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Start date: 2017 × Author: Baune, Bernhard × Author: Patton, George × End date: 2019 ×

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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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    Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
    Gakidou, E ; Afshin, A ; Abajobir, AA ; Abate, KH ; Abbafati, C ; Abbas, KM ; Abd-Allah, F ; Abdulle, AM ; Abera, SF ; Aboyans, V ; Abu-Raddad, LJ ; Abu-Rmeileh, NME ; Abyu, GY ; Adedeji, IA ; Adetokunboh, O ; Afarideh, M ; Agrawal, A ; Agrawal, S ; Kiadaliri, AA ; Ahmadieh, H ; Ahmed, MB ; Aichour, AN ; Aichour, I ; Aichour, MTE ; Akinyemi, RO ; Akseer, N ; Alahdab, F ; Al-Aly, Z ; Alam, K ; Alam, N ; Alam, T ; Alasfoor, D ; Alene, KA ; Ali, K ; Alizadeh-Navaei, R ; Alkerwi, A ; Alla, F ; Allebeck, P ; Al-Raddadi, R ; Alsharif, U ; Altirkawi, KA ; Alvis-Guzman, N ; Amare, AT ; Amini, E ; Ammar, W ; Amoako, YA ; Ansari, H ; Anto, JM ; Antonio, CAT ; Anwari, P ; Arian, N ; Arnlov, J ; Artaman, A ; Aryal, KK ; Asayesh, H ; Asgedom, SW ; Atey, TM ; Avila-Burgos, L ; Avokpaho, EFGA ; Awasthi, A ; Azzopardi, P ; Bacha, U ; Badawi, A ; Balakrishnan, K ; Ballew, SH ; Barac, A ; Barber, RM ; Barker-Collo, SL ; Barnighausen, T ; Barquera, S ; Barregard, L ; Barrero, LH ; Batis, C ; Battle, KE ; 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Larsson, A ; Lee, A ; Lee, PH ; Leigh, J ; Leung, J ; Levi, M ; Li, Y ; Li, Y ; Liang, X ; Liben, ML ; Linn, S ; Liu, P ; Lodha, R ; Logroscino, G ; Looker, KJ ; Lopez, AD ; Lorkowski, S ; Lotufo, PA ; Lozano, R ; Lunevicius, R ; Macarayan, ERK ; 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 ; Mapoma, CC ; Martin, RV ; Martinez-Raga, J ; Martins-Melo, FR ; Mathur, MR ; Matsushita, K ; Matzopoulos, R ; Mazidi, M ; McAlinden, C ; McGrath, JJ ; Mehata, S ; Mehndiratta, MM ; Meier, T ; Melaku, YA ; Memiah, P ; Memish, ZA ; Mendoza, W ; Mengesha, MM ; 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 ; Mohammad, KA ; Mohammed, KE ; Mohammed, S ; Ibrahim, NM ; Mohan, MBV ; Mokdad, AH ; Monasta, L ; Montanez Hernandez, JC ; Montico, M ; Moradi-Lakeh, M ; Moraga, P ; Morawska, L ; Morrison, SD ; Mountjoy-Venning, C ; Mueller, UO ; Mullany, EC ; Muller, K ; Murthy, GVS ; Musa, KI ; Naghavi, M ; Naheed, A ; 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 ; Norrving, B ; Noubiap, JJN ; Obermeyer, CM ; Ogbo, FA ; Oh, H ; Oladimeji, O ; Olagunju, AT ; Olagunju, TO ; Olivares, PR ; Olsen, HE ; Olusanya, BO ; Olusanya, JO ; Opio, JN ; Oren, E ; Ortiz, A ; Ota, E ; Owolabi, MO ; Pa, M ; Pacella, RE ; Pana, A ; Panda, BK ; Panda-Jonas, S ; Pandian, JD ; Papachristou, C ; Park, E-K ; Parry, CD ; Patten, SB ; Patton, GC ; Pereira, DM ; Perico, N ; Pesudovs, K ; Petzold, M ; Phillips, MR ; Pillay, JD ; Piradov, MA ; Pishgar, F ; Plass, D ; Pletcher, MA ; Polinder, S ; Popova, S ; Poulton, RG ; Pourmalek, F ; Prasad, N ; Purcell, C ; Qorbani, M ; Radfar, A ; Rafay, A ; Rahimi-Movaghar, A ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MHU ; Rahman, MA ; Rai, RK ; Rajsic, S ; Ram, U ; Rawaf, S ; Rehm, CD ; Rehm, J ; Reiner, RC ; Reitsma, MB ; Myriam Reynales-Shigematsu, L ; Remuzzi, G ; Renzaho, AMN ; Resnikoff, S ; Rezaei, S ; Ribeiro, AL ; Rivera, JA ; Roba, KT ; Rojas-Rueda, D ; Roman, Y ; Room, R ; Roshandel, G ; Roth, GA ; Rothenbacher, D ; Rubagotti, E ; Rushton, L ; Sadat, N ; Safdarian, M ; Safi, S ; Safiri, S ; Sahathevan, R ; Salama, J ; Salomon, JA ; Samy, AM ; Sanabria, JR ; Dolores Sanchez-Nino, M ; Sanchez-Pimienta, TG ; Santomauro, D ; Santos, IS ; Milicevic, MMS ; Sartorius, B ; Satpathy, M ; Sawhney, M ; Saxena, S ; Schaeffner, E ; Schmidt, MI ; Schneider, IJC ; Schutte, AE ; Schwebel, DC ; Schwendicke, F ; Seedat, S ; Sepanlou, SG ; Serdar, B ; Servan-Mori, EE ; Shaddick, G ; Shaheen, A ; Shahraz, S ; Shaikh, MA ; Levy, TS ; Shamsipour, M ; Shamsizadeh, M ; Islam, SMS ; Sharma, J ; Sharma, R ; She, J ; Shen, J ; Shi, P ; Shibuya, K ; Shields, C ; Shiferaw, MS ; Shigematsu, M ; Shin, M-J ; Shiri, R ; Shirkoohi, R ; Shishani, K ; Shoman, H ; Shrime, MG ; Sigfusdottir, ID ; Santos Silva, DA ; Silva, JP ; Alves Silveira, DG ; Singh, JA ; Singh, V ; Sinha, DN ; Skiadaresi, E ; Slepak, EL ; Smith, DL ; Smith, M ; Sobaih, BHA ; Sobngwi, E ; Soneji, S ; Sorensen, RJD ; Sposato, LA ; Sreeramareddy, CT ; Srinivasan, V ; Steel, N ; Stein, DJ ; Steiner, C ; Steinke, S ; Stokes, MA ; Strub, B ; Subart, M ; Sufiyan, MB ; Strub, B ; Subart, M ; Sufiyan, MB ; Suliankatchi, RA ; Sur, PJ ; Swaminathan, S ; Sykes, BL ; Szoeke, CEI ; Tabares-Seisdedos, R ; Tadakamadla, SK ; Takahashi, K ; Takala, JS ; Tandon, N ; Tanner, M ; Tarekegn, YL ; Tavakkoli, M ; Tegegne, TK ; Tehrani-Banihashemi, A ; Terkawi, AS ; Tesssema, B ; Thakur, JS ; Thamsuwan, O ; Thankappan, KR ; Theis, AM ; Thomas, ML ; Thomson, AJ ; Thrift, AG ; Tillmann, T ; Tobe-Gai, R ; Tobollik, M ; Tollanes, MC ; Tonelli, M ; Topor-Madry, R ; Torre, A ; Tortajada, M ; Touvier, M ; Tran, BX ; Truelsen, T ; Tuem, KB ; Tuzcu, EM ; Tyrovolas, S ; Ukwaja, KN ; Uneke, CJ ; Updike, R ; Uthman, OA ; van Boven, JFM ; van Donkelaar, A ; Varughese, S ; Vasankari, T ; Veerman, LJ ; Venkateswaran, V ; Venketasubramanian, N ; 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 ; Wiysonge, CS ; Woldeyes, BG ; Wolfe, CDA ; Woodbrook, R ; Workicho, A ; Hanson, SW ; Xavier, D ; Xu, G ; Yadgir, S ; Yakob, B ; Yan, LL ; Yaseri, M ; Yimam, HH ; Yip, P ; Yonemoto, N ; Yoon, S-J ; Yotebieng, M ; Younis, MZ ; Zaidi, Z ; Zaki, MES ; Zavala-Arciniega, L ; Zhang, X ; Zimsen, SRM ; Zipkin, B ; Zodpey, S ; Lim, SS ; Murray, CJL (ELSEVIER SCIENCE INC, 2017-09-16)
    BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. METHODS: We used the comparative risk assessment 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 clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. 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. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. FINDINGS: Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. INTERPRETATION: Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. FUNDING: The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
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    Maternal mortality and morbidity burden in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study
    Mokdad, AH ; Khalil, I ; Collison, M ; El Bcheraoui, C ; Charara, R ; Moradi-Lakeh, M ; Afshin, A ; Chew, A ; Daoud, F ; Krohn, KJ ; Colombara, D ; Ehrenkranz, R ; Kutz, M ; Wang, H ; Abajobir, AA ; Abd-Allah, F ; Abraha, HN ; Abu-Raddad, LJ ; Kiadaliri, AA ; Ahmadi, A ; Ahmed, KY ; Ahmed, MB ; Al Lami, FH ; Alam, K ; Alasfoor, D ; Alizadeh-Navaei, R ; Alkaabi, JM ; Al-Maskari, F ; Al-Raddadi, R ; Altirkawi, KA ; Anber, N ; Ansari, H ; Asayesh, H ; Asghar, RJ ; Atey, TM ; Ayele, TA ; Baernighausen, T ; Bacha, U ; Barac, A ; Barker-Collo, SL ; Baune, BT ; Bazargan-Hejazi, S ; Geffen, D ; Bedi, N ; Bensenor, IM ; Berhane, A ; Beyene, AS ; Bhutta, ZA ; Boneya, DJ ; Borschmann, R ; Breitborde, NJK ; Butt, ZA ; Catala-Lopez, F ; Ciobanu, LG ; Danawi, H ; Deribew, A ; Dharmaratne, SD ; Doyle, KE ; Endries, AY ; Faraon, EJA ; Faro, A ; Farvid, MS ; Fekadu, W ; Fereshtehnejad, S-M ; Fischer, F ; Gebrehiwot, TT ; Giref, AZ ; Gishu, MD ; Goulart, AC ; Habtewold, TD ; Hamadeh, RR ; Hambisa, MT ; Hamidi, S ; Maria Haro, J ; Hassanvand, MS ; Horita, N ; Hsairi, M ; Huang, H ; Husseini, A ; Jakovljevic, MB ; James, SL ; Jonas, JB ; Kasaeian, A ; Khader, YS ; Khan, EA ; Khoja, ATA ; Khosravi, A ; Khubchandani, J ; Kim, D ; Kim, YJ ; Kokubo, Y ; Koyanagi, A ; Defo, BK ; Larson, HJ ; Latif, AA ; Lee, PH ; Leshargie, CT ; Leung, R ; Lo, L-T ; Lunevicius, R ; Abd El Razek, HM ; Abd El Razek, MM ; Majdzadeh, R ; Majeed, A ; Malekzadeh, R ; Martinez-Raga, J ; Farid, HM ; Mazidi, M ; McGrath, JJ ; Memish, ZA ; Mendoza, W ; Mengesha, MM ; Mengistie, MA ; Mensah, GA ; Mezgebe, HB ; Miller, TR ; Mitchell, PB ; Mohammadi, A ; Mohammed, S ; Obermeyer, CM ; Ogbo, FA ; Palomares Castillo, E ; Papachristou, C ; Patten, SB ; Patton, GC ; Pereira, DM ; Pervaiz, A ; Phillips, MR ; Pourmalek, F ; Qorbani, M ; Radfar, A ; Rafay, A ; Rahimi-Movaghar, V ; Rai, RK ; Rawaf, DL ; Rawaf, S ; Refaat, AH ; Rezaei, S ; Rezai, MS ; Roshandel, G ; Safdarian, M ; Safiabadi, M ; Safiri, S ; Sagar, R ; Sahraian, MA ; Salamati, P ; Samy, AM ; Sartorius, B ; Saylan, MI ; Seedat, S ; Sepanlou, SG ; Shaikh, MA ; Shamsizadeh, M ; Santos Silva, DA ; Singh, JA ; Sobaih, BHA ; Sreeramareddy, CT ; Stein, DJ ; Abdulkader, RS ; Sykes, BL ; Tabares-Seisdedos, R ; Sufiyan, M ; Tabb, KM ; Tehrani-Banihashemi, A ; Temsah, M-H ; Terkawi, AS ; Topor-Madry, R ; Ukwaja, KN ; Uthman, OA ; Vollset, SE ; Wakayo, T ; Wang, Y-P ; Werdecker, A ; Westerman, R ; Workicho, A ; Yaghoubi, M ; Yimam, HH ; Yonemoto, N ; Younis, MZ ; Yu, C ; Zaki, MES ; Jumaan, AO ; Vos, T ; Hay, SI ; Naghavi, M ; Kassebaum, NJ ; Murray, CJL (SPRINGER BASEL AG, 2018-05-01)
    OBJECTIVES: Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. METHODS: We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. RESULTS: The maternal mortality ratio in the EMR decreased 16.3% from 283 (241-328) maternal deaths per 100,000 live births in 1990 to 237 (188-293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. CONCLUSION: Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life.
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    The burden of mental disorders in the Eastern Mediterranean region, 1990-2015: findings from the global burden of disease 2015 study
    Mokdad, AH ; Charara, R ; El Bcheraoui, C ; Khalil, I ; Moradi-Lakeh, M ; Afshin, A ; Kassebaum, NJ ; Collison, M ; Krohn, KJ ; Chew, A ; Daoud, F ; Charlson, FJ ; Colombara, D ; Degenhardt, L ; Ehrenkranz, R ; Erskine, HE ; Ferrari, AJ ; Kutz, M ; Leung, J ; Santomauro, D ; Wang, H ; Whiteford, HA ; Abajobir, AA ; Abd-Allah, F ; Abraha, HN ; Abu-Raddad, LJ ; Kiadaliri, AA ; Ahmadi, A ; Yimam, K ; Beshir, M ; Al Lami, FH ; Alam, K ; Alasfoor, D ; Alizadeh-Navaei, R ; Alkaabi, JM ; Al-Maskari, F ; Al-Raddadi, R ; Altirkawi, KA ; Anber, N ; Ansari, H ; Asayesh, H ; Asghar, RJ ; Atey, TM ; Ayele, TA ; Baernighausen, T ; Bacha, U ; Barac, A ; Barker-Collo, SL ; Baune, BT ; Bazargan-Hejazi, S ; Drew, CR ; Geffen, D ; Bedi, N ; Bensenor, IM ; Berhane, A ; Beyene, AS ; Bhutta, ZA ; Boneya, DJ ; Borschmann, R ; Breitborde, NJK ; Butt, ZA ; Catala-Lopez, F ; Ciobanu, LG ; Danawi, H ; Deribew, A ; Dharmaratne, SD ; Doyle, KE ; Endries, AY ; Faraon, EJA ; Faro, A ; Farvid, MS ; Fekadu, W ; Fereshtehnejad, S-M ; Fischer, F ; Gebrehiwot, TT ; Giref, AZ ; Gishu, MD ; Carvalho, A ; Habtewold, TD ; Hamadeh, RR ; Hambisa, MT ; Hamidi, S ; Haro, JM ; Hassanvand, MS ; Horita, N ; Hsairi, M ; Huang, H ; Husseini, A ; Jakovljevic, MB ; James, SL ; Jonas, JB ; Kasaeian, A ; Khader, YS ; Khan, EA ; Khoja, ATA ; Khosravi, A ; Khubchandani, J ; Kim, D ; Kim, YJ ; Kokubo, Y ; Koyanagi, A ; Defo, BK ; Larson, HJ ; Latif, AA ; Lee, PH ; Leshargie, CT ; Leung, R ; Lo, L-T ; Lunevicius, R ; Abd El Razek, HM ; Abd El Razek, MM ; Majdzadeh, R ; Majeed, A ; Malekzadeh, R ; Martinez-Raga, J ; Farid, HM ; Mazidi, M ; McGrath, JJ ; Memish, ZA ; Mendoza, W ; Mengesha, MM ; Mengistie, MA ; Mezgebe, HB ; Miller, TR ; Mitchell, PB ; Mohammadi, A ; Mohammed, S ; Obermeyer, CM ; Ogbo, FA ; Castillo, EP ; Papachristou, C ; Patten, SB ; Patton, GC ; Pervaiz, A ; Phillips, MR ; Pourmalek, F ; Qorbani, M ; Radfar, A ; Rafay, A ; Rahimi-Movaghar, V ; Rai, RK ; Rawaf, DL ; Rawaf, S ; Refaat, AH ; Rezaei, S ; Rezai, MS ; Roshandel, G ; Safdarian, M ; Safiabadi, M ; Safiri, S ; Sagar, R ; Sahraian, MA ; Salamati, P ; Samy, AM ; Sartorius, B ; Saylan, MI ; Seedat, S ; Sepanlou, SG ; Shaikh, MA ; Shamsizadeh, M ; Silva, DAS ; Singh, JA ; Sobaih, BHA ; Stein, DJ ; Abdulkader, RS ; Sykes, BL ; Tabares-Seisdedos, R ; Tabb, KM ; Tehrani-Banihashemi, A ; Temsah, M-H ; Terkawi, AS ; Topor-Madry, R ; Ukwaja, KN ; Uthman, OA ; Vollset, SE ; Wakayo, T ; Wang, Y-P ; Werdecker, A ; Westerman, R ; Workicho, A ; Yaghoubi, M ; Yimam, HH ; Yonemoto, N ; Younis, MZ ; Yu, C ; Zaki, MES ; Zein, B ; Jumaan, AO ; Vos, T ; Hay, SI ; Naghavi, M ; Murray, CJL (SPRINGER BASEL AG, 2018-05-01)
    OBJECTIVES: Mental disorders are among the leading causes of nonfatal burden of disease globally. METHODS: We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases. RESULTS: Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7-5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values. CONCLUSIONS: The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.
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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 ;