Mamun, AA ; Manguerra, H ; Manhertz, T ; Mansournia, MA ; Mantovani, LG ; Manyazewal, T ; Mapoma, CC ; Margono, C ; Martinez-Raga, J ; Martins, SCO ; Martins-Melo, FR ; Martopullo, I ; Maerz, W ; Massenburg, BB ; Mathur, MR ; Maulik, PK ; Mazidi, M ; McAlinden, C ; McGrath, JJ ; McKee, M ; Mehata, S ; Mehrotra, R ; Mehta, KM ; Mehta, V ; Meier, T ; Mejia-Rodriguez, F ; Meles, KG ; Melku, M ; Memiah, P ; Memish, ZA ; Mendoza, W ; Mengiste, DA ; Mengistu, DT ; Menota, BG ; Mensah, GA ; Meretoja, A ; Meretoja, TJ ; Mezgebe, HB ; Miazgowski, T ; Micha, R ; Milam, R ; Millear, A ; Miller, TR ; Mini, GK ; Minnig, S ; Mirica, A ; Mirrakhimov, EM ; Misganaw, A ; Mitchell, PB ; Mlashu, FW ; Moazen, B ; Mohammad, KA ; Mohammadibakhsh, R ; Mohammed, E ; Mohammed, MA ; Mohammed, S ; Mokdad, AH ; Mola, GLD ; Molokhia, M ; Momeniha, F ; Monasta, L ; Montanez Hernandez, JC ; Moosazadeh, M ; Moradi-Lakeh, M ; Moraga, P ; Morawska, L ; Velasquez, IM ; Mori, R ; Morrison, SD ; Moses, M ; Mousavi, SM ; Mueller, UO ; Murhekar, M ; Murthy, GVS ; Murthy, S ; Musa, J ; Musa, KI ; Mustafa, G ; Muthupandian, S ; Nagata, C ; Nagel, G ; Naghavi, M ; Naheed, A ; Naik, GA ; Naik, N ; Najafi, F ; Naldi, L ; Nangia, V ; Nansseu, JRN ; Narayan, KMV ; Nascimento, BR ; Negoi, I ; Negoi, RI ; Newton, CR ; Ngunjiri, JW ; Grant, N ; Long, N ; Trang, HN ; Nichols, E ; Ningrum, DNA ; Nolte, E ; Vuong, MN ; Norheim, OF ; Norrving, B ; Noubiap, JJN ; Nyandwi, A ; Obermeyer, CM ; Ofori-Asenso, R ; Ogbo, FA ; Oh, I-H ; Oladimeji, O ; Olagunju, AT ; Olagunju, TO ; Olivares, PR ; Vasconcelos de Oliveira, PP ; Olsen, HE ; Olusanya, BO ; Olusanya, JO ; Ong, K ; Opio, JN ; Oren, E ; Ortega-Altamirano, DV ; Ortiz, A ; Ozdemir, R ; Mahesh, PA ; Pain, AW ; Palone, MRT ; Pana, A ; Panda-Jonas, S ; Pandian, JD ; Park, E-K ; Parsian, H ; Patel, T ; Pati, S ; Patil, ST ; Patle, A ; Patton, GC ; Paturi, VR ; Paudel, D ; Pedroso, MDM ; Pedroza, SP ; Pereira, DM ; Perico, N ; Peterson, H ; Petzold, M ; Peykari, N ; Phillips, MR ; Piel, FB ; Pigott, DM ; Pillay, JD ; Piradov, MA ; Polinder, S ; Pond, CD ; Postma, MJ ; Pourmalek, F ; Prakash, S ; Prakash, V ; Prasad, N ; Prasad, NM ; Purcell, C ; Qorbani, M ; Quintana, HK ; Radfar, A ; Rafay, A ; Rafiei, A ; Rahimi, K ; Rahimi-Movaghar, A ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MA ; Rahman, SU ; Rai, RK ; Raju, B ; Ram, U ; Rana, SM ; Rankin, Z ; Rasella, D ; Rawaf, DL ; Rawaf, S ; Ray, SE ; Aspacia Razo-Garcia, C ; Reddy, P ; Reiner, RC ; Reis, C ; Reitsma, MB ; Remuzzi, G ; Renzaho, AMN ; Resnikoff, S ; Rezaei, S ; Rezai, MS ; Ribeiro, AL ; Rios Blancas, MJ ; Rivera, JA ; Roever, L ; Ronfani, L ; Roshandel, G ; Rostami, A ; Roth, GA ; Rothenbacher, D ; Roy, A ; Roy, N ; Ruhago, GM ; Sabde, YD ; Sachdev, PS ; Sadat, N ; Safdarian, M ; Safiri, S ; Sagar, R ; Sahebkar, A ; Sahraian, MA ; Sajadi, HS ; Salama, J ; Salamati, P ; Saldanha, RDF ; Salimzadeh, H ; Salomon, JA ; Samy, AM ; Sanabria, JR ; Sancheti, PK ; Sanchez-Nino, MD ; Santomauro, D ; Santos, IS ; Milicevic, MMS ; Sarker, AR ; Sarrafzadegan, N ; Sartorius, B ; Satpathy, M ; Savic, M ; Sawhney, M ; Saxena, S ; Saylan, MI ; Schaeffner, E ; Schmidhuber, J ; Schmidt, MI ; Schneider, IJC ; Schumacher, AE ; Schutte, AE ; Schwebel, DC ; Schwendicke, F ; Sekerija, M ; Sepanlou, SG ; Servan-Mori, EE ; Shafieesabet, A ; Shaikh, MA ; Shakh-Nazarova, M ; Shams-Beyranvand, M ; Sharafi, H ; Sharif-Alhoseini, M ; Islam, SMS ; Sharma, M ; Sharma, R ; She, J ; Sheikh, A ; Shfare, MT ; Shi, P ; Shields, C ; Shigematsu, M ; Shinohara, Y ; Shiri, R ; Shirkoohi, R ; Shiue, I ; Shrime, MG ; Shukla, SR ; Siabani, S ; Sigfusdottir, ID ; Silberberg, DH ; Santos Silva, DA ; Silva, JP ; Alves Silveira, DG ; Singh, JA ; Singh, L ; Singh, NP ; Singh, V ; Sinha, DN ; Sinke, AH ; Sisay, M ; Skirbekk, V ; Sliwa, K ; Smith, A ; Soares Filho, AM ; Sobaih, BHA ; Somai, M ; Soneji, S ; Soofi, M ; Sorensen, RJD ; Soriano, JB ; Soyiri, IN ; Sposato, LA ; Sreeramareddy, CT ; Srinivasan, V ; Stanaway, JD ; Stathopoulou, V ; Steel, N ; Stein, DJ ; Stokes, MA ; Sturua, L ; Sufiyan, MB ; Suliankatchi, RA ; Sunguya, BF ; Sur, PJ ; Sykes, BL ; Sylaja, PN ; Szoeke, CEI ; Tabares-Seisdedos, R ; Tadakamadla, SK ; Tadesse, AH ; Taffere, GR ; Tandon, N ; Tariku, AT ; Taveira, N ; Tehrani-Banihashemi, A ; Shifa, GT ; Temsah, M-H ; Terkawi, AS ; Tesema, AG ; Tesfaye, DJ ; Tessema, B ; Thakur, JS ; Thomas, N ; Thompson, MJ ; Tillmann, T ; To, QG ; Tobe-Gai, R ; Tonelli, M ; Topor-Madry, R ; Topouzis, F ; Torre, A ; Tortajada, M ; Tran, BX ; Khanh, BT ; Tripathi, A ; Tripathy, SP ; Troeger, C ; Truelsen, T ; Tsoi, D ; Car, LT ; Tuem, KB ; Tyrovolas, S ; Uchendu, US ; Ukwaja, KN ; Ullah, I ; Updike, R ; Uthman, OA ; Uzochukwu, BSC ; Ruben Valdez, P ; van Boven, JFM ; Varughese, S ; Vasankari, T ; Venketasubramanian, N ; Violante, FS ; Vladimirov, SK ; Vlassov, VV ; Vollset, SE ; Vos, T ; Wagnew, F ; Waheed, Y ; Wallin, MT ; Walson, JL ; Wang, Y ; Wang, Y-P ; Wassie, MM ; Weaver, MR ; Weiderpass, E ; Weintraub, RG ; Weiss, J ; Weldegwergs, KG ; Werdecker, A ; West, TE ; Westerman, R ; White, RG ; Whiteford, HA ; Widecka, J ; Winkler, AS ; Wiysonge, CS ; Wolfe, CDA ; Wondimkun, YA ; Workicho, A ; Wyper, GMA ; Xavier, D ; Xu, G ; Yan, LL ; Yano, Y ; Yaseri, M ; Yimer, NB ; Yin, P ; Yip, P ; Yirsaw, BD ; Yonemoto, N ; Yonga, G ; Yoon, S-J ; Yotebieng, M ; Younis, MZ ; Yu, C ; Zadnik, V ; Zaidi, Z ; Zaki, MES ; Bin Zaman, S ; Zamani, M ; Zenebe, ZM ; Zhou, M ; Zhu, J ; Zimsen, SRM ; Zipkin, B ; Zodpey, S ; Zuhlke, LJ ; Murray, CJL ; Lozano, R (ELSEVIER SCIENCE INC, 2018-06-02)
    BACKGROUND: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. METHODS: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. FINDINGS: In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. INTERPRETATION: GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations. FUNDING: Bill & Melinda Gates Foundation.
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    Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
    Vos, T ; Abajobir, AA ; Abbafati, C ; Abbas, KM ; Abate, KH ; Abd-Allah, F ; Abdulle, AM ; Abebo, TA ; Abera, SF ; Aboyans, V ; Abu-Raddad, LJ ; Ackerman, IN ; Adamu, AA ; Adetokunboh, O ; Afarideh, M ; Afshin, A ; Agarwal, SK ; Aggarwal, R ; Agrawal, A ; Agrawal, S ; Kiadaliri, AA ; Ahmadieh, H ; Ahmed, MB ; Aichour, AN ; Aichour, I ; Aichour, MTE ; Aiyar, S ; Akinyemi, RO ; Akseer, N ; Al Lami, FH ; Alahdab, F ; Al-Aly, Z ; Alam, K ; Alam, N ; Alam, T ; Alasfoor, D ; Alene, KA ; Ali, R ; Alizadeh-Navaei, R ; Alkerwi, A ; Alla, F ; Allebeck, P ; Allen, C ; Al-Maskari, F ; Al-Raddadi, R ; Alsharif, U ; Alsowaidi, S ; Altirkawi, KA ; Amare, AT ; Amini, E ; Ammar, W ; Amoako, YA ; Andersen, HH ; Antonio, CAT ; Anwari, P ; Arnlov, J ; Artaman, A ; Aryal, KK ; Asayesh, H ; Asgedom, SW ; Assadi, R ; Atey, TM ; Atnafu, NT ; Atre, SR ; Avila-Burgos, L ; Avokpaho, EFGA ; Awasthi, A ; Ayala Quintanilla, BP ; Saleem, HOB ; Bacha, U ; Badawi, A ; Balakrishnan, K ; Banerjee, A ; Bannick, MS ; Barac, A ; Barber, RM ; Barker-Collo, SL ; Baernighausen, T ; Barquera, S ; Barregard, L ; Barrero, LH ; Basu, S ; Battista, B ; Battle, KE ; Baune, BT ; Bazargan-Hejazi, S ; Beardsley, J ; Bedi, N ; Beghi, E ; Bejot, Y ; Bekele, BB ; Bell, ML ; Bennett, DA ; Bensenor, IM ; Benson, J ; Berhane, A ; Berhe, DF ; Bernabe, E ; Betsu, BD ; Beuran, M ; Beyene, AS ; Bhala, N ; Bhansali, A ; Bhatt, S ; Bhutta, ZA ; Biadgilign, S ; Bienhoff, K ; Bikbov, B ; Birungi, C ; Biryukov, S ; Bisanzio, D ; Bizuayehu, HM ; Boneya, DJ ; Boufous, S ; Bourne, RRA ; Brazinova, A ; Brugha, TS ; Buchbinder, R ; Bulto, LNB ; Bumgarner, BR ; Butt, ZA ; Cahuana-Hurtado, L ; Cameron, E ; Car, M ; Carabin, H ; Carapetis, JR ; Cardenas, R ; Carpenter, DO ; Carrero, JJ ; Carter, A ; Carvalho, F ; Casey, DC ; Caso, V ; Castaneda-Orjuela, CA ; Castle, CD ; Catala-Lopez, F ; Chang, H-Y ; Chang, J-C ; Charlson, FJ ; Chen, H ; Chibalabala, M ; Chibueze, CE ; Chisumpa, VH ; Chitheer, AA ; Christopher, DJ ; Ciobanu, LG ; Cirillo, M ; Colombara, D ; Cooper, C ; Cortesi, PA ; Criqui, MH ; Crump, JA ; Dadi, AF ; Dalal, K ; Dandona, L ; Dandona, R ; das Neves, J ; Davitoiu, DV ; de Courten, B ; De Leo, D ; Degenhardt, L ; Deiparine, S ; Dellavalle, RP ; Deribe, K ; Des Jarlais, DC ; Dey, S ; Dharmaratne, SD ; Dhillon, PK ; Dicker, D ; Ding, EL ; Djalalinia, S ; Huyen, PD ; Dorsey, ER ; Bender dos Santos, KP ; Douwes-Schultz, D ; Doyle, KE ; Driscoll, TR ; Dubey, M ; Duncan, BB ; El-Khatib, ZZ ; Ellerstrand, J ; Enayati, A ; Endries, AY ; Ermakov, SP ; Erskine, HE ; Eshrati, B ; Eskandarieh, S ; Esteghamati, A ; Estep, K ; Fanuel, FBB ; Sa Farinha, CSE ; Faro, A ; Farzadfar, F ; Fazeli, MS ; Feigin, VL ; Fereshtehnejad, S-M ; Fernandes, JC ; Ferrari, AJ ; Feyissa, TR ; Filip, I ; Fischer, F ; Fitzmaurice, C ; Flaxman, AD ; Flor, LS ; Foigt, N ; Foreman, KJ ; Franklin, RC ; Fullman, N ; Furst, T ; Furtado, JM ; Futran, ND ; Gakidou, E ; Ganji, M ; Garcia-Basteiro, AL ; Gebre, T ; Gebrehiwot, TT ; Geleto, A ; Gemechu, BL ; Gesesew, HA ; Gething, PW ; Ghajar, A ; Gibney, KB ; Gill, PS ; Gillum, RF ; Ginawi, IAM ; Giref, AZ ; Gishu, MD ; Giussani, G ; Godwin, WW ; Gold, AL ; Goldberg, EM ; Gona, PN ; Goodridge, A ; Gopalani, SV ; Goto, A ; Goulart, AC ; Griswold, M ; Gugnani, HC ; Gupta, R ; Gupta, R ; Gupta, T ; Gupta, V ; Hafezi-Nejad, N ; Hailu, AD ; Hailu, GB ; Hamadeh, RR ; Hamidi, S ; Handal, AJ ; Hankey, GJ ; Hao, Y ; Harb, HL ; Hareri, HA ; Maria Haro, J ; Harvey, J ; Hassanvand, MS ; Havmoeller, R ; Hawley, C ; Hay, RJ ; Hay, SI ; Henry, NJ ; Beatriz Heredia-Pi, I ; Heydarpour, P ; Hoek, HW ; Hoffman, HJ ; Horita, N ; Hosgood, HD ; Hostiuc, S ; Hotez, PJ ; Hoy, DG ; Htet, AS ; Hu, G ; Huang, H ; Huynh, C ; Iburg, KM ; Igumbor, EU ; Ikeda, C ; Irvine, CMS ; Jacobsen, KH ; Jahanmehr, N ; Jakovljevic, MB ; Jassal, SK ; Javanbakht, M ; Jayaraman, SP ; Jeemon, P ; Jensen, PN ; Jha, V ; Jiang, G ; John, D ; Johnson, CO ; Johnson, SC ; Jonas, JB ; Jurisson, M ; Kabir, Z ; Kadel, R ; Kahsay, A ; Kamal, R ; Kan, H ; Karam, NE ; Karch, A ; Karema, CK ; Kasaeian, A ; Kassa, GM ; Kassaw, NA ; Kassebaum, NJ ; Kastor, A ; Katikireddi, SV ; Kaul, A ; Kawakami, N ; Keiyoro, PN ; Kengne, AP ; Keren, A ; Khader, YS ; Khalil, IA ; Khan, EA ; Khang, Y-H ; Khosravi, A ; Khubchandani, J ; Kieling, C ; Kim, D ; Kim, P ; Kim, YJ ; Kimokoti, RW ; Kinfu, Y ; Kisa, A ; Kissimova-Skarbek, KA ; Kivimaki, M ; Knudsen, AK ; Kokubo, Y ; Kolte, D ; Kopec, JA ; Kosen, S ; Koul, PA ; Koyanagi, A ; Kravchenko, M ; Krishnaswami, S ; Krohn, KJ ; Defo, BK ; Bicer, BK ; Kumar, GA ; Kumar, P ; Kumar, S ; Kyu, HH ;