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    Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
    Kassebaum, NJ ; Arora, M ; Barber, RM ; Bhutta, ZA ; Carter, A ; Casey, DC ; Charlson, FJ ; Coates, MM ; Coggeshall, M ; Cornaby, L ; Dandona, L ; Dicker, DJ ; Erskine, HE ; Ferrari, AJ ; Fitzmaurice, C ; Foreman, K ; Forouzanfar, MH ; Fullman, N ; Gething, PW ; Goldberg, EM ; Graetz, N ; Haagsma, JA ; Johnson, C ; Kemmer, L ; Khalil, IA ; Kinfu, Y ; Kutz, MJ ; Kyu, HH ; Leung, J ; Liang, X ; Lim, SS ; Lozano, R ; Mensah, GA ; Mikesell, J ; Mokdad, AH ; Mooney, MD ; Naghavi, M ; Nguyen, G ; Nsoesie, E ; Pigott, DM ; Pinho, C ; Rankin, Z ; Reinig, N ; Salomon, JA ; Sandar, L ; Smith, A ; Sorensen, RJD ; Stanaway, J ; Steiner, C ; Teeple, S ; Thomas, BA ; Troeger, C ; VanderZanden, A ; Wagner, JA ; Wanga, V ; Whiteford, HA ; Zhou, M ; Zoeckler, L ; Abajobir, AA ; Abate, KH ; Abbafati, C ; Abbas, KM ; Abd-Allah, F ; Abraham, B ; Abubakar, I ; Abu-Raddad, LJ ; Abu-Rmeileh, NME ; Achoki, T ; Ackerman, IN ; Adebiyi, AO ; Adedeji, IA ; Adsuar, JC ; Afanvi, KA ; Afshin, A ; Agardh, EE ; Agarwal, A ; Kumar, S ; Ahmed, MB ; Kiadaliri, AA ; Ahmadieh, H ; Akseer, N ; Al-Aly, Z ; Alam, K ; Alam, NKM ; Aldhahri, SF ; Alegretti, MA ; Aleman, AV ; Alemu, ZA ; Alexander, LT ; Raghib, A ; Alkerwi, A ; Alla, F ; Allebeck, P ; Alsharif, U ; Altirkawi, KA ; Martin, EA ; Alvis-Guzman, N ; Amare, AT ; Amberbir, A ; Amegah, AK ; Amini, H ; Ammar, W ; Amrock, SM ; Anderson, GM ; Anderson, BO ; Antonio, CAT ; Anwari, P ; Arnlov, J ; Arsenijevic, VSA ; Artaman, A ; Asayesh, H ; Asghar, RJ ; Avokpaho, EFGA ; Awasthi, A ; Quintanilla, BPA ; Azzopardi, P ; Bacha, U ; Badawi, A ; Balakrishnan, K ; Banerjee, A ; Barac, A ; Barker-Collo, SL ; Barnighausen, T ; Barregard, L ; Barrero, LH ; Basu, S ; Bayou, TA ; Beardsley, J ; Bedi, N ; Beghi, E ; Bell, B ; Bell, ML ; Benjet, C ; Bennett, DA ; Bensenor, IM ; Berhane, A ; Bernabe, E ; Betsu, BD ; Beyene, AS ; Bhala, N ; Bhansali, A ; Bhatt, S ; Biadgilign, S ; Bienhofff, K ; Bikbov, B ; Bin Abdulhak, AA ; Bisanzio, D ; Bjertness, E ; Blore, JD ; Borschmann, R ; Boufous, S ; Bourne, RRA ; Brainin, M ; Brazinova, A ; Breitborde, NJK ; Brugha, TS ; Buchbinder, R ; Buckle, GC ; Butt, ZA ; Calabria, B ; Campos-Nonato, IR ; Campuzano, JC ; Carabin, H ; Carapetis, JR ; Cardenas, R ; Carrero, JJ ; Castaneda-Orjuela, CA ; Rivas, JC ; Catala-Lopez, F ; Cavalleri, F ; Chang, J-C ; Chiang, PP-C ; Chibalabala, M ; Chibueze, CE ; Chisumpa, VH ; Choi, J-YJ ; Choudhury, L ; Christensen, H ; Ciobanu, LG ; Colistro, V ; Colomar, M ; Colquhoun, SM ; Cortinovis, M ; Crump, JA ; Damasceno, A ; Dandona, R ; Dargan, PI ; Das Neves, J ; Davey, G ; Davis, AC ; De Leo, D ; Degenhardt, L ; Del Gobbo, LC ; Derrett, S ; Des Jarlais, DC ; Deveber, GA ; Dharmaratne, SD ; Dhillon, PK ; Ding, EL ; Doyle, KE ; Driscoll, TR ; Duan, L ; Dubey, M ; Duncan, BB ; Ebrahimi, H ; Ellenbogen, RG ; Elyazar, I ; Endries, AY ; Ermakov, SP ; Eshrati, B ; Esteghamati, A ; Estep, K ; Fahimi, S ; Farid, TA ; Sa Farinha, CSE ; Faro, A ; Farvid, MS ; Farzadfar, F ; Feigin, VL ; Fereshtehnejad, S-M ; Fernandes, JG ; Fernandes, JC ; Fischer, F ; Fitchett, JRA ; Foigt, N ; Fowkes, FGR ; Franklin, RC ; Friedman, J ; Frostad, J ; Furst, T ; Futran, ND ; Gabbe, B ; Gankpe, FG ; Garcia-Basteiro, AL ; Gebrehiwot, TT ; Gebremedhin, AT ; Geleijnse, JM ; Gibney, KB ; Gillum, RF ; Ginawi, IAM ; Giref, AZ ; Giroud, M ; Gishu, MD ; Godwin, WW ; Gomez-Dantes, H ; Gona, P ; Goodridge, A ; Gopalani, SV ; Gotay, CC ; Goto, A ; Gouda, HN ; Guo, Y ; Gupta, R ; Gupta, R ; Gupta, V ; Gutierrez, RA ; Hafezi-Nejad, N ; Haile, D ; Hailu, AD ; Hailu, GB ; Halasa, YA ; Hamadeh, RR ; Hamidi, S ; Hammami, M ; Handal, AJ ; Hankey, GJ ; Harb, HL ; Harikrishnan, S ; Haro, JM ; Hassanvand, MS ; Hassen, TA ; Havmoeller, R ; Hay, RJ ; Hedayati, MT ; Heredia-Pi, IB ; Heydarpour, P ; Hoek, HW ; Hoffman, DJ ; Horino, M ; Horita, N ; Hosgood, HD ; Hoy, DG ; Hsairi, M ; Huang, H ; Huang, JJ ; Iburg, KM ; Idrisov, BT ; Innos, K ; Inoue, M ; Jacobsen, KH ; Jauregui, A ; Jayatilleke, AU ; Jeemon, P ; Jha, V ; Jiang, G ; Jiang, Y ; Jibat, T ; Jimenez-Corona, A ; Jin, Y ; Jonas, JB ; Kabir, Z ; Kajungu, DK ; Kalkonde, Y ; Kamal, R ; Kan, H ; Kandel, A ; Karch, A ; Karema, CK ; Karimkhani, C ; Kasaeian, A ; Katibeh, M ; Kaul, A ; Kawakami, N ; Kazi, DS ; Keiyoro, PN ; Kemp, AH ; Kengne, AP ; Keren, A ; Kesavachandran, CN ; Khader, YS ; Khan, AR ; Khan, EA ; Khang, Y-H ; Khoja, TAM ; Khubchandani, J ; Kieling, C ; Kim, C-I ; Kim, D ; Kim, YJ ; Kissoon, N ; Kivipelto, M ; Knibbs, LD ; Knudsen, AK ; Kokubo, Y ; Kolte, D ; Kopec, JA ; Koul, PA ; Koyanagi, A ; Defo, BK ; Kuchenbecker, RS ; Bicer, BK ; Kuipers, EJ ; Kumar, GA ; Kwan, GF ; Lalloo, R ; Lallukka, T ; Larsson, A ; Latif, AA ; Lavados, PM ; Lawrynowicz, AEB ; Leasher, JL ; Leigh, J ; Leung, R ; Li, Y ; Li, Y ; Lipshultz, SE ; Liu, PY ; Liu, Y ; Lloyd, BK ; Logroscino, G ; Looker, KJ ; Lotufo, PA ; Lucas, RM ; Lunevicius, R ; Lyons, RA ; El Razek, HMA ; Mahdavi, M ; Majdan, M ; Majeed, A ; Malekzadeh, R ; Malta, DC ; Marcenes, W ; Martinez-Raga, J ; Masiye, F ; Mason-Jones, AJ ; Matzopoulos, R ; Mayosi, BM ; McGrath, JJ ; Mckee, M ; Meaney, PA ; Mehari, A ; Melaku, YA ; Memiah, P ; Memish, ZA ; Mendoza, W ; Meretoja, A ; Meretoja, TJ ; Mesfin, YM ; Mhimbira, FA ; Miller, TR ; Mills, EJ ; Mirarefin, M ; Mirrakhimov, EM ; Mitchell, PB ; Mock, CN ; Mohammad, KA ; Mohammadi, A ; Mohammed, S ; Monasta, L ; Montanez Hernandez, JC ; Montico, M ; Moradi-Lakeh, M ; Mori, R ; Mueller, UO ; Mumford, JE ; Murdoch, ME ; Murthy, GVS ; Nachega, JB ; Naheed, A ; Naldi, L ; Nangia, V ; Newton, JN ; Ng, M ; Ngalesoni, FN ; Le Nguyen, Q ; Nisar, MI ; Pete, PMN ; Nolla, JM ; Norheim, OF ; Norman, RE ; Norrving, B ; Obermeyer, CM ; Ogbo, FA ; Oh, I-H ; Oladimeji, O ; Olivares, PR ; Olusanya, BO ; Olusanya, JO ; Oren, E ; Ortiz, A ; Ota, E ; Oyekale, AS ; Pa, M ; Park, E-K ; Parsaeian, M ; Patten, SB ; Patton, GC ; Pedro, JM ; Pereira, DM ; Perico, N ; Pesudovs, K ; Petzold, M ; Phillips, MR ; Piel, FB ; Pillay, JD ; Pishgar, F ; Plass, D ; Polinder, S ; Popova, S ; Poulton, RG ; Pourmalek, F ; Prasad, NM ; Qorbani, M ; Rabiee, RHS ; Radfar, A ; Rafay, A ; Rahimi, K ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MHU ; Rahman, SU ; Rai, D ; Rai, RK ; Rajsic, S ; Raju, M ; Ram, U ; Ranganathan, K ; Refaat, AH ; Reitsma, MB ; Remuzzi, G ; Resnikoff, S ; Reynolds, A ; Ribeiro, AL ; Ricci, S ; Roba, HS ; Rojas-Rueda, D ; Ronfani, L ; Roshandel, G ; Roth, GA ; Roy, A ; Sackey, BB ; Sagar, R ; Sanabria, JR ; Dolores Sanchez-Nino, M ; Santos, IS ; Santos, JV ; Sarmiento-Suarez, R ; Sartorius, B ; Satpathy, M ; Savic, M ; Sawhney, M ; Schmidt, MI ; Schneider, IJC ; Schutte, AE ; Schwebel, DC ; Seedat, S ; Sepanlou, SG ; Servan-Mori, EE ; Shahraz, S ; Shaikh, MA ; Sharma, R ; She, J ; Sheikhbahaei, S ; Shen, J ; Sheth, KN ; Shibuya, K ; Shigematsu, M ; Shin, M-J ; Shin, R ; Sigfusdottir, ID ; Santos Silva, DA ; Silverberg, JI ; Simard, EP ; Singh, A ; Singh, JA ; Singh, PK ; Skirbekk, V ; Skogen, JC ; Soljak, M ; Soreide, K ; Sreeramareddy, CT ; Stathopoulou, V ; Steel, N ; Stein, DJ ; Stein, MB ; Steiner, TJ ; Stovner, LJ ; Stranges, S ; Stroumpoulis, K ; Sunguya, BF ; Sur, PJ ; Swaminathan, S ; Sykes, BL ; Szoeke, CEI ; Tabares-Seisdedos, R ; Landon, N ; Tanne, D ; Tavakkoli, M ; Taye, B ; Taylor, HR ; Ao, BJT ; Tegegne, TK ; Tekle, DY ; Terkawi, AS ; Tessema, GA ; Thakur, JS ; Thomson, AJ ; Thorne-Lyman, AL ; Thrift, AG ; Thurston, GD ; Tobe-Gai, R ; Tonelli, M ; Topor-Madry, R ; Topouzis, F ; Tran, BX ; Dimbuene, ZT ; Tsilimbaris, M ; Tura, AK ; Tuzcu, EM ; Tyrovolas, S ; Ukwaja, KN ; Undurraga, EA ; Uneke, CJ ; Uthman, OA ; van Gool, CH ; van Os, J ; Vasankari, T ; Vasconcelos, AMN ; Venketasubramanian, N ; Violante, FS ; Vlassov, VV ; Vollset, SE ; Wagner, GR ; Wallin, MT ; Wang, L ; Weichenthal, S ; Weiderpass, E ; Weintraub, RG ; Werdecker, A ; WestermaM, R ; Wijeratne, T ; Wilkinson, JD ; Williams, HC ; Wiysonge, CS ; Woldeyohannes, SM ; Wolfe, CDA ; Won, S ; Xu, G ; Yadav, AK ; Yakob, B ; Yan, LL ; Yan, Y ; Yaseri, M ; Ye, P ; Yip, P ; Yonemoto, N ; Yoon, S-J ; Younis, MZ ; Yu, C ; Zaidi, Z ; Zaki, MES ; Zeeb, H ; Zodpey, S ; Zonies, D ; Zuhlke, LJ ; Vos, T ; Lopez, AD ; Murray, CJL (ELSEVIER SCIENCE INC, 2016-10-08)
    BACKGROUND: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) 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 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS: Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION: Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING: Bill & Melinda Gates Foundation.
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    Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015
    Wang, H ; Naghavi, M ; Allen, C ; Barber, RM ; Bhutta, ZA ; Carter, A ; Casey, DC ; Charlson, FJ ; Chen, AZ ; Coates, MM ; Coggeshall, M ; Dandona, L ; Dicker, DJ ; Erskine, HE ; Ferrari, AJ ; Fitzmaurice, C ; Foreman, K ; Forouzanfar, MH ; Fraser, MS ; Pullman, N ; Gething, PW ; Goldberg, EM ; Graetz, N ; Haagsma, JA ; Hay, SI ; Huynh, C ; Johnson, C ; Kassebaum, NJ ; Kinfu, Y ; Kulikoff, XR ; Kutz, M ; Kyu, HH ; Larson, HJ ; Leung, J ; Liang, X ; Lim, SS ; Lind, M ; Lozano, R ; Marquez, N ; Mensah, GA ; Mikesell, J ; Mokdad, AH ; Mooney, MD ; Nguyen, G ; Nsoesie, E ; Pigott, DM ; Pinho, C ; Roth, GA ; Salomon, JA ; Sandar, L ; Silpakit, N ; Sligar, A ; Sorensen, RJD ; Stanaway, J ; Steiner, C ; Teeple, S ; Thomas, BA ; Troeger, C ; VanderZanden, A ; Vollset, SE ; Wanga, V ; Whiteford, HA ; Wolock, T ; Zoeckler, L ; Abate, KH ; Abbafati, C ; Abbas, KM ; Abd-Allah, F ; Abera, SF ; Abreu, DMX ; Abu-Raddad, LJ ; Abyu, GY ; Achoki, T ; Adelekan, AL ; Ademi, Z ; Adou, AK ; Adsuar, JC ; Afanvi, KA ; Afshin, A ; Agardh, EE ; Agarwal, A ; Agrawal, A ; Kiadaliri, AA ; Ajala, ON ; Akanda, AS ; Akinyemi, RO ; Akinyemiju, TF ; Akseer, N ; Al Lami, FH ; Alabed, S ; Al-Aly, Z ; Alam, K ; Alam, NKM ; Alasfoor, D ; Aldhahri, SF ; Aldridge, RW ; Alegretti, MA ; Aleman, AV ; Alemu, ZA ; Alexander, LT ; Alhabib, S ; Ali, R ; Alkerwi, A ; Alla, F ; Allebeck, P ; Al-Raddadi, R ; Alsharif, U ; Altirkawi, KA ; Martin, EA ; Alvis-Guzman, N ; Amare, AT ; Amegah, AK ; Ameh, EA ; Amini, H ; Ammar, W ; Amrock, SM ; Andersen, HH ; Anderson, B ; Anderson, GM ; Antonio, CAT ; Aregay, AF ; Arnlov, J ; Arsenijevic, VSA ; Al, A ; Asayesh, H ; Asghar, RJ ; Atique, S ; Arthur Avokpaho, EFG ; Awasthi, A ; Azzopardi, P ; Bacha, U ; Badawi, A ; Bahit, MC ; Balakrishnan, K ; Banerjee, A ; Barac, A ; Barker-Collo, SL ; Barnighausen, T ; Barregard, L ; Barrero, LH ; Basu, A ; Basu, S ; Bayou, YT ; Bazargan-Hejazi, S ; Beardsley, J ; Bedi, N ; Beghi, E ; Belay, HA ; Bell, B ; Bell, ML ; Bello, AK ; Bennett, DA ; Bensenor, IM ; Berhane, A ; Bernabe, E ; Betsu, BD ; Beyene, AS ; Bhala, N ; Bhalla, A ; Biadgilign, S ; Bikbov, B ; Bin Abdulhak, AA ; Biroscak, BJ ; Biryukov, S ; Bjertness, E ; Blore, JD ; Blosser, CD ; Bohensky, MA ; Borschmann, R ; Bose, D ; Bourne, RRA ; Brainin, M ; Brayne, CEG ; Brazinova, A ; Breitborde, NJK ; Brenner, H ; Brewer, JD ; Brown, A ; Brown, J ; Brugha, TS ; Buckle, GC ; Butt, ZA ; Calabria, B ; Campos-Novato, IR ; Campuzano, JC ; Carapetis, JR ; Cardenas, R ; Carpenter, D ; Carrero, JJ ; Castaneda-Oquela, CA ; Rivas, JC ; Catala-Lopez, F ; Cavalleri, F ; Cercy, K ; Cerda, J ; Chen, W ; Chew, A ; Chiang, PP-C ; Chibalabala, M ; Chibueze, CE ; Chimed-Ochir, O ; Chisumpa, VH ; Choi, J-YJ ; Chowdhury, R ; Christensen, H ; Christopher, DJ ; Ciobanu, LG ; Cirillo, M ; Cohen, AJ ; Colistro, V ; Colomar, M ; Colquhoun, SM ; Cooper, C ; Cooper, LT ; Cortinovis, M ; Cowie, BC ; Crump, JA ; Damsere-Derry, J ; Danawi, H ; Dandona, R ; Daoud, F ; Darby, SC ; Dargan, PI ; das Neves, J ; Davey, G ; Davis, AC ; Davitoiu, DV ; de Castro, EF ; de Jager, P ; De Leo, D ; Degenhardt, L ; Dellavalle, RP ; Deribe, K ; Deribew, A ; Dharmaratne, SD ; Dhillon, PK ; Diaz-Torne, C ; Ding, EL ; dos Santos, KPB ; Dossou, E ; Driscoll, TR ; Duan, L ; Dubey, M ; Bartholow, B ; Ellenbogen, RG ; Lycke, C ; Elyazar, I ; Endries, AY ; Ermakov, SP ; Eshrati, B ; Esteghamati, A ; Estep, K ; Faghmous, IDA ; Fahimi, S ; Jose, E ; Farid, TA ; Sa Farinha, CSE ; Faro, A ; Farvid, MS ; Farzadfar, F ; Feigin, VL ; Fereshtehnejad, S-M ; Fernandes, JG ; Fernandes, JC ; Fischer, F ; Fitchett, JRA ; Flaxman, A ; Foigt, N ; Fowkes, FGR ; Franca, EB ; Franklin, RC ; Friedman, J ; Frostad, J ; Hirst, T ; Futran, ND ; Gall, SL ; Gambashidze, K ; Gamkrelidze, A ; Ganguly, P ; Gankpe, FG ; Gebre, T ; Gebrehiwot, TT ; Gebremedhin, AT ; Gebru, AA ; Geleijnse, JM ; Gessner, BD ; Ghoshal, AG ; Gibney, KB ; Gillum, RF ; Gilmour, S ; Giref, AZ ; Giroud, M ; Gishu, MD ; Giussani, G ; Glaser, E ; Godwin, WW ; Gomez-Dantes, H ; Gona, P ; Goodridge, A ; Gopalani, SV ; Gosselin, RA ; Gotay, CC ; Goto, A ; Gouda, HN ; Greaves, F ; Gugnani, HC ; Gupta, R ; Gupta, R ; Gupta, V ; Gutierrez, RA ; Hafezi-Nejad, N ; Haile, D ; Hailu, AD ; Hailu, GB ; Halasa, YA ; Hamadeh, RR ; Hamidi, S ; Hancock, J ; Handal, AJ ; Hankey, GJ ; Hao, Y ; Harb, HL ; Harikrishnan, S ; Haro, JM ; Havmoeller, R ; Heckbert, SR ; Heredia-Pi, IB ; Heydarpour, P ; Hilderink, HBM ; Hoek, HW ; Hogg, RS ; Horino, M ; Horita, N ; Hosgood, HD ; Hotez, PJ ; Hoy, DG ; Hsairi, M ; Htet, AS ; Than Htike, MM ; Hu, G ; Huang, C ; Huang, H ; Huiart, L ; Husseini, A ; Huybrechts, I ; Huynh, G ; Iburg, KM ; Innos, K ; Inoue, M ; Iyer, VJ ; Jacobs, TA ; Jacobsen, KH ; Jahanmehr, N ; Jakovljevic, MB ; James, P ; Javanbakht, M ; Jayaraman, SP ; Jayatilleke, AU ; Jeemon, P ; Jensen, PN ; Jha, V ; Jiang, G ; Jiang, Y ; Jibat, T ; Jimenez-Corona, A ; Jonas, JB ; Joshi, TK ; Kabir, Z ; Karnak, R ; Kan, H ; Kant, S ; Karch, A ; Karema, CK ; Karimkhani, C ; Karletsos, D ; Karthikeyan, G ; Kasaeian, A ; Katibeh, M ; Kaul, A ; Kawakami, N ; Kayibanda, JF ; Keiyoro, PN ; Kemmer, L ; Kemp, AH ; Kengne, AP ; Keren, A ; Kereselidze, M ; Kesavachandran, CN ; Khader, YS ; Khalil, IA ; Khan, AR ; Khan, EA ; Khang, Y-H ; Khera, S ; Muthafer Khoja, TA ; Kieling, C ; Kim, D ; Kim, YJ ; Kissela, BM ; Kissoon, N ; Knibbs, LD ; Knudsen, AK ; Kokubo, Y ; Kolte, D ; Kopec, JA ; Kosen, S ; Koul, PA ; Koyanagi, A ; Krog, NH ; Defo, BK ; Bicer, BK ; Kudom, AA ; Kuipers, EJ ; Kulkarni, VS ; Kumar, GA ; Kwan, GF ; Lal, A ; Lal, DK ; Lalloo, R ; Lam, H ; Lam, JO ; Langan, SM ; Lansingh, VC ; Larsson, A ; Laryea, DO ; Latif, AA ; Lawrynowicz, AEB ; Leigh, J ; Levi, M ; Li, Y ; Lindsay, MP ; Lipshultz, SE ; Liu, PY ; Liu, S ; Liu, Y ; Lo, L-T ; Logroscino, G ; Lotufo, PA ; Lucas, RM ; Lunevicius, R ; Lyons, RA ; Ma, S ; Pedro Machado, VM ; Mackay, MT ; MacLachlan, JH ; Abd El Razek, HM ; Abd El Razek, MM ; Majdan, M ; Majeed, A ; Malekzadeh, R ; Ayele Manamo, WA ; Mandisarisa, J ; Mangalam, S ; Mapoma, CC ; Marcenes, W ; Margolis, DJ ; Martin, GR ; Martinez-Raga, J ; Marzan, MB ; Masiye, F ; Mason-Jones, AJ ; Massano, J ; Matzopoulos, R ; Mayosi, BM ; McGarvey, ST ; McGrath, JJ ; Mckee, M ; McMahon, BJ ; Meaney, PA ; Mehari, A ; Mehndiratta, MM ; Mena-Rodriguez, F ; Mekonnen, AB ; Melaku, YA ; Memiah, P ; Memish, ZA ; Mendoza, W ; Meretoja, A ; Meretoja, TJ ; Mhimbira, FA ; Micha, R ; Miller, TR ; Mirarefin, M ; Misganaw, A ; Mock, CN ; Abdulmuhsin Mohammad, K ; Mohammadi, A ; Mohammed, S ; Mohan, V ; Mola, GLD ; Monasta, L ; Montanez Hernandez, JC ; Montero, P ; Montico, M ; Montine, TJ ; Moradi-Lakeh, M ; Morawska, L ; Morgan, K ; Mori, R ; Mozaffarian, D ; Mueller, U ; Satyanarayana Murthy, GV ; Murthy, S ; Musa, KI ; Nachega, JB ; Nagel, G ; Naidoo, KS ; Naik, N ; Naldi, L ; Nangia, V ; Nash, D ; Nejjari, C ; Neupane, S ; Newton, CR ; Newton, JN ; Ng, M ; Ngalesoni, FN ; Ngirabega, JDD ; Quyen, LN ; Nisar, MI ; Nkamedjie Pete, PM ; Nomura, M ; Norheim, OF ; Norman, PE ; Norrving, B ; Nyakarahuka, L ; Ogbo, FA ; Ohkubo, T ; Ojelabi, FA ; Olivares, PR ; Olusanya, BO ; Olusanya, JO ; Opio, JN ; Oren, E ; Ortiz, A ; Osman, M ; Ota, E ; Ozdemir, R ; Pa, M ; Pandian, JD ; Pant, PR ; Papachristou, C ; Park, E-K ; Park, J-H ; Parry, CD ; Parsaeian, M ; Caicedo, AJP ; Patten, SB ; Patton, GC ; Paul, VK ; Pearce, N ; Pedro, JM ; Stokic, LP ; Pereira, DM ; Perico, N ; Pesudovs, K ; Petzold, M ; Phillips, MR ; Piel, FB ; Pillay, JD ; Plass, D ; Platts-Mills, JA ; Polinder, S ; Pope, CA ; Popova, S ; Poulton, RG ; Pourmalek, F ; Prabhakaran, D ; Qorbani, M ; Quame-Amaglo, J ; Quistberg, DA ; Rafay, A ; Rahimi, K ; Rahimi-Movaghar, V ; Rahman, M ; Rahman, MHU ; Rahman, SU ; Rai, RK ; Rajavi, Z ; Rajsic, S ; Raju, M ; Rakovac, I ; Rana, SM ; Ranabhat, CL ; Rangaswamy, T ; Rao, P ; Rao, SR ; Refaat, AH ; Rehm, J ; Reitsma, MB ; Remuzzi, G ; Resnikofff, S ; Ribeiro, AL ; Ricci, S ; Blancas, MJR ; Roberts, B ; Roca, A ; Rojas-Rueda, D ; Ronfani, L ; Roshandel, G ; Rothenbacher, D ; Roy, A ; Roy, NK ; Ruhago, GM ; Sagar, R ; Saha, S ; Sahathevan, R ; Saleh, MM ; Sanabria, JR ; Sanchez-Nino, MD ; Sanchez-Riera, L ; Santos, IS ; Sarmiento-Suarez, R ; Sartorius, B ; Satpathy, M ; Savic, M ; Sawhney, M ; Schaub, MP ; Schmidt, MI ; Schneider, IJC ; Schottker, B ; Schutte, AE ; Schwebel, DC ; Seedat, S ; Sepanlou, SG ; Servan-Mori, EE ; Shackelford, KA ; Shaddick, G ; Shaheen, A ; Shahraz, S ; Shaikh, MA ; Shakh-Nazarova, M ; Sharma, R ; She, J ; Sheikhbahaei, S ; Shen, J ; Shen, Z ; Shepard, DS ; Sheth, KN ; Shetty, BP ; Shi, P ; Shibuya, K ; Shin, M-J ; Shiri, R ; Shiue, I ; Shrime, MG ; Sigfusdottir, ID ; Silberberg, DH ; Silva, DAS ; Silveira, DGA ; Silverberg, JI ; Simard, EP ; Singh, A ; Singh, GM ; Singh, JA ; Singh, OP ; Singh, PK ; Singh, V ; Soneji, S ; Soreide, K ; Soriano, JB ; Sposato, LA ; Sreeramareddy, CT ; Stathopoulou, V ; Stein, DJ ; Stein, MB ; Stranges, S ; Stroumpoulis, K ; Sunguya, BF ; Sur, P ; Swaminathan, S ; Sykes, BL ; Szoeke, CEI ; Tabares-Seisdedos, R ; Tabb, KM ; Takahashi, K ; Takala, JS ; Talongwa, RT ; Tandon, N ; Tavakkoli, M ; Taye, B ; Taylor, HR ; Ao, BJT ; Tedla, BA ; Tefera, WM ; Ten Have, M ; Terkawi, AS ; Tesfay, FH ; Tessema, GA ; Thomson, AJ ; Thorne-Lyman, AL ; Thrift, AG ; Thurston, GD ; Tillmann, T ; Tirschwell, DL ; Tonelli, M ; Topor-Madry, R ; Topouzis, F ; Nx, JAT ; Traebert, J ; Tran, BX ; Truelsen, T ; Trujillo, U ; Tura, AK ; Tuzcu, EM ; Uchendu, US ; Ukwaja, KN ; Undurraga, EA ; Uthman, OA ; Van Dingenen, R ; Van Donkelaar, A ; Vasankari, T ; Vasconcelos, AMN ; Venketasubramanian, N ; Vidavalur, R ; Vijayakumar, L ; Villalpando, S ; Violante, FS ; Vlassov, VV ; Wagner, JA ; Wagner, GR ; Wallin, MT ; Wang, L ; Watkins, DA ; Weichenthal, S ; Weiderpass, E ; Weintraub, RG ; Werdecker, A ; Westerman, R ; White, RA ; Wijeratne, T ; Wilkinson, JD ; Williams, HC ; Wiysonge, CS ; Woldeyohannes, SM ; Wolfe, CDA ; Won, S ; Wong, JQ ; Woolf, AD ; Xavier, D ; Xiao, Q ; Xu, G ; Yakob, B ; Yalew, AZ ; Yan, LL ; Yano, Y ; Yaseri, M ; Ye, P ; Yebyo, HG ; Yip, P ; Yirsaw, BD ; Yonemoto, N ; Yonga, G ; Younis, MZ ; Yu, S ; Zaidi, Z ; Zaki, MES ; Zannad, F ; Zavala, DE ; Zeeb, H ; Zeleke, BM ; Zhang, H ; Zodpey, S ; Zonies, D ; Zuhlke, LJ ; Vos, T ; Lopez, AD ; Murray, CJL (ELSEVIER SCIENCE INC, 2016-10-08)
    BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. FUNDING: Bill & Melinda Gates Foundation.
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    Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries
    Dieleman, J ; Campbell, M ; Chapin, A ; Eldrenkamp, E ; Fan, VY ; Haakenstad, A ; Kates, J ; Liu, Y ; Matyasz, T ; Micah, A ; Reynolds, A ; Sadat, N ; Schneider, MT ; Sorensen, R ; Evans, T ; Evans, D ; Kurowski, C ; Tandon, A ; Abbas, KM ; Abera, SF ; Kiadaliri, AA ; Ahmed, KY ; Ahmed, MB ; Alam, K ; Alizadeh-Navaei, R ; Alkerwi, A ; Amini, E ; Ammar, W ; Amrock, SM ; Antonio, CAT ; Atey, TM ; Avila-Burgos, L ; Awasthi, A ; Barac, A ; Alberto Bernal, O ; Beyene, AS ; Beyene, TJ ; Birungi, C ; Bizuayehu, HM ; Breitborde, NJK ; Cahuana-Hurtado, L ; Estanislao Castro, R ; Catala-Lopez, F ; Dalal, K ; Dandona, L ; Dandona, R ; de Jager, P ; Dharmaratne, SD ; Dubey, M ; Farinha, CSES ; Faro, A ; Feigl, AB ; Fischer, F ; Fitchett, JRA ; Foigt, N ; Giref, AZ ; Gupta, R ; Hamidi, S ; Harb, HL ; Hay, SI ; Hendrie, D ; Horino, M ; Jurisson, M ; Jakovljevic, MB ; Javanbakht, M ; John, D ; Jonas, JB ; Karimi, SM ; Khang, Y-H ; Khubchandani, J ; Kim, YJ ; Kinge, JM ; Krohn, KJ ; Kumar, GA ; Abd El Razek, HM ; Abd El Razek, MM ; Majeed, A ; Malekzadeh, R ; Masiye, F ; Meier, T ; Meretoja, A ; Miller, TR ; Mirrakhimov, EM ; Mohammed, S ; Nangia, V ; Olgiati, S ; Osman, AS ; Owolabi, MO ; Patel, T ; Paternina Caicedo, AJ ; Pereira, DM ; Perelman, J ; Polinder, S ; Rafay, A ; Rahimi-Movaghar, V ; Rai, RK ; Ram, U ; Ranabhat, CL ; Roba, HS ; Salama, J ; Savic, M ; Sepanlou, SG ; Shrime, MG ; Talongwa, RT ; Te Ao, BJ ; Tediosi, F ; Tesema, AG ; Thomson, AJ ; Tobe-Gai, R ; Topor-Madry, R ; Undurraga, EA ; Vasankari, T ; Violante, FS ; Werdecker, A ; Wijeratne, T ; Xu, G ; Yonemoto, N ; Younis, MZ ; Yu, C ; Zaidi, Z ; Zaki, MES ; Murray, CJL (ELSEVIER SCIENCE INC, 2017-05-20)
    BACKGROUND: An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. METHODS: We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. FINDINGS: Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. INTERPRETATION: Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage. FUNDING: The Bill & Melinda Gates Foundation.
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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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    Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study
    Mokdad, AH ; Tehrani-Banihashemi, A ; Moradi-Lakeh, M ; El Bcheraoui, C ; Charara, R ; Khalil, I ; Afshin, A ; Collison, M ; Daoud, F ; Krohn, KJ ; Chew, A ; Cornaby, L ; Foreman, KJ ; Frostad, J ; Kassebaum, NJ ; Kemmer, L ; Kutz, M ; Liu, P ; Mirarefin, M ; Nguyen, G ; Wang, H ; Zipkin, B ; Abajobir, AA ; Abouzeid, M ; Abu-Rmeileh, NME ; Kiadaliri, AA ; Ahmed, MB ; Aksut, B ; Alam, K ; Alasfoor, D ; Ali, R ; Alizadeh-Navaei, R ; Al-Raddadi, R ; Alsharif, U ; Altirkawi, KA ; Alvis-Guzman, N ; Anber, N ; Anwari, P ; Arnlov, J ; Asgedom, SW ; Atey, TM ; Awasthi, A ; Baernighausen, T ; Bacha, U ; Barac, A ; Barker-Collo, SL ; Bedi, N ; Bennett, DA ; Berhe, DF ; Biadgilign, S ; Butt, ZA ; Carapetis, JR ; Estanislao Castro, R ; Chitheer, AA ; Davletov, K ; Dharmaratne, SD ; Djalalinia, S ; Huyen, PD ; Dubey, M ; Ebrahimi, H ; Eshrati, B ; Esteghamati, A ; Farvid, MS ; Fereshtehnejad, S-M ; Fischer, F ; Gebrehiwot, SW ; Gebrehiwot, TT ; Gillum, RF ; Gona, PN ; Gupta, R ; Hafezi-Nejad, N ; Hamadeh, RR ; Hamidi, S ; Hsairi, M ; Jee, SH ; Jonas, JB ; Karimkhani, C ; Kasaeian, A ; Khader, YS ; Khan, EA ; Kim, D ; Lal, DK ; Larson, HJ ; Latif, AA ; Linn, S ; Lotufo, PA ; Lunevicius, R ; Abd El Razek, HM ; Majeed, A ; Malekzadeh, R ; Malta, DC ; Meier, T ; Memiah, P ; Memish, ZA ; Mendoza, W ; Mensah, GA ; Meretoja, A ; Miller, TR ; Mirrakhimov, EM ; Mohammed, S ; Quyen, LN ; Vuong, MN ; Pearson-Stuttard, J ; Pishgar, F ; Pourmalek, F ; Qorbani, M ; Radfar, A ; Rafay, A ; Rahimi-Movaghar, V ; Rai, RK ; Rana, SM ; Rawaf, DL ; Rawaf, S ; Renzaho, AMN ; Rezaei, S ; Roba, KT ; Roshandel, G ; Safdarian, M ; Safi, S ; Safiri, S ; Sahraian, MA ; Salamati, P ; Samy, AM ; Milicevic, MMS ; Sartorius, B ; Sepanlou, SG ; Shaikh, MA ; Santos Silva, DA ; Singh, JA ; Sobaih, BHA ; Stroumpoulis, K ; Abdulkader, RS ; Szoeke, CEI ; Temsah, M-H ; Tran, BX ; Ukwaja, KN ; Uthman, OA ; Vasankari, T ; Vlassov, VV ; Vollset, SE ; Wakayo, T ; Weintraub, RG ; Wessly, PR ; Wijeratne, T ; Wolfe, CDA ; Workicho, A ; Yaghoubi, M ; Yano, Y ; Yaseri, M ; Yonemoto, N ; Younis, MZ ; Yu, C ; Zaki, MES ; Jumaan, AO ; Vos, T ; Roth, GA ; Hay, SI ; Naghavi, M ; Murray, CJL (SPRINGER BASEL AG, 2018-05-01)
    OBJECTIVES: To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990-2015. METHODS: We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. RESULTS: A total of 1.4 million CVD deaths (95% UI: 1.3-1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest age-standardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. CONCLUSIONS: The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.
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    Future and potential spending on health 2015-40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries
    Dieleman, JL ; Campbell, M ; Chapin, A ; Eldrenkamp, E ; Fan, VY ; Haakenstad, A ; Kates, J ; Li, Z ; Matyasz, T ; Micah, A ; Reynolds, A ; Sadat, N ; Schneider, MT ; Sorensen, R ; Abbas, KM ; Abera, SF ; Kiadaliri, AA ; Ahmed, MB ; Alam, K ; Alizadeh-Navaei, R ; Alkerwi, A ; Amini, E ; Ammar, W ; Antonio, CAT ; Atey, TM ; Avila-Burgos, L ; Awasthi, A ; Barac, A ; Berheto, TM ; Beyene, AS ; Beyene, TJ ; Birungi, C ; Bizuayehu, HM ; Breitborde, NJK ; Cahuana-Hurtado, L ; Estanislao Castro, R ; Catala-Lopez, F ; Dalal, K ; Dandona, L ; Dandona, R ; Dharmaratne, SD ; Dubey, M ; Faro, A ; Feigl, AB ; Fischer, F ; Fitchett, JRA ; Foigt, N ; Giref, AZ ; Gupta, R ; Hamidi, S ; Harb, HL ; Hay, SI ; Hendrie, D ; Horino, M ; Jurisson, M ; Jakovljevic, MB ; Javanbakht, M ; John, D ; Jonas, JB ; Karimi, SM ; Khang, Y-H ; Khubchandani, J ; Kim, YJ ; Kinge, JM ; Krohn, KJ ; Kumar, GA ; Leung, R ; Abd El Razek, HM ; Abd El Razek, MM ; Majeed, A ; Malekzadeh, R ; Malta, DC ; Meretoja, A ; Miller, TR ; Mirrakhimov, EM ; Mohammed, S ; Molla, G ; Nangia, V ; Olgiati, S ; Owolabi, MO ; Patel, T ; Caicedo, AJP ; Pereira, DM ; Perelman, J ; Polinder, S ; Rafay, A ; Rahimi-Movaghar, V ; Rai, RK ; Ram, U ; Ranabhat, CL ; Roba, HS ; Savic, M ; Sepanlou, SG ; Te Ao, BJ ; Tesema, AG ; Thomson, AJ ; Tobe-Gai, R ; Topor-Madry, R ; Undurraga, EA ; Vargas, V ; Vasankari, T ; Violante, FS ; Wijeratne, T ; Xu, G ; Yonemoto, N ; Younis, MZ ; Yu, C ; Zaidi, Z ; Zaki, MES ; Murray, CJL (ELSEVIER SCIENCE INC, 2017-05-20)
    BACKGROUND: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. METHODS: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. FINDINGS: We estimated that global spending on health will increase from US$9·21 trillion in 2014 to $24·24 trillion (uncertainty interval [UI] 20·47-29·72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5·3% (UI 4·1-6·8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4·2% (3·8-4·9). High-income countries are expected to grow at 2·1% (UI 1·8-2·4) and low-income countries are expected to grow at 1·8% (1·0-2·8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. INTERPRETATION: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential. FUNDING: Bill & Melinda Gates Foundation.
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    Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
    Feigin, VL ; Abajobir, AA ; Abate, KH ; Abd-Allah, F ; Abdulle, AM ; Abera, SF ; Abyu, GY ; Ahmed, MB ; Aichour, AN ; Aichour, I ; Aichour, MTE ; Akinyemi, RO ; Alabed, S ; Al-Raddadi, R ; Alvis-Guzman, N ; Amare, AT ; Ansari, H ; Anwari, P ; Arnlov, J ; Asayesh, H ; Asgedom, SW ; Atey, TM ; Avila-Burgos, L ; Avokpaho, EFGA ; Azarpazhooh, MR ; Barac, A ; Barboza, M ; Barker-Collo, SL ; Baernighausen, T ; Bedi, N ; Beghi, E ; Bennett, DA ; Bensenor, IM ; Berhane, A ; Betsu, BD ; Bhaumik, S ; Birlik, SM ; Biryukov, S ; Boneya, DJ ; Bulto, LN ; Carabin, H ; Casey, D ; Castaneda-Orjuela, CA ; Catala-Lopez, F ; Chen, H ; Chitheer, AA ; Chowdhury, R ; Christensen, H ; Dandona, L ; Dandona, R ; deVeber, GA