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1.
PLoS Negl Trop Dis. 2017 Aug 3;11(8):e0005424. doi: 10.1371/journal.pntd.0005424. eCollection 2017 Aug.

The global burden of disease study 2013: What does it mean for the NTDs?

Author information

1
Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.
2
James A. Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America.
3
Texas Children's Hospital Center for Vaccine Development, Houston, Texas, United States of America.
4
Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, Texas, United States of America.
5
Department of Biology, Baylor University, Waco, Texas, United States of America.
6
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
7
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
8
London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
9
University of California, San Francisco, San Francisco, California, United States of America.
10
Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America.
11
Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America.
12
International Livestock Research Institute, Nairobi, Kenya.
13
Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
14
School of Public Health, Imperial College London, London, United Kingdom.
15
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
16
University of Basel, Basel, Switzerland.
17
Schneider Institutes for Health Policy, Brandeis University, Waltham, Massachusetts, United States of America.
18
Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
19
Department of Dermatology, Watford General Hospital, Watford, Herts, United Kingdom.
20
Consultant on Lymphatic Filariasis, Tagore Nagar, Pondicherry, India.
PMID:
28771480
PMCID:
PMC5542388
DOI:
10.1371/journal.pntd.0005424
[Indexed for MEDLINE]
Free PMC Article
Icon for Public Library of Science Icon for PubMed Central
2.
BMC Oral Health. 2017 Apr 11;17(1):74. doi: 10.1186/s12903-017-0356-7.

A comparison of DALYs for periodontal disease in China between 1990 and 2013: insights from the 2013 global burden of disease study.

Author information

1
National Center for Chronic and Non--Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
2
Parker Indian Health Center, 12033 West Agency Road, Parker, Arizona, 85344, USA.
3
National Center for Chronic and Non--Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China. linhong@chinawch.org.cn.

Abstract

BACKGROUND:

China has undergone a rapid demographic and epidemiological transition with fast ecomonic development since the 1980s. Oral health is becoming a major public health problem as the prevalence of non-communicable diseases has greatly increased. Periodontal disease (PD) and caries are among the most prevalent oral diseases. PD accounts for the majority of tooth loss and increases with age. China's third national epidemiological investigation on oral diseases (2005) revealed that periodontitis affected >50% of the adult population. The Global Burden of Disease Study 2013 (GBD2013) have been used to estimate DALYs for 301 acute and chronic diseases and injuries in 188 countries for 1990-2013. The estimation of burden of PD between 1990 and 2013 will provide a unique perspective for planning interventions and developing public health policies for PD even chronic diseases in China.

METHODS:

We used the GBD 2013 results for Years of Life Lost (YLLs) and Years Lived with Disability (YLDs) to calculate Disability Adjusted Life Years (DALYs) for PD in China. PD standardized DALYs rate (SDR) per 100,000 persons, the percentage of PD standardized DALYs rate (% PD SDR) in all diseases DALYs, and variance ratio of these two indexes between the years of 1990 and 2013 were compared by province, gender and age groups.

RESULTS:

Nationwide, compared to 1990, the SDR in 2013 increased slightly from 24.7 to 25.7, while the variance ratio of SDR for provinces in the middle, west and south of China showed a greater variation(4.8-6.2%). The % PD SDR in all disease DALYs increased from 0.06 to 0.11% for all groups. The four highest variance ratios % PD SDR in all diseases DALYs between 1990 and 2013 occurred in the west of China (97, 98.6, 108.4 and 112.8%). The PD SDR changed slightly in the women (20.3 to 21.7), meanwhile the variance ratio of PD SDR and % PD SDR in all diseases DALYs for the women (6.7 and 94.5%) was also higher than for men (2.1 and 60.6%). The highest variance ratio % PD SDR in all oral diseases DALYs occurred between 1990 and 2013 in ages 20 to 24 (50.7%) and 25 to 29 years (50.5%).

CONCLUSION:

The PD standardized DALYs rate and % PD SDR in all diseases DALYs in China in 2013 has increased from 1990. Especially, the variance ratio of % PD SDR in all disease DALYs among Young population and women, in the west provinces of China have been becoming the highest in all age groups and national wide. Future intervention measurements should include young women of child-bearing age because women's health impacts infant health. Periodontal disease has risk factors in common with a number of other non-communicable diseases (NCD) and conditions, and focusing on the common behavioral and environmental risk factors would be instrumental in the effective prevention of periodontal disease.

PMID:
28399833
PMCID:
PMC5387189
DOI:
10.1186/s12903-017-0356-7
[Indexed for MEDLINE]
Free PMC Article
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3.
JAMA Dermatol. 2017 May 1;153(5):406-412. doi: 10.1001/jamadermatol.2016.5538.

Global Skin Disease Morbidity and Mortality: An Update From the Global Burden of Disease Study 2013.

Author information

1
University Hospitals Case Western Medical Center, Cleveland, Ohio2now with Department of Dermatology, University of Colorado, Denver.
2
Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver4University of Colorado School of Medicine, Aurora5Colorado School of Public Health, Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora.
3
Institute for Health Metrics and Evaluation, University of Washington, Seattle7Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
4
Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.
5
Department of Dermatology, Kings College NHS Trust, London, United Kingdom.
6
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
7
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
8
Institute for Health Metrics and Evaluation, University of Washington, Seattle11School of Public Health, University of Queensland, Herston, Queensland, Australia12Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
9
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois14Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois15Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Abstract

Importance:

Disability secondary to skin conditions is substantial worldwide. The Global Burden of Disease Study 2013 includes estimates of global morbidity and mortality due to skin diseases.

Objective:

To measure the burden of skin diseases worldwide.

Data Sources:

For nonfatal estimates, data were found by literature search using PubMed and Google Scholar in English and Spanish for years 1980 through 2013 and by accessing administrative data on hospital inpatient and outpatient episodes. Data for fatal estimates were based on vital registration and verbal autopsy data.

Study Selection:

Skin disease data were extracted from more than 4000 sources including systematic reviews, surveys, population-based disease registries, hospital inpatient data, outpatient data, cohort studies, and autopsy data. Data metrics included incidence, prevalence, remission, duration, severity, deaths, and mortality risk.

Data Extraction and Synthesis:

Data were extracted by age, time period, case definitions, and other study characteristics. Data points were modeled with Bayesian meta-regression to generate estimates of morbidity and mortality metrics for skin diseases. All estimates were made with 95% uncertainty intervals.

Main Outcomes and Measures:

Disability-adjusted life years (DALYs), years lived with disability, and years of life lost from 15 skin conditions in 188 countries.

Results:

Skin conditions contributed 1.79% to the global burden of disease measured in DALYs from 306 diseases and injuries in 2013. Individual skin diseases varied in size from 0.38% of total burden for dermatitis (atopic, contact, and seborrheic dermatitis), 0.29% for acne vulgaris, 0.19% for psoriasis, 0.19% for urticaria, 0.16% for viral skin diseases, 0.15% for fungal skin diseases, 0.07% for scabies, 0.06% for malignant skin melanoma, 0.05% for pyoderma, 0.04% for cellulitis, 0.03% for keratinocyte carcinoma, 0.03% for decubitus ulcer, and 0.01% for alopecia areata. All other skin and subcutaneous diseases composed 0.12% of total DALYs.

Conclusions and Relevance:

Skin and subcutaneous diseases were the 18th leading cause of global DALYs in Global Burden of Disease 2013. Excluding mortality, skin diseases were the fourth leading cause of disability worldwide.

PMID:
28249066
PMCID:
PMC5817488
DOI:
10.1001/jamadermatol.2016.5538
[Indexed for MEDLINE]
Free PMC Article
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4.
Ann Rheum Dis. 2017 Aug;76(8):1365-1373. doi: 10.1136/annrheumdis-2016-210146. Epub 2017 Feb 16.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
2
Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
3
Norwegian Institute of Public Health, Bergen, Norway.
4
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
5
Japan International Cooperation Agency, Lusaka, Zambia.
6
Ophthalmology resident in Aswan University Hospital, Aswan, Egypt.
7
Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
8
Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
9
The University of Melbourne, Melbourne, Victoria, Australia.
10
The University of Sydney, Sydney, New South Wales, Australia.
11
Hospital for Sick Children, Toronto, Ontario, Canada.
12
University of Toronto, Toronto, Ontario, Canada.
13
Food and Nutrition Administration, Ministry of Health, Safat, Kuwait.
14
University of Oxford, Oxford, UK.
15
Saudi Ministry of Health, Riyadh, Saudi Arabia.
16
Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
17
Charité Universitätsmedizin, Berlin, Germany.
18
King Saud University, Riyadh, Saudi Arabia.
19
Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.
20
Public Health Agency of Canada, Toronto, Ontario, Canada.
21
Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogota, Colombia.
22
Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.
23
David Geffen School of Medicine, University of California at Los Angeles (UCLA), California, USA.
24
College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.
25
University of São Paulo, São Paulo, Brazil.
26
Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.
27
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
28
Walden University, Minneapolis, Minnesota, USA.
29
Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
30
Clinical Investigation Centre INSERM (the National Institute for Health and Medical Research), Université de Lorraine, Vandoeuvre les Nancy, France.
31
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
32
Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA.
33
Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden.
34
Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
35
Bielefeld University, Bielefeld, Germany.
36
West Virginia Bureau for Public Health, Charleston, West Virginia, USA.
37
Arabian Gulf University, Manama, Bahrain.
38
Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates.
39
Nevada Division of Behavior and Public Health, Carson City, Nevada, USA.
40
Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
41
Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia.
42
Salah Azaiz Institute, Tunis, Tunisia.
43
Institute of Community and Public Health, Birzeit University, Birzeit, Palestine.
44
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
45
Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
46
Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
47
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
48
Health Services Academy, Islamabad, Pakistan.
49
Ball State University, Muncie, Indiana, USA.
50
Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway.
51
University of British Columbia, Vancouver, British Columbia, Canada.
52
Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK.
53
School of Medicine, University of Liverpool, Liverpool, UK.
54
Mansoura Faculty of Medicine, Mansoura, Egypt.
55
Imperial College London, London, UK.
56
Digestive Disease Research Institute, Tehran Universities of Medical Sciences, Tehran, Iran.
57
McGill University, Montreal, Quebec, Canada.
58
College of Medicine, Howard University, Washington DC, USA.
59
Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
60
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
61
Hunger Action Los Angeles, Los Angeles, California, USA.
62
Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria.
63
Institute of Public Health, Heidelberg University, Heidelberg, Germany.
64
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
65
Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon.
66
Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea.
67
Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea.
68
National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
69
Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
70
Contech International Health Consultants, Lahore, Pakistan.
71
Contech School of Public Health, Lahore, Pakistan.
72
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
73
Finnish Institute of Occupational Health, Helsinki, Finland.
74
Sweidi Hospital, Riyadh, Saudi Arabia.
75
Society for Health and Demographic Surveillance, Suri, India.
76
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
77
Independent Consultant, Karachi, Pakistan.
78
Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
79
Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
80
Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
81
Federal University of Santa Catarina, Florianópolis, Brazil.
82
University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
83
Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway.
84
Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.
85
Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.
86
Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
87
Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria.
88
Federal Institute for Population Research, Wiesbaden, Germany.
89
German National Cohort Consortium, Heidelberg, Germany.
90
Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan.
91
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
92
Jackson State University, Jackson, Mississippi, USA.
93
University Hospital, Setif, Algeria.
94
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.

Abstract

OBJECTIVES:

We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR).

METHODS:

The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs).

RESULTS:

For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries.

CONCLUSIONS:

This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

KEYWORDS:

Epidemiology; Gout; Low Back Pain; Osteoarthritis; Rheumatoid Arthritis

PMID:
28209629
PMCID:
PMC5738600
DOI:
10.1136/annrheumdis-2016-210146
[Indexed for MEDLINE]
Free PMC Article
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5.
Int J Behav Nutr Phys Act. 2016 Dec 16;13(1):122.

The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013.

Author information

1
School of Public Health, Mekelle University, Mekelle, Ethiopia. adamayohannes@gmail.com.
2
Population Research and Outcome Studies, School of Medicine, The University of Adelaide, Adelaide, SA, Australia. adamayohannes@gmail.com.
3
Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA.
4
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
5
Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
6
St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
7
Department of Reproductive Health, University of Gondar, Gondar, Ethiopia.
8
School of Public Health, The University of Adelaide, Adelaide, Australia.
9
Brighton & Sussex Medical School, Brighton, UK.
10
School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
11
Federal Ministry of Health, Addis Ababa, Ethiopia.
12
School of Public Health, Mekelle University, Mekelle, Ethiopia.
13
Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
14
Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany.
15
Department of Public Health, Madda Walabu University, Bale Goba, Ethiopia.
16
Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, Australia.
17
School of Medicine and Health Sciences, Bahir dar University, Bahir Dar, Ethiopia.
18
Department of Epidemiology, University Medical Center Groningen, the University of Groningen, Groningen, The Netherlands.
19
Department of Public Health, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
20
Health observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, The University of Adelaide, Adelaide, Australia.
21
Population Research and Outcome Studies, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.

Abstract

BACKGROUND:

The burden of non-communicable diseases (NCDs) has increased in sub-Saharan countries, including Ethiopia. The contribution of dietary behaviours to the NCD burden in Ethiopia has not been evaluated. This study, therefore, aimed to assess diet-related burden of disease in Ethiopia between 1990 and 2013.

METHOD:

We used the 2013 Global Burden of Disease (GBD) data to estimate deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) related to eight food types, five nutrients and fibre intake. Dietary exposure was estimated using a Bayesian hierarchical meta-regression. The effect size of each diet-disease pair was obtained based on meta-analyses of prospective observational studies and randomized controlled trials. A comparative risk assessment approach was used to quantify the proportion of NCD burden associated with dietary risk factors.

RESULTS:

In 2013, dietary factors were responsible for 60,402 deaths (95% Uncertainty Interval [UI]: 44,943-74,898) in Ethiopia-almost a quarter (23.0%) of all NCD deaths. Nearly nine in every ten diet-related deaths (88.0%) were from cardiovascular diseases (CVD) and 44.0% of all CVD deaths were related to poor diet. Suboptimal diet accounted for 1,353,407 DALYs (95% UI: 1,010,433-1,672,828) and 1,291,703 YLLs (95% UI: 961,915-1,599,985). Low intake of fruits and vegetables and high intake of sodium were the most important dietary factors. The proportion of NCD deaths associated with low fruit consumption slightly increased (11.3% in 1990 and 11.9% in 2013). In these years, the rate of burden of disease related to poor diet slightly decreased; however, their contribution to NCDs remained stable.

CONCLUSIONS:

Dietary behaviour contributes significantly to the NCD burden in Ethiopia. Intakes of diet low in fruits and vegetables and high in sodium are the leading dietary risks. To effectively mitigate the oncoming NCD burden in Ethiopia, multisectoral interventions are required; and nutrition policies and dietary guidelines should be developed.

KEYWORDS:

Burden of disease; Dietary risks; Ethiopia; Non-communicable diseases

PMID:
27978839
PMCID:
PMC5159959
DOI:
10.1186/s12966-016-0447-x
[Indexed for MEDLINE]
Free PMC Article
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6.
Stroke. 2017 Feb;48(2):271-275. doi: 10.1161/STROKEAHA.116.015031. Epub 2016 Dec 13.

Age-Period-Cohort Analysis of Stroke Mortality in China: Data From the Global Burden of Disease Study 2013.

Author information

1
From the School of Public Health (Z.W., S.H., L.L., C.Y.) and Global Health Institute (C.Y.), Wuhan University, China; School of Medicine, Yunnan University, Kunming, China (S.S.); and The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus (Z.W.).
2
From the School of Public Health (Z.W., S.H., L.L., C.Y.) and Global Health Institute (C.Y.), Wuhan University, China; School of Medicine, Yunnan University, Kunming, China (S.S.); and The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus (Z.W.). yuchua@163.com.

Abstract

BACKGROUND AND PURPOSE:

Stroke has been the leading cause of death in China. The aim of this study is to assess the long-term trends of stroke mortality in China between 1994 and 2013.

METHODS:

The mortality data were obtained from the GBD 2013 (Global Burden of Disease Study 2013) and were analyzed with the age-period-cohort framework.

RESULTS:

We found that the net drift was -2.665% (95% confidence interval, -2.854% to -2.474%) per year for men and -4.064% (95% confidence interval, -4.279% to -3.849%) per year for women, and the local drift values were below 0 in all age groups (P<0.05 for all) in both sexes during the period of 1994 to 2013. In the same birth cohort, the risk of death from stroke rose exponentially with age for both sexes after controlling for period deviations. The estimated period and cohort relative risks were found in similar monotonic downward patterns (significantly with P<0.05 for all) for both sexes, with more quickly decreasing for women than for men during the whole period (significantly with P<0.05 for both).

CONCLUSIONS:

The decreased mortality rates of stroke in China are likely to be related to improvements in medical care and techniques, spectacular economic growth and fast urbanization, and better early life nutrition conditions of Chinese people. Besides, better education and better awareness of stroke-related knowledge in successive generations could also probably play a role.

KEYWORDS:

China; cause of death; mortality rate; risk; stroke; trends

PMID:
27965429
DOI:
10.1161/STROKEAHA.116.015031
[Indexed for MEDLINE]
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7.
Am J Trop Med Hyg. 2016 Dec 7;95(6):1319-1329. Epub 2016 Oct 10.

Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013.

Khalil I1, Colombara DV1, Forouzanfar MH1, Troeger C1, Daoud F1, Moradi-Lakeh M1,2, Bcheraoui CE1, Rao PC1, Afshin A1, Charara R1, Abate KH3, Razek MM4, Abd-Allah F5, Abu-Elyazeed R6, Kiadaliri AA7,8, Akanda AS9, Akseer N10,11, Alam K12,13,14, Alasfoor D15, Ali R16, AlMazroa MA17, Alomari MA18, Al-Raddadi RM19, Alsharif U20, Alsowaidi S21, Altirkawi KA22, Alvis-Guzman N23, Ammar W24, Antonio CA25, Asayesh H26, Asghar RJ27, Atique S28, Awasthi A29, Bacha U30, Badawi A31, Barac A32, Bedi N33, Bekele T34, Bensenor IM35, Betsu BD36, Bhutta Z10,37, Abdulhak AA38, Butt ZA39, Danawi H40, Dubey M41, Endries AY42, Faghmous ID43, Farid T44, Farvid MS44,45, Farzadfar F46, Fereshtehnejad SM47, Fischer F48, Fitchett JR49, Gibney KB50,51, Ginawi IA52, Gishu MD53,54, Gugnani HC55,56, Gupta R57, Hailu GB36,58, Hamadeh RR59, Hamidi S60, Harb HL24, Hedayati MT61, Hsairi M62, Husseini A63, Jahanmehr N64, Javanbakht M65, Jibat T66,67, Jonas JB68, Kasaeian A46,69, Khader YS70, Khan AR44, Khan EA71, Khan G72, Khoja TA73, Kinfu Y74, Kissoon N75, Koyanagi A76, Lal A77, Latif AA78, Lunevicius R79,80, Razek HM81, Majeed A82, Malekzadeh R83, Mehari A84, Mekonnen AB14,85, Melaku YA86,87, Memish ZA88,89, Mendoza W90, Misganaw A1, Mohamed LA91, Nachega JB92,93, Nguyen QL94, Nisar MI95, Peprah EK96, Platts-Mills JA97, Pourmalek F75, Qorbani M98, Rafay A99,100, Rahimi-Movaghar V101, Rahman SU102, Rai RK103, Rana SM99,100, Ranabhat CL104,105, Rao SR106, Refaat AH40,107, Riddle M108, Roshandel G83,109, Ruhago GM110, Saleh MM111, Sanabria JR112,113, Sawhney M114, Sepanlou SG83, Setegn T115, Sliwa K116, Sreeramareddy CT117, Sykes BL118, Tavakkoli M119, Tedla BA85,120, Terkawi AS121,122,123, Ukwaja K124, Uthman OA125, Westerman R126,127, Wubshet M85,128, Yenesew MA115, Yonemoto N129, Younis MZ130, Zaidi Z131, Zaki ME132, Rabeeah AA17, Wang H1, Naghavi M1, Vos T1, Lopez AD1,133, Murray CJ1, Mokdad AH134.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.
2
Department of Community Medicine, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.
3
Jimma University, Jimma, Ethiopia.
4
Aswan Faculty of Medicine, Aswan, Egypt.
5
Department of Neurology, Cairo University, Cairo, Egypt.
6
GlaxoSmithKline, Philadelphia, Pennsylvania.
7
Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
8
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
9
University of Rhode Island, Kingston, Rhode Island.
10
The Hospital for Sick Children, Toronto, Canada.
11
University of Toronto, Toronto, Canada.
12
Murdoch Children's Research Institute, Melbourne, Australia.
13
University of Melbourne, Melbourne, Australia.
14
University of Sydney, Sydney, Australia.
15
Ministry of Health, Al Khuwair, Oman.
16
University of Oxford, Oxford, United Kingdom.
17
Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.
18
Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan.
19
Ministry of Health, Jeddah, Saudi Arabia.
20
Charité Universitätsmedizin, Berlin, Germany.
21
Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
22
King Saud University, Riyadh, Saudi Arabia.
23
Universidad de Cartagena, Cartagena de Indias, Colombia.
24
Ministry of Public Health, Beirut, Lebanon.
25
Department of Health Policy and Administration, College of Public Health, University of the Philippines, Manila, Philippines.
26
Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran.
27
South Asian Public Health Forum, Islamabad, Pakistan.
28
Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.
29
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
30
School of Health Sciences, University of Management and Technology, Lahore, Pakistan.
31
Public Health Agency of Canada, Toronto, Canada.
32
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
33
College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.
34
Madawalabu University, Bale Goba, Ethiopia.
35
University of São Paulo, São Paulo, Brazil.
36
Mekelle University, Mekelle, Ethiopia.
37
Medical Center, Aga Khan University, Karachi, Pakistan.
38
University of Iowa Hospitals and Clinics, Iowa City, Iowa.
39
Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan.
40
Walden University, Minneapolis, Minnesota.
41
International Institute for Population Sciences, Mumbai, India.
42
Arba Minch University, Arba Minch, Ethiopia.
43
London School of Hygiene and Tropical Medicine, London, United Kingdom.
44
University of Louisville, Louisville, Kentucky.
45
Institute for Health Policy, Boston, Massachusetts.
46
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
47
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
48
Bielefeld University, Bielefeld, Germany.
49
Harvard University, Boston, Massachusetts.
50
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
51
Melbourne Health, Parkville, Australia.
52
College of Medicine, University of Hail, Hail, Saudi Arabia.
53
Haramaya University, Dire Dawa, Ethiopia.
54
Kersa Health and Demographic Surveillance System, Harar, Ethiopia.
55
Department of Microbiology, Saint James School of Medicine, Anguilla, British West Indies.
56
Department of Epidemiology and Biostatistics, Saint James School of Medicine, Anguilla, British West Indies.
57
West Virginia Bureau for Public Health, Charleston, West Virginia.
58
Kilte Awlaelo Health and Demographic Surveillance System, Ethiopia.
59
Arabian Gulf University, Manama, Bahrain.
60
Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates.
61
Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
62
Department of Epidemiology, Salah Azaiz Institute, Tunis, Tunisia.
63
Qatar University, Doha, Qatar.
64
Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
65
University of Aberdeen, Aberdeen, United Kingdom.
66
Addis Ababa University, Debre Zeit, Ethiopia.
67
Wageningen University, Wageningen, Netherlands.
68
Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
69
Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
70
Jordan University of Science and Technology, Irbid, Jordan.
71
Health Services Academy, Islamabad, Pakistan.
72
Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
73
Executive Board of the Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia.
74
Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, Canberra, Australia.
75
University of British Columbia, Vancouver, Canada.
76
Research and Development Unit, Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain.
77
Australian National University, Canberra, Australia.
78
Department of Zoology, Lahore College for Women University, Lahore, Pakistan.
79
Aintree University Hospital, National Health Service Foundation Trust, Liverpool, United Kingdom.
80
School of Medicine, University of Liverpool, Liverpool, United Kingdom.
81
Mansoura Faculty of Medicine, Mansoura, Egypt.
82
Imperial College London, London, United Kingdom.
83
Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
84
Howard University College of Medicine, Washington, District of Columbia.
85
University of Gondar, Gondar, Ethiopia.
86
School of Public Health, Mekelle University, Mekelle, Ethiopia.
87
School of Medicine, University of Adelaide, Adelaide, Australia.
88
Saudi Ministry of Health, Riyadh, Saudi Arabia.
89
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
90
United Nations Population Fund, Lima, Peru.
91
Federal Ministry of Health, Khartoum, Sudan.
92
University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
93
Stellenbosch University, Cape Town, Western Cape, South Africa.
94
Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
95
Aga Khan University, Karachi, Pakistan.
96
National Heart, Lung, and Blood Institute, Bethesda, Maryland.
97
University of Virginia, Charlottesville, Virginia.
98
Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
99
Contech International Health Consultants, Lahore, Pakistan.
100
Contech School of Public Health, Lahore, Pakistan.
101
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
102
Hamad Medical Corporation, Doha, Qatar.
103
Society for Health and Demographic Surveillance, Suri, India.
104
Wonju College of Medicine, Yonsei University, Wonju, South Korea.
105
Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea.
106
Department of Surgery, School of Medicine, Boston University, Boston, Massachusetts.
107
Suez Canal University, Ismailia, Egypt.
108
Naval Medical Research Center, Silver Spring, Maryland.
109
Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
110
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
111
Development Research and Projects Center, Abuja, Nigeria.
112
Department of Surgery and Comprehensive Cancer Center, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia.
113
Case Western Reserve University, Cleveland, Ohio.
114
Marshall University, Huntington, West Virginia.
115
Bahir Dar University, Bahir Dar, Ethiopia.
116
Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.
117
Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia.
118
Departments of Criminology, Law and Society, Sociology, and Public Health, University of California-Irvine, Irvine, California.
119
Westchester Medical Center, Valhalla, New York.
120
James Cook University, Cairns, Australia.
121
Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.
122
Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio.
123
Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
124
Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria.
125
Warwick Medical School, University of Warwick, Coventry, United Kingdom.
126
Federal Institute for Population Research, Wiesbaden, Germany.
127
German National Cohort Consortium, Heidelberg, Germany.
128
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
129
Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan.
130
Jackson State University, Jackson, Mississippi.
131
University Hospital, Setif, Algeria.
132
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
133
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
134
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington. mokdaa@uw.edu.

Abstract

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.

PMID:
27928080
PMCID:
PMC5154365
DOI:
10.4269/ajtmh.16-0339
[Indexed for MEDLINE]
Free PMC Article
Icon for Ingenta plc Icon for PubMed Central
8.
Popul Health Metr. 2016 Nov 14;14:42. eCollection 2016.

Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990-2013: findings from the Global Burden of Disease Study 2013.

Author information

1
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya ; Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK ; St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
2
School of Public Health, University of Adelaide, Adelaide, Australia ; Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
3
Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK ; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
4
School of Public Health, Mekelle University, Mekelle, Ethiopia ; School of Medicine, University of Adelaide, Adelaide, Australia.
5
Ethiopian Public Health Association, Addis Ababa, Ethiopia.
6
School of Medicine, University of Adelaide, Adelaide, Australia ; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia ; Department of Epidemiology, University of Groningen, Groningen, The Netherlands.
7
School of Public Health, Mekelle University, Mekelle, Ethiopia ; Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Ethiopia ; Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany.
8
Federal Ministry of Health, Addis Ababa, Ethiopia.
9
Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.

Abstract

BACKGROUND:

Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990-2013.

METHODS:

We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used.

RESULTS:

Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1-4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013. Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap.

CONCLUSIONS:

LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.

PMID:
27891065
PMCID:
PMC5109762
DOI:
10.1186/s12963-016-0112-2
[Indexed for MEDLINE]
Free PMC Article
Icon for BioMed Central Icon for PubMed Central
9.
Diabetes Care. 2017 Jan;40(1):22-29. doi: 10.2337/dc16-1075. Epub 2016 Oct 26.

High Fasting Plasma Glucose, Diabetes, and Its Risk Factors in the Eastern Mediterranean Region, 1990-2013: Findings From the Global Burden of Disease Study 2013.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA.
2
Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
3
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA mokdaa@uw.edu.

Abstract

OBJECTIVE:

The prevalence of diabetes in the Eastern Mediterranean Region (EMR) is among the highest in the world. We used findings from the Global Burden of Disease 2013 study to calculate the burden of diabetes in the EMR.

RESEARCH DESIGN AND METHODS:

The burden of diabetes and burden attributable to high fasting plasma glucose (HFPG) were calculated for each of the 22 countries in the EMR between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, deaths, and disability-adjusted life years (DALYs).

RESULTS:

The diabetes death rate increased by 60.7%, from 12.1 per 100,000 population (95% uncertainty interval [UI]: 11.2-13.2) in 1990 to 19.5 per 100,000 population (95% UI: 17.4-21.5) in 2013. The diabetes DALY rate increased from 589.9 per 100,000 (95% UI: 498.0-698.0) in 1990 to 883.5 per 100,000 population (95% UI: 732.2-1,051.5) in 2013. In 2013, HFPG accounted for 4.9% (95% UI: 4.4-5.3) of DALYs from all causes. Total DALYs from diabetes increased by 148.6% during 1990-2013; population growth accounted for a 62.9% increase, and aging and increase in age-specific DALY rates accounted for 31.8% and 53.9%, respectively.

CONCLUSIONS:

Our findings show that diabetes causes a major burden in the EMR, which is increasing. Aging and population growth do not fully explain this increase in the diabetes burden. Programs and policies are urgently needed to reduce risk factors for diabetes, increase awareness of the disease, and improve diagnosis and control of diabetes to reduce its burden.

PMID:
27797926
DOI:
10.2337/dc16-1075
[Indexed for MEDLINE]
Icon for HighWire
10.
PLoS Negl Trop Dis. 2016 Oct 27;10(10):e0004744. doi: 10.1371/journal.pntd.0004744. eCollection 2016 Oct.

Blue Marble Health and the Global Burden of Disease Study 2013.

Author information

1
Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine at Baylor College of Medicine, Houston, Texas, USA.
2
Department of Biology, Baylor University, Waco, Texas, USA.
3
Center for Health and Biosciences, James A Baker III Institute for Public Policy, Rice University, Houston, Texas, USA.
4
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
PMID:
27788134
PMCID:
PMC5082884
DOI:
10.1371/journal.pntd.0004744
[Indexed for MEDLINE]
Free PMC Article
Icon for Public Library of Science Icon for PubMed Central
11.
J Korean Med Sci. 2016 Nov;31 Suppl 2:S114-S120. doi: 10.3346/jkms.2016.31.S2.S114.

Health Performance and Challenges in Korea: a Review of the Global Burden of Disease Study 2013.

Author information

1
Department of Public Healthcare Services, Seoul Bukbu Hospital, Seoul, Korea.
2
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea. yoonsj02@korea.ac.kr.
3
Department of Public Health, Graduate School, Korea University, Seoul, Korea.
4
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.

Abstract

The global burden of disease study (GBD) provides valuable information for evaluating population health in terms of disease burden. This study collected and reviewed GBD data in Korea for the year 1990 and 2013. The burdens of cancer, cardiovascular disease, communicable disease, and injuries have decreased remarkably, thereby greatly diminishing the overall disease burden on Korea. Meanwhile, the burdens due to non-fatal chronic diseases such as neuropsychiatric and musculoskeletal disease became major burden contributors. Responding to this circumstance presents a complex challenge to the Korean health system and Korean health policy.

KEYWORDS:

Burden of Disease; Health Policy; Health System; Population Health

PMID:
27775248
PMCID:
PMC5081292
DOI:
10.3346/jkms.2016.31.S2.S114
[Indexed for MEDLINE]
Free PMC Article
Icon for Korean Academy of Medical Sciences Icon for PubMed Central
12.
Lancet. 2016 Nov 12;388(10058):2386-2402. doi: 10.1016/S0140-6736(16)31773-1. Epub 2016 Oct 5.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Author information

1
Instituto Nacional de Salud Pública, Cuernavaca, Mexico.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
3
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
4
Fundación Mexicana para la Salud, Mexico City, Mexico.
5
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
6
Universidad Iberoamericana, Mexico City, Mexico.
7
Secretaría de Salud, Mexico City, Mexico.
8
Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
9
Academia Nacional de Medicina, Mexico City, Mexico.
10
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
11
Instituto Nacional de Salud Pública, Cuernavaca, Mexico; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: rafael.lozano@insp.mx.

Abstract

BACKGROUND:

Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time.

METHODS:

We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors.

FINDINGS:

From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013.

INTERPRETATION:

Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state.

FUNDING:

Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

PMID:
27720260
DOI:
10.1016/S0140-6736(16)31773-1
[Indexed for MEDLINE]
Icon for Elsevier Science
13.
Chest. 2016 Dec;150(6):1269-1280. doi: 10.1016/j.chest.2016.08.1474. Epub 2016 Sep 29.

A Subnational Analysis of Mortality and Prevalence of COPD in China From 1990 to 2013: Findings From the Global Burden of Disease Study 2013.

Author information

1
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA.
3
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: maigengzhou@126.com.

Abstract

BACKGROUND:

The trends of COPD mortality and prevalence over the past 2 decades across all provinces remain unknown in China. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to estimate the mortality and prevalence of COPD during 1990 to 2013 at a provincial level.

METHODS:

Following the general analytic strategy used in GBD 2013, we analyzed the age- sex- and province-specific mortality and prevalence of COPD in China. Levels of and trends in COPD mortality and prevalence were assessed for 33 province-level administrative units during 1990 to 2013.

RESULTS:

In 2013, there were 910,809 deaths from COPD in China, accounting for 31.1% of the total deaths from COPD in the world. From 1990 to 2013, the age-standardized COPD mortality rate decreased in all provinces, with the highest reduction in Heilongjiang (70.2%) and Jilin (70.0%) and the lowest reduction in Guizhou (26.8%). In 2013, the death rate per 100,000 was highest in Guizhou (196.0) and lowest in Tianjin (34.0) among men and highest in Gansu (141.1) and lowest in Beijing (23.7) among women. The number of COPD cases increased dramatically from 32.4 million in 1990 to 54.8 million in 2013. The age-standardized prevalence rate of COPD remained stable overall and varied little for all provinces.

CONCLUSIONS:

COPD remains a huge health burden in many western provinces in China. The substantial increase in COPD cases represents an ongoing challenge given the rapidly aging Chinese population. A targeted control and prevention strategy should be developed at a provincial level to reduce the burden caused by COPD.

KEYWORDS:

COPD; burden of disease; epidemiology

PMID:
27693597
DOI:
10.1016/j.chest.2016.08.1474
[Indexed for MEDLINE]
Icon for Elsevier Science
14.
Lancet Infect Dis. 2016 Dec;16(12):1385-1398. doi: 10.1016/S1473-3099(16)30325-5. Epub 2016 Sep 21.

Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013.

Author information

1
National Drug and Alcohol Research Centre, University of New South Wales Australia, Sydney, NSW, Australia. Electronic address: l.degenhardt@unsw.edu.au.
2
Policy and Evaluation Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; School of Population Health, University of Queensland, Brisbane, QLD, Australia.
3
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
4
National Drug and Alcohol Research Centre, University of New South Wales Australia, Sydney, NSW, Australia.
5
School of Social and Community Medicine, University of Bristol, Bristol, UK.
6
Doherty Institute, University of Melbourne, Melbourne, VIC, Australia.
7
Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia; National Addiction Centre, King's College London, London, UK.
8
National Addiction Centre, King's College London, London, UK.

Abstract

BACKGROUND:

Previous estimates of the burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We aimed to provide these estimates as part of the Global Burden of Disease (GBD) Study 2013.

METHODS:

We modelled the burden of HBV and HCV (including cirrhosis and liver cancer burden) and HIV at the country, regional, and global level. We extracted United Nations data on the proportion of notified HIV cases by transmission route, and estimated the contribution of injecting drug use (IDU) to HBV and HCV disease burden by use of a cohort method that recalibrated individuals' history of IDU, and accumulated risk of HBV and HCV due to IDU. We estimated data on current IDU from a meta-analysis of HBV and HCV incidence among injecting drug users and country-level data on the incidence of HBV and HCV between 1990 and 2013. We calculated estimates of burden of disease through years of life lost (YLL), years of life lived with disability (YLD), deaths, and disability-adjusted life-years (DALYs), with 95% uncertainty intervals (UIs) calculated for each metric.

FINDINGS:

In 2013, an estimated 10·08 million DALYs were attributable to previous exposure to HIV, HBV, and HCV via IDU, a four-times increase since 1990. In total in 2013, IDU was estimated to cause 4·0% (2·82 million DALYs, 95% UI 2·4 million to 3·8 million) of DALYs due to HIV, 1·1% (216 000, 101 000-338 000) of DALYs due to HBV, and 39·1% (7·05 million, 5·88 million to 8·15 million) of DALYs due to HCV. IDU-attributable HIV burden was highest in low-to-middle-income countries, and IDU-attributable HCV burden was highest in high-income countries.

INTERPRETATION:

IDU is a major contributor to the global burden of disease. Effective interventions to prevent and treat these important causes of health burden need to be scaled up.

FUNDING:

Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

Comment in

PMID:
27665254
DOI:
10.1016/S1473-3099(16)30325-5
[Indexed for MEDLINE]
Free full text
Icon for Elsevier Science
15.
Lancet Glob Health. 2016 Oct;4(10):e704-13. doi: 10.1016/S2214-109X(16)30168-1. Epub 2016 Aug 25.

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Mokdad AH1, Forouzanfar MH2, Daoud F2, El Bcheraoui C2, Moradi-Lakeh M3, Khalil I2, Afshin A2, Tuffaha M2, Charara R2, Barber RM2, Wagner J2, Cercy K2, Kravitz H2, Coates MM2, Robinson M2, Estep K2, Steiner C2, Jaber S2, Mokdad AA4, O'Rourke KF2, Chew A2, Kim P2, El Razek MM5, Abdalla S6, Abd-Allah F7, Abraham JP8, Abu-Raddad LJ9, Abu-Rmeileh NM10, Al-Nehmi AA11, Akanda AS12, Al Ahmadi H13, Al Khabouri MJ14, Al Lami FH15, Al Rayess ZA16, Alasfoor D14, AlBuhairan FS17, Aldhahri SF18, Alghnam S19, Alhabib S20, Al-Hamad N21, Ali R22, Ali SD23, Alkhateeb M24, AlMazroa MA25, Alomari MA26, Al-Raddadi R25, Alsharif U27, Al-Sheyab N28, Alsowaidi S29, Al-Thani M30, Altirkawi KA31, Amare AT32, Amini H33, Ammar W34, Anwari P35, Asayesh H36, Asghar R37, Assabri AM38, Assadi R39, Bacha U40, Badawi A41, Bakfalouni T42, Basulaiman MO25, Bazargan-Hejazi S43, Bedi N44, Bhakta AR45, Bhutta ZA46, Bin Abdulhak AA47, Boufous S48, Bourne RR49, Danawi H50, Das J51, Deribew A52, Ding EL53, Durrani AM54, Elshrek Y55, Ibrahim ME56, Eshrati B57, Esteghamati A58, Faghmous IA59, Farzadfar F60, Feigl AB61, Fereshtehnejad SM62, Filip I63, Fischer F64, Gankpé FG65, Ginawi I66, Gishu MD67, Gupta R68, Habash RM25, Hafezi-Nejad N58, Hamadeh RR69, Hamdouni H70, Hamidi S71, Harb HL34, Hassanvand MS72, Hedayati MT73, Heydarpour P74, Hsairi M75, Husseini A76, Jahanmehr N77, Jha V78, Jonas JB79, Karam NE80, Kasaeian A81, Kassa NA82, Kaul A83, Khader Y84, Khalifa SE30, Khan EA85, Khan G86, Khoja T87, Khosravi A88, Kinfu Y89, Defo BK90, Balaji AL91, Lunevicius R92, Obermeyer CM93, Malekzadeh R94, Mansourian M95, Marcenes W96, Farid HM97, Mehari A98, Mehio-Sibai A99, Memish ZA100, Mensah GA101, Mohammad KA102, Nahas Z103, Nasher JT104, Nawaz H105, Nejjari C106, Nisar MI107, Omer SB108, Parsaeian M109, Peprah EK110, Pervaiz A111, Pourmalek F112, Qato DM113, Qorbani M114, Radfar A115, Rafay A116, Rahimi K22, Rahimi-Movaghar V117, Rahman SU118, Rai RK119, Rana SM120, Rao SR121, Refaat AH122, Resnikoff S123, Roshandel G124, Saade G125, Saeedi MY25, Sahraian MA74, Saleh S126, Sanchez-Riera L127, Satpathy M128, Sepanlou SG94, Setegn T129, Shaheen A130, Shahraz S131, Sheikhbahaei S58, Shishani K132, Sliwa K133, Tavakkoli M134, Terkawi AS135, Uthman OA136, Westerman R137, Younis MZ138, El Sayed Zaki M139, Zannad F140, Roth GA2, Wang H2, Naghavi M2, Vos T2, Al Rabeeah AA25, Lopez AD141, Murray CJ2.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mokdaa@uw.edu.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
3
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
4
Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
5
Aswan University Hospital, Aswan Faculty of Medicine, Aswan, Egypt.
6
Sudanese Public Health Consultancy Group, Solihull, UK.
7
Department of Neurology, Cairo University, Cairo, Egypt.
8
Family Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, USA; Institute for Global Health, Harvard University, Boston, MA, USA.
9
Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar.
10
Institute of Community and Public Health, Birzeit University, Ramallah, Palestine.
11
Ministry of Health, Sana'a, Yemen.
12
University of Rhode Island, Kingston, RI, USA.
13
Majlis Al Shura, Riyadh, Saudi Arabia.
14
Ministry of Health, Muscat, Oman.
15
College of Medicine, University of Baghdad, Baghdad, Iraq.
16
The Saudi Center for Evidence Based Healthcare, Riyadh, Saudi Arabia.
17
King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
18
King Saud University, Riyadh, Saudi Arabia; King Fahad Medical City, Riyadh, Saudi Arabia.
19
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
20
King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
21
Public Authority for Food and Nutrition, Kuwait.
22
University of Oxford, Oxford, UK.
23
University of London, London, UK; Institute and Faculty of Actuaries, Oxford, UK.
24
Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia.
25
Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia.
26
Division of Physical Therapy, Department of Rehabilitation Sciences, Irbid, Jordan.
27
Charité Universitätsmedizin, Berlin, Germany.
28
Maternal and Child Health Department, Irbid, Jordan.
29
Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
30
Supreme Council of Health, Doha, Qatar.
31
King Saud University, Riyadh, Saudi Arabia.
32
Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia; College of Medicine and Health Sciences, Bahir Dar, Ethiopia.
33
Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
34
Ministry of Public Health, Beirut, Lebanon.
35
Kabul, Afghanistan.
36
Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran.
37
South Asian Public Health Forum, Islamabad, Pakistan.
38
Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
39
Mashhad University of Medical Sciences, Mashhad, Iran.
40
School of Health Sciences, University of Management and Technology, Lahore, Pakistan.
41
Public Health Agency of Canada, Toronto, ON, Canada.
42
Ministry of Health, Damascus, Syria.
43
Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
44
College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.
45
National Institute of Mental Health, Montgomery Village, MD, USA.
46
Centre of Excellence in Women and Child Health, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.
47
University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
48
Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia.
49
Vision & Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
50
Walden University, Minneapolis, MN, USA.
51
Department of Paediatrics and Child Health, Karachi, Pakistan.
52
Nuffield Department of Medicine, Oxford, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
53
Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
54
National Institutes of Health, Montgomery Village, MD, USA.
55
Food Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, Libya.
56
Cardiovascular Diseases Control and Prevention Program, Riyadh, Saudi Arabia.
57
Ministry of Health and Medical Education, Tehran, Iran; Arak University of Medical Sciences, Arak, Iran.
58
Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
59
London School of Hygiene & Tropical Medicine, London, UK.
60
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
61
Department of Global Health and Population, Harvard University, Boston, MA, USA.
62
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
63
Kaiser Permanente Psychiatry Residency Program, Fontana, CA, USA.
64
Bielefeld University, Bielefeld, Germany.
65
Leras Afrique, Cotonou, Benin; CHU Hassan II, Fez, Morocco.
66
College of Medicine, University of Hail, Hail, Saudi Arabia.
67
Haramaya University, Dira Dawa, Ethiopia; Kersa Health and Demographic Surveillance System, Harar, Ethiopia.
68
West Virginia Bureau for Public Health, Charleston, WV, USA.
69
Arabian Gulf University, Manama, Bahrain.
70
Direction des Soins de Santé de Base, Ministry of Health, Tunis, Tunisia.
71
Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates.
72
Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
73
Department of Medical Mycology and Parasitology, School of Medicine, Mazndaran University of Medical Sciences, Sari, Iran.
74
Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
75
Salah Azaiz Institute, Tunis, Tunisia.
76
Qatar University, Doha, Qatar.
77
School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
78
The George Institute for Global Health India, University of Oxford, New Delhi, India.
79
Ruprecht-Karls-University Heidelberg, Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany.
80
University of Balamand, Beirut, Lebanon.
81
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
82
Haramaya University, Harari, Ethiopia.
83
Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
84
Jordan University of Science and Technology, Irbid, Jordan.
85
Health Services Academy, Islamabad, Pakistan.
86
Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
87
Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia.
88
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Iranian Ministry of Health and Medical Education, Tehran, Iran.
89
Centre for Research & Action in Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
90
Department of Demography and Public Health Research Institute, University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
91
Indegene, Bangalore, India.
92
Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK.
93
Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
94
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
95
Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran.
96
Queen Mary University of London, London, UK.
97
State Welfare Organisation, Tehran, Iran.
98
Howard University College of Medicine, Washington, DC, USA.
99
Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
100
Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
101
Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Montgomery Village, MD, USA.
102
University of Salahaddin, Erbil, Iraq.
103
Medical Center, American University of Beirut, Beirut, Lebanon.
104
Ministry of Public Health and Population, Sana'a, Yemen.
105
Southern Illinois University, Springfield, IL, USA.
106
Faculty of Medicine, Fez, Morocco.
107
Aga Khan University, Karachi, Pakistan.
108
Emory University, Atlanta, GA, USA.
109
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
110
National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
111
Postgraduate Medical Institute, Lahore, Pakistan.
112
University of British Columbia, Vancouver, BC, Canada.
113
College of Pharmacy, University of Illinois, Chicago, IL, USA.
114
Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
115
A T Still University of Health Sciences, Kirksville, MO, USA.
116
Contech International Health Consultants, Lahore, Pakistan.
117
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
118
Hamad Medical Corporation, Doha, Qatar.
119
Society for Health and Demographic Surveillance, Suri, India.
120
Contech International Health Consultants, Lahore, Pakistan; Contech School of Public Health, Lahore, Pakistan.
121
Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
122
Walden University, Minneapolis, MN, USA; Suez Canal University, Ismailia, Egypt.
123
Brien Holden Vision Institute, University of New South Wales, Sydney, NSW, Australia; International Health and Development, Geneva, Switzerland.
124
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
125
Lebanese University, Beirut, Lebanon; Bellevue Medical Center, Mansourieh El Metn, Lebanon.
126
Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.
127
Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
128
All India Institute of Medical Sciences, New Delhi, India.
129
Bahir Dar University, Bahir Dar, Ethiopia.
130
Department of Public Health, An-Najah University, Nablus, Palestine.
131
Tufts Medical Center, Boston, MA, USA.
132
Washington State University, Spokane, WA, USA.
133
Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.
134
Westchester Medical Center, Valhalla, NY, USA.
135
Department of Anesthesiology, Riyadh, Saudi Arabia; Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA.
136
Warwick Medical School, University of Warwick, Coventry, UK.
137
Federal Institute for Population Research, Wiesbaden, Germany; German National Cohort Consortium, Heidelberg, Germany.
138
Jackson State University, Jackson, MS, USA.
139
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
140
Clinical Investigation Centre INSERM, Université de Lorraine, Vandoeuvre les Nancy, France; CHU de Nancy, Vandoeuvre les Nancy, France.
141
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.

Abstract

BACKGROUND:

The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013.

METHODS:

GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically.

FINDINGS:

The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred.

INTERPRETATION:

Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts.

FUNDING:

Bill & Melinda Gates Foundation.

Comment in

PMID:
27568068
DOI:
10.1016/S2214-109X(16)30168-1
[Indexed for MEDLINE]
Free full text
Icon for Elsevier Science
16.
Bipolar Disord. 2016 Aug;18(5):440-50. doi: 10.1111/bdi.12423.

The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013.

Author information

1
The University of Queensland, School of Public Health, Herston, QLD, Australia.
2
Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
3
University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA.
4
University of New South Wales, National Drug and Alcohol Research Centre, Sydney, NSW, Australia.
5
University of Melbourne, Melbourne School of Population and Global Health, Melbourne, VIC, Australia.

Abstract

OBJECTIVES:

We present the global burden of bipolar disorder based on findings from the Global Burden of Disease Study 2013 (GBD 2013).

METHODS:

Data on the epidemiology of bipolar disorder were obtained from a systematic literature review and assembled using Bayesian meta-regression modelling to produce prevalence by country, age, sex and year. Years lived with disability (YLDs) were estimated by multiplying prevalence by disability weights quantifying the severity of the health loss associated with bipolar disorder. As there were no years of life lost (YLLs) attributed to bipolar disorder, YLDs equated to disability-adjusted life years (DALYs) as a measure of total burden.

RESULTS:

There were 32.7 million cases of bipolar disorder globally in 1990 and 48.8 million in 2013; equivalent to a 49.1% increase in prevalent cases, all accounted for by population increase and ageing. Bipolar disorder accounted for 9.9 million DALYs in 2013, explaining 0.4% of total DALYs and 1.3% of total YLDs. There were 5.5 million DALYs recorded for female individuals and 4.4 million for male individuals. DALYs were evident from age 10 years, peaked in the 20s, and decreased thereafter. DALYs were relatively constant geographically.

CONCLUSIONS:

Despite being relatively rare, bipolar disorder is a disabling illness due to its early onset, severity and chronicity. Population growth and aging are leading to an increase in the burden of bipolar disorder over time. It is important that resources be directed towards improving the coverage of evidence-based intervention strategies for bipolar disorder and establishing strategies to prevent new cases of the disorder.

KEYWORDS:

bipolar disorder; disability; epidemiology; global burden of disease; prevalence

PMID:
27566286
DOI:
10.1111/bdi.12423
[Indexed for MEDLINE]
Icon for Wiley
17.
BMJ. 2016 Aug 9;354:i3857. doi: 10.1136/bmj.i3857.

Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA.
2
School of Medicine, University of Washington, Seattle, WA 98105, USA.
3
School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4006, Australia.
4
Geisel School of Medicine, Dartmouth College, Hanover, NH 03755-1404, USA.
5
Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA forouzan@uw.edu.

Abstract

OBJECTIVE:

 To quantify the dose-response associations between total physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events.

DESIGN:

 Systematic review and Bayesian dose-response meta-analysis.

DATA SOURCES:

 PubMed and Embase from 1980 to 27 February 2016, and references from relevant systematic reviews. Data from the Study on Global AGEing and Adult Health conducted in China, Ghana, India, Mexico, Russia, and South Africa from 2007 to 2010 and the US National Health and Nutrition Examination Surveys from 1999 to 2011 were used to map domain specific physical activity (reported in included studies) to total activity.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES:

 Prospective cohort studies examining the associations between physical activity (any domain) and at least one of the five diseases studied.

RESULTS:

 174 articles were identified: 35 for breast cancer, 19 for colon cancer, 55 for diabetes, 43 for ischemic heart disease, and 26 for ischemic stroke (some articles included multiple outcomes). Although higher levels of total physical activity were significantly associated with lower risk for all outcomes, major gains occurred at lower levels of activity (up to 3000-4000 metabolic equivalent (MET) minutes/week). For example, individuals with a total activity level of 600 MET minutes/week (the minimum recommended level) had a 2% lower risk of diabetes compared with those reporting no physical activity. An increase from 600 to 3600 MET minutes/week reduced the risk by an additional 19%. The same amount of increase yielded much smaller returns at higher levels of activity: an increase of total activity from 9000 to 12 000 MET minutes/week reduced the risk of diabetes by only 0.6%. Compared with insufficiently active individuals (total activity <600 MET minutes/week), the risk reduction for those in the highly active category (≥8000 MET minutes/week) was 14% (relative risk 0.863, 95% uncertainty interval 0.829 to 0.900) for breast cancer; 21% (0.789, 0.735 to 0.850) for colon cancer; 28% (0.722, 0.678 to 0.768) for diabetes; 25% (0.754, 0.704 to 0.809) for ischemic heart disease; and 26% (0.736, 0.659 to 0.811) for ischemic stroke.

CONCLUSIONS:

 People who achieve total physical activity levels several times higher than the current recommended minimum level have a significant reduction in the risk of the five diseases studied. More studies with detailed quantification of total physical activity will help to find more precise relative risk estimates for different levels of activity.

PMID:
27510511
PMCID:
PMC4979358
DOI:
10.1136/bmj.i3857
[Indexed for MEDLINE]
Free PMC Article
Icon for HighWire Icon for PubMed Central

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

18.
Lancet. 2016 Sep 10;388(10049):1081-1088. doi: 10.1016/S0140-6736(16)30579-7. Epub 2016 Jul 7.

The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: stanaway@uw.edu.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
3
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA.
4
Institute for Global Health, University College London, London, UK.
5
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.
6
Mashhad University of Medical Sciences, Mashhad, Iran.
7
Queen Elizabeth Hospital Birmingham, Birmingham, UK; University of Otago Medical School, Wellington, New Zealand.
8
WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia; Doherty Institute, University of Melbourne, Melbourne, VIC, Australia.
9
Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
10
Centre for Biomedical Research, Burnet Institute, Melbourne, VIC, Australia; School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia.
11
Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
12
Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA.
13
Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
14
Division of Global Public Health, University of California San Diego, San Diego, CA, USA; School of Social and Community Medicine, University of Bristol, Bristol, UK.
15
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
16
Section Exposure Assessment and Environmental Health Indicators, Federal Environmental Agency, Berlin, Germany.
17
Contech School of Public Health, Lahore, Pakistan; Contech International Health Consultants, Lahore, Pakistan.
18
NORC at the University of Chicago, Chicago, IL, USA.
19
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
20
Case Western Reserve University, Cleveland, OH, USA; Cancer Treatment Centers of America, Rosalind Franklin University Chicago Medical School, North Chicago, IL, USA.
21
Bayer AG Turkey, Fatih Sultan Mehmet Mah Balkan Cad, Istanbul, Turkey.
22
Tufts Medical Center, Boston, MA, USA.
23
Asian Liver Center, Stanford University School of Medicine, Palo Alto, CA, USA.
24
National Research University Higher School of Economics, Moscow, Russia.
25
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway; Genetic Epidemiology Group, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland.
26
US Centers for Disease Control and Prevention, Kampala, Uganda.
27
Jackson State University, Jackson, MS, USA.
28
Department of Epidemiology and Biostatistics, School of Public Health, and Global Health Institute, Wuhan University, Wuhan, Hubei, China.
29
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
30
Division of Infectious Diseases, Imperial College, London, UK. Electronic address: g.cooke@imperial.ac.uk.

Abstract

BACKGROUND:

With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013.

METHODS:

We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs).

FINDINGS:

Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990.

INTERPRETATION:

Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health.

FUNDING:

Bill & Melinda Gates Foundation.

PMID:
27394647
PMCID:
PMC5100695
DOI:
10.1016/S0140-6736(16)30579-7
[Indexed for MEDLINE]
Free PMC Article
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19.
Lancet Neurol. 2016 Aug;15(9):913-924. doi: 10.1016/S1474-4422(16)30073-4. Epub 2016 Jun 9.

Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Author information

1
National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand. Electronic address: valery.feigin@aut.ac.nz.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
3
National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.
4
Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
5
Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden.
6
Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.

Abstract

BACKGROUND:

The contribution of modifiable risk factors to the increasing global and regional burden of stroke is unclear, but knowledge about this contribution is crucial for informing stroke prevention strategies. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to estimate the population-attributable fraction (PAF) of stroke-related disability-adjusted life-years (DALYs) associated with potentially modifiable environmental, occupational, behavioural, physiological, and metabolic risk factors in different age and sex groups worldwide and in high-income countries and low-income and middle-income countries, from 1990 to 2013.

METHODS:

We used data on stroke-related DALYs, risk factors, and PAF from the GBD 2013 Study to estimate the burden of stroke by age and sex (with corresponding 95% uncertainty intervals [UI]) in 188 countries, as measured with stroke-related DALYs in 1990 and 2013. We evaluated attributable DALYs for 17 risk factors (air pollution and environmental, dietary, physical activity, tobacco smoke, and physiological) and six clusters of risk factors by use of three inputs: risk factor exposure, relative risks, and the theoretical minimum risk exposure level. For most risk factors, we synthesised data for exposure with a Bayesian meta-regression method (DisMod-MR) or spatial-temporal Gaussian process regression. We based relative risks on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks, such as high body-mass index (BMI), through other risks, such as high systolic blood pressure (SBP) and high total cholesterol.

FINDINGS:

Globally, 90·5% (95% UI 88·5-92·2) of the stroke burden (as measured in DALYs) was attributable to the modifiable risk factors analysed, including 74·2% (95% UI 70·7-76·7) due to behavioural factors (smoking, poor diet, and low physical activity). Clusters of metabolic factors (high SBP, high BMI, high fasting plasma glucose, high total cholesterol, and low glomerular filtration rate; 72·4%, 95% UI 70·2-73·5) and environmental factors (air pollution and lead exposure; 33·4%, 95% UI 32·4-34·3) were the second and third largest contributors to DALYs. Globally, 29·2% (95% UI 28·2-29·6) of the burden of stroke was attributed to air pollution. Although globally there were no significant differences between sexes in the proportion of stroke burden due to behavioural, environmental, and metabolic risk clusters, in the low-income and middle-income countries, the PAF of behavioural risk clusters in males was greater than in females. The PAF of all risk factors increased from 1990 to 2013 (except for second-hand smoking and household air pollution from solid fuels) and varied significantly between countries.

INTERPRETATION:

Our results suggest that more than 90% of the stroke burden is attributable to modifiable risk factors, and achieving control of behavioural and metabolic risk factors could avert more than three-quarters of the global stroke burden. Air pollution has emerged as a significant contributor to global stroke burden, especially in low-income and middle-income countries, and therefore reducing exposure to air pollution should be one of the main priorities to reduce stroke burden in these countries.

FUNDING:

Bill & Melinda Gates Foundation, American Heart Association, US National Heart, Lung, and Blood Institute, Columbia University, Health Research Council of New Zealand, Brain Research New Zealand Centre of Research Excellence, and National Science Challenge, Ministry of Business, Innovation and Employment of New Zealand.

PMID:
27291521
DOI:
10.1016/S1474-4422(16)30073-4
[Indexed for MEDLINE]
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20.
Scand J Public Health. 2016 Aug;44(6):604-10. doi: 10.1177/1403494816653512. Epub 2016 Jun 9.

Disease burden attributed to alcohol: How methodological advances in the Global Burden of Disease 2013 study have changed the estimates in Sweden.

Author information

1
Department of Public Health Sciences, Karolinska Institutet, Sweden.
2
Department of Public Health Sciences, Karolinska Institutet, Sweden Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden.
3
Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
4
Department of Public Health Sciences, Karolinska Institutet, Sweden emilie.agardh@ki.se.

Abstract

AIM:

The Global Burden of Disease (GBD) study continuously refines its estimates as new data and methods become available. In the latest iteration of the study, GBD 2013, changes were made related to the disease burden attributed to alcohol. The aim of this study was to briefly present these changes and to compare the disease burden attributed to alcohol in Swedish men and women in 2010 using previous and updated methods.

METHODS:

In the GBD study, the contribution of alcohol to the burden of disease is estimated by theoretically assessing how much of the disease burden can be avoided by reducing the consumption of alcohol to zero. The updated methods mainly consider improved measurements of alcohol consumption, including less severe alcohol dependence, assigning the most severe injuries and removing the protective effect of drinking on cardiovascular diseases if combined with binge drinking.

RESULTS:

The overall disease burden attributed to alcohol in 2010 increased by 14% when using the updated methods. Women accounted for this overall increase, mainly because the updated methods led to an overall higher alcohol consumption in women. By contrast, the overall burden decreased in men, one reason being the lower overall alcohol consumption with the new methods. In men, the inclusion of less severe alcohol dependence resulted in a large decrease in the alcohol attributed disease burden. This was, however, evened out to a great extent by the increase in cardiovascular disease and injuries. CONCLUSIONS WHEN USING THE UPDATED GBD METHODS, THE OVERALL DISEASE BURDEN ATTRIBUTED TO ALCOHOL INCREASED IN WOMEN, BUT NOT IN MEN.

KEYWORDS:

Alcohol; Global Burden of Disease project; disease burden; methodological changes

PMID:
27282643
DOI:
10.1177/1403494816653512
[Indexed for MEDLINE]
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