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  • 1. Barber, R. M.
    et al.
    Fullman, N.
    Sorensen, R. J. D.
    Bollyky, T.
    McKee, M.
    Nolte, E.
    Abajobir, A. A.
    Abate, K. H.
    Abbafati, C.
    Abbas, K. M.
    Abd-Allah, F.
    Abdulle, A. M.
    Abdurahman, A. A.
    Abera, S. F.
    Abraham, B.
    Abreha, G. F.
    Adane, K.
    Adelekan, A. L.
    Adetifa, I. M. O.
    Afshin, A.
    Agarwal, A.
    Agarwal, S. K.
    Agarwal, S.
    Agrawal, A.
    Ahmad Kiadaliri, A.
    Ahmadi, A.
    Ahmed, K. Y.
    Ahmed, M. B.
    Akinyemi, R. O.
    Akinyemiju, T. F.
    Akseer, N.
    Al-Aly, Z.
    Alam, K.
    Alam, N.
    Alam, S. S.
    Alemu, Z. A.
    Alene, K. A.
    Alexander, L.
    Ali, R.
    Ali, S. D.
    Alizadeh-Navaei, R.
    Alkerwi, A.
    Alla, F.
    Allebeck, P.
    Allen, C.
    Al-Raddadi, R.
    Alsharif, U.
    Altirkawi, K. A.
    Alvarez Martin, E.
    Alvis-Guzman, N.
    Amare, A. T.
    Amini, E.
    Ammar, W.
    Amo-Adjei, J.
    Amoako, Y. A.
    Anderson, B. O.
    Androudi, S.
    Ansari, H.
    Ansha, M. G.
    Antonio, C. A. T.
    Ärnlöv, J.
    Artaman, A.
    Asayesh, H.
    Assadi, R.
    Astatkie, A.
    Atey, T. M.
    Atique, S.
    Atnafu, N. T.
    Atre, S. R.
    Avila-Burgos, L.
    Avokpaho, E. F. G. A.
    Ayala Quintanilla, B. P.
    Awasthi, A.
    Ayele, N. N.
    Azzopardi, P.
    Ba Saleem, H. O.
    BÀrnighausen, T.
    Bacha, U.
    Badawi, A.
    Banerjee, A.
    Barac, A.
    Barboza, M. A.
    Barker-Collo, S. L.
    Barrero, L. H.
    Basu, S.
    Baune, B. T.
    Baye, K.
    Bayou, Y. T.
    Bazargan-Hejazi, S.
    Bedi, N.
    Beghi, E.
    Béjot, Y.
    Bello, A. K.
    Bennett, D. A.
    Bensenor, I. M.
    Berhane, A.
    Bernabé, E.
    Bernal, O. A.
    Beyene, A. S.
    Beyene, T. J.
    Bhutta, Z. A.
    Biadgilign, S.
    Bikbov, B.
    Birlik, S. M.
    Birungi, C.
    Biryukov, S.
    Bisanzio, D.
    Bizuayehu, H. M.
    Bose, D.
    Brainin, M.
    Brauer, M.
    Brazinova, A.
    Breitborde, N. J. K.
    Brenner, H.
    Butt, Z. A.
    Cárdenas, R.
    Cahuana-Hurtado, L.
    Campos-Nonato, I. R.
    Car, J.
    Carrero, J. J.
    Casey, D.
    Caso, V.
    Castañeda-Orjuela, C. A.
    Castillo Rivas, J.
    Catalá-López, F.
    Cecilio, P.
    Cercy, K.
    Charlson, F. J.
    Chen, A. Z.
    Chew, A.
    Chibalabala, M.
    Chibueze, C. E.
    Chisumpa, V. H.
    Chitheer, A. A.
    Chowdhury, R.
    Christensen, H.
    Christopher, D. J.
    Ciobanu, L. G.
    Cirillo, M.
    Coggeshall, M. S.
    Cooper, L. T.
    Cortinovis, M.
    Crump, J. A.
    Dalal, Koustuv
    Danawi, H.
    Dandona, L.
    Dandona, R.
    Dargan, P. I.
    Das Neves, J.
    Davey, G.
    Davitoiu, D. V.
    Davletov, K.
    De Leo, D.
    Del Gobbo, L. C.
    Del Pozo-Cruz, B.
    Dellavalle, R. P.
    Deribe, K.
    Deribew, A.
    Des Jarlais, D. C.
    Dey, S.
    Dharmaratne, S. D.
    Dicker, D.
    Ding, E. L.
    Dokova, K.
    Dorsey, E. R.
    Doyle, K. E.
    Dubey, M.
    Ehrenkranz, R.
    Ellingsen, C. L.
    Elyazar, I.
    Enayati, A.
    Ermakov, S. P.
    Eshrati, B.
    Esteghamati, A.
    Estep, K.
    FÃŒrst, T.
    Faghmous, I. D. A.
    Fanuel, F. B. B.
    Faraon, E. J. A.
    Farid, T. A.
    Farinha, C. S. E. S.
    Faro, A.
    Farvid, M. S.
    Farzadfar, F.
    Feigin, V. L.
    Feigl, A. B.
    Fereshtehnejad, S. -M
    Fernandes, J. G.
    Fernandes, J. C.
    Feyissa, T. R.
    Fischer, F.
    Fitzmaurice, C.
    Fleming, T. D.
    Foigt, N.
    Foreman, K. J.
    Forouzanfar, M. H.
    Franklin, R. C.
    Frostad, J.
    Ghiwot, T. T.
    Gakidou, E.
    Gambashidze, K.
    Gamkrelidze, A.
    Gao, W.
    Garcia-Basteiro, A. L.
    Gebre, T.
    Gebremedhin, A. T.
    Gebremichael, M. W.
    Gebru, A. A.
    Gelaye, A. A.
    Geleijnse, J. M.
    Genova-Maleras, R.
    Gibney, K. B.
    Giref, A. Z.
    Gishu, M. D.
    Giussani, G.
    Godwin, W. W.
    Gold, A.
    Goldberg, E. M.
    Gona, P. N.
    Goodridge, A.
    Gopalani, S. V.
    Goto, A.
    Graetz, N.
    Greaves, F.
    Griswold, M.
    Guban, P. I.
    Gugnani, H. C.
    Gupta, P. C.
    Gupta, R.
    Gupta, T.
    Gupta, V.
    Habtewold, T. D.
    Hafezi-Nejad, N.
    Haile, D.
    Hailu, A. D.
    Hailu, G. B.
    Hakuzimana, A.
    Hamadeh, R. R.
    Hambisa, M. T.
    Hamidi, S.
    Hammami, M.
    Hankey, G. J.
    Hao, Y.
    Harb, H. L.
    Hareri, H. A.
    Haro, J. M.
    Hassanvand, M. S.
    Havmoeller, R.
    Hay, R. J.
    Hay, S. I.
    Hendrie, D.
    Heredia-Pi, I. B.
    Hoek, H. W.
    Horino, M.
    Horita, N.
    Hosgood, H. D.
    Htet, A. S.
    Hu, G.
    Huang, H.
    Huang, J. J.
    Huntley, B. M.
    Huynh, C.
    Iburg, K. M.
    Ileanu, B. V.
    Innos, K.
    Irenso, A. A.
    Jahanmehr, N.
    Jakovljevic, M. B.
    James, P.
    James, S. L.
    Javanbakht, M.
    Jayaraman, S. P.
    Jayatilleke, A. U.
    Jeemon, P.
    Jha, V.
    John, D.
    Johnson, C.
    Johnson, S. C.
    Jonas, J. B.
    Juel, K.
    Kabir, Z.
    Kalkonde, Y.
    Kamal, R.
    Kan, H.
    Karch, A.
    Karema, C. K.
    Karimi, S. M.
    Kasaeian, A.
    Kassebaum, N. J.
    Kastor, A.
    Katikireddi, S. V.
    Kazanjan, K.
    Keiyoro, P. N.
    Kemmer, L.
    Kemp, A. H.
    Kengne, A. P.
    Kerbo, A. A.
    Kereselidze, M.
    Kesavachandran, C. N.
    Khader, Y. S.
    Khalil, I.
    Khan, A. R.
    Khan, E. A.
    Khan, G.
    Khang, Y. -H
    Khoja, A. T. A.
    Khonelidze, I.
    Khubchandani, J.
    Kibret, G. D.
    Kim, D.
    Kim, P.
    Kim, Y. J.
    Kimokoti, R. W.
    Kinfu, Y.
    Kissoon, N.
    Kivipelto, M.
    Kokubo, Y.
    Kolk, A.
    Kolte, D.
    Kopec, J. A.
    Kosen, S.
    Koul, P. A.
    Koyanagi, A.
    Kravchenko, M.
    Krishnaswami, S.
    Krohn, K. J.
    Kuate Defo, B.
    Kucuk Bicer, B.
    Kuipers, E. J.
    Kulkarni, V. S.
    Kumar, G. A.
    Kumsa, F. A.
    Kutz, M.
    Kyu, H. H.
    Lager, A. C. J.
    Lal, A.
    Lal, D. K.
    Lalloo, R.
    Lallukka, T.
    Lan, Q.
    Langan, S. M.
    Lansingh, V. C.
    Larson, H. J.
    Larsson, A.
    Laryea, D. O.
    Latif, A. A.
    Lawrynowicz, A. E. B.
    Leasher, J. L.
    Leigh, J.
    Leinsalu, M.
    Leshargie, C. T.
    Leung, J.
    Leung, R.
    Levi, M.
    Liang, X.
    Lim, S. S.
    Lind, M.
    Linn, S.
    Lipshultz, S. E.
    Liu, P.
    Liu, Y.
    Lo, L. -T
    Logroscino, G.
    Lopez, A. D.
    Lorch, S. A.
    Lotufo, P. A.
    Lozano, R.
    Lunevicius, R.
    Lyons, R. A.
    Macarayan, E. R. K.
    Mackay, M. T.
    Magdy Abd El Razek, H.
    Magdy Abd El Razek, M.
    Mahdavi, M.
    Majeed, A.
    Malekzadeh, R.
    Malta, D. C.
    Mantovani, L. G.
    Manyazewal, T.
    Mapoma, C. C.
    Marcenes, W.
    Marks, G. B.
    Marquez, N.
    Martinez-Raga, J.
    Marzan, M. B.
    Massano, J.
    Mathur, M. R.
    Maulik, P. K.
    Mazidi, M.
    McAlinden, C.
    McGrath, J. J.
    McNellan, C.
    Meaney, P. A.
    Mehari, A.
    Mehndiratta, M. M.
    Meier, T.
    Mekonnen, A. B.
    Meles, K. G.
    Memish, Z. A.
    Mengesha, M. M.
    Mengiste, D. T.
    Mengistie, M. A.
    Menota, B. G.
    Mensah, G. A.
    Mereta, S. T.
    Meretoja, A.
    Meretoja, T. J.
    Mezgebe, H. B.
    Micha, R.
    Millear, A.
    Mills, E. J.
    Minnig, S.
    Mirarefin, M.
    Mirrakhimov, E. M.
    Mock, C. N.
    Mohammad, K. A.
    Mohammed, S.
    Mohanty, S. K.
    Mokdad, A. H.
    Mola, G. L. D.
    Molokhia, M.
    Monasta, L.
    Montico, M.
    Moradi-Lakeh, M.
    Moraga, P.
    Morawska, L.
    Mori, R.
    Moses, M.
    Mueller, U. O.
    Murthy, S.
    Musa, K. I.
    Nachega, J. B.
    Nagata, C.
    Nagel, G.
    Naghavi, M.
    Naheed, A.
    Naldi, L.
    Nangia, V.
    Nascimento, B. R.
    Negoi, I.
    Neupane, S. P.
    Newton, C. R.
    Ng, M.
    Ngalesoni, F. N.
    Ngunjiri, J. W.
    Nguyen, G.
    Ningrum, D. N. A.
    Nolte, S.
    Nomura, M.
    Norheim, O. F.
    Norrving, B.
    Noubiap, J. J. N.
    Obermeyer, C. M.
    Ogbo, F. A.
    Oh, I. -H
    Okoro, A.
    Oladimeji, O.
    Olagunju, A. T.
    Olivares, P. R.
    Olsen, H. E.
    Olusanya, B. O.
    Olusanya, J. O.
    Opio, J. N.
    Oren, E.
    Ortiz, A.
    Osborne, R. H.
    Osman, M.
    Owolabi, M. O.
    Mahesh, P. A.
    Pain, A. W.
    Pakhale, S.
    Palomares Castillo, E.
    Pana, A.
    Papachristou, C.
    Parsaeian, M.
    Patel, T.
    Patton, G. C.
    Paudel, D.
    Paul, V. K.
    Pearce, N.
    Pereira, D. M.
    Perez-Padilla, R.
    Perez-Ruiz, F.
    Perico, N.
    Pesudovs, K.
    Petzold, M.
    Phillips, M. R.
    Pigott, D. M.
    Pillay, J. D.
    Pinho, C.
    Polinder, S.
    Pond, C. D.
    Prakash, V.
    Purwar, M.
    Qorbani, M.
    Quistberg, D. A.
    Radfar, A.
    Rafay, A.
    Rahimi, K.
    Rahimi-Movaghar, V.
    Rahman, M.
    Rahman, M. H. U.
    Rai, R. K.
    Ram, U.
    Rana, S. M.
    Rankin, Z.
    Rao, P. V.
    Rao, P. C.
    Rawaf, S.
    Rego, M. A. S.
    Reitsma, M.
    Remuzzi, G.
    Renzaho, A. M. N. N.
    Resnikoff, S.
    Rezaei, S.
    Rezai, M. S.
    Ribeiro, A. L.
    Roba, H. S.
    Rokni, M. B.
    Ronfani, L.
    Roshandel, G.
    Roth, G. A.
    Rothenbacher, D.
    Roy, N. K.
    Sachdev, P. S.
    Sackey, B. B.
    Saeedi, M. Y.
    Safiri, S.
    Sagar, R.
    Sahraian, M. A.
    Saleh, M. M.
    Salomon, J. A.
    Samy, A. M.
    Sanabria, J. R.
    Sanchez-Niño, M. D.
    Sandar, L.
    Santos, I. S.
    Santos, J. V.
    Santric Milicevic, M. M.
    Sarmiento-Suarez, R.
    Sartorius, B.
    Satpathy, M.
    Savic, M.
    Sawhney, M.
    Saylan, M. I.
    Schöttker, B.
    Schutte, A. E.
    Schwebel, D. C.
    Seedat, S.
    Seid, A. M.
    Seifu, C. N.
    Sepanlou, S. G.
    Serdar, B.
    Servan-Mori, E. E.
    Setegn, T.
    Shackelford, K. A.
    Shaheen, A.
    Shahraz, S.
    Shaikh, M. A.
    Shakh-Nazarova, M.
    Shamsipour, M.
    Shariful Islam, S. M.
    Sharma, J.
    Sharma, R.
    She, J.
    Sheikhbahaei, S.
    Shen, J.
    Shi, P.
    Shigematsu, M.
    Shin, M. -J
    Shiri, R.
    Shoman, H.
    Shrime, M. G.
    Sibamo, E. L. S.
    Sigfusdottir, I. D.
    Silva, D. A. S.
    Silveira, D. G. A.
    Sindi, S.
    Singh, A.
    Singh, J. A.
    Singh, O. P.
    Singh, P. K.
    Singh, V.
    Sinke, A. H.
    Sinshaw, A. E.
    Skirbekk, V.
    Sliwa, K.
    Smith, A.
    Sobngwi, E.
    Soneji, S.
    Soriano, J. B.
    Sousa, T. C. M.
    Sposato, L. A.
    Sreeramareddy, C. T.
    Stathopoulou, V.
    Steel, N.
    Steiner, C.
    Steinke, S.
    Stokes, M. A.
    Stranges, S.
    Strong, M.
    Stroumpoulis, K.
    Sturua, L.
    Sufiyan, M. B.
    Suliankatchi, R. A.
    Sun, J.
    Sur, P.
    Swaminathan, S.
    Sykes, B. L.
    Tabarés-Seisdedos, R.
    Tabb, K. M.
    Taffere, G. R.
    Talongwa, R. T.
    Tarajia, M.
    Tavakkoli, M.
    Taveira, N.
    Teeple, S.
    Tegegne, T. K.
    Tehrani-Banihashemi, A.
    Tekelab, T.
    Tekle, D. Y.
    Temam Shifa, G.
    Terkawi, A. S.
    Tesema, A. G.
    Thakur, J. S.
    Thomson, A. J.
    Tillmann, T.
    Tiruye, T. Y.
    Tobe-Gai, R.
    Tonelli, M.
    Topor-Madry, R.
    Tortajada, M.
    Troeger, C.
    Truelsen, T.
    Tura, A. K.
    Uchendu, U. S.
    Ukwaja, K. N.
    Undurraga, E. A.
    Uneke, C. J.
    Uthman, O. A.
    Van Boven, J. F. M.
    Van Dingenen, R.
    Varughese, S.
    Vasankari, T.
    Venketasubramanian, N.
    Violante, F. S.
    Vladimirov, S. K.
    Vlassov, V. V.
    Vollset, S. E.
    Vos, T.
    Wagner, J. A.
    Wakayo, T.
    Waller, S. G.
    Walson, J. L.
    Wang, H.
    Wang, Y. -P
    Watkins, D. A.
    Weiderpass, E.
    Weintraub, R. G.
    Wen, C. -P
    Werdecker, A.
    Wesana, J.
    Westerman, R.
    Whiteford, H. A.
    Wilkinson, J. D.
    Wiysonge, C. S.
    Woldeyes, B. G.
    Wolfe, C. D. A.
    Won, S.
    Workicho, A.
    Workie, S. B.
    Wubshet, M.
    Xavier, D.
    Xu, G.
    Yadav, A. K.
    Yaghoubi, M.
    Yakob, B.
    Yan, L. L.
    Yano, Y.
    Yaseri, M.
    Yimam, H. H.
    Yip, P.
    Yonemoto, N.
    Yoon, S. -J
    Younis, M. Z.
    Yu, C.
    Zaidi, Z.
    El Sayed Zaki, M.
    Zambrana-Torrelio, C.
    Zapata, T.
    Zenebe, Z. M.
    Zodpey, S.
    Zoeckler, L.
    Zuhlke, L. J.
    Murray, C. J. L.
    Access, GBD 2015 Healthcare
    Collaborators, Quality
    Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: A novel analysis from the global burden of disease study 20152017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10091, p. 231-266Article in journal (Refereed)
    Abstract [en]

    Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd.

  • 2. Chang, A. Y.
    et al.
    Cowling, K.
    Micah, A. E.
    Chapin, A.
    Chen, C. S.
    Ikilezi, G.
    Sadat, N.
    Tsakalos, G.
    Wu, J.
    Younker, T.
    Zhao, Y.
    Zlavog, B. S.
    Abbafati, C.
    Ahmed, A. E.
    Alam, K.
    Alipour, V.
    Aljunid, S. M.
    Almalki, M. J.
    Alvis-Guzman, N.
    Ammar, W.
    Andrei, C. L.
    Anjomshoa, M.
    Antonio, C. A. T.
    Arabloo, J.
    Aremu, O.
    Ausloos, M.
    Avila-Burgos, L.
    Awasthi, A.
    Ayanore, M. A.
    Azari, S.
    Azzopardi-Muscat, N.
    Bagherzadeh, M.
    BÀrnighausen, T. W.
    Baune, B. T.
    Bayati, M.
    Belay, Y. B.
    Belay, Y. A.
    Belete, H.
    Berbada, D. A.
    Berman, A. E.
    Beuran, M.
    Bijani, A.
    Busse, R.
    Cahuana-Hurtado, L.
    Cámera, L. A.
    Catalá-López, F.
    Chauhan, B. G.
    Constantin, M. -M
    Crowe, C. S.
    Cucu, A.
    Dalal, Koustuv
    De Neve, J. -W
    Deiparine, S.
    Demeke, F. M.
    Do, H. P.
    Dubey, M.
    Tantawi, M. E.
    Eskandarieh, S.
    Esmaeili, R.
    Fakhar, M.
    Fazaeli, A. A.
    Fischer, F.
    Foigt, N. A.
    Fukumoto, T.
    Fullman, N.
    Galan, A.
    Gamkrelidze, A.
    Gezae, K. E.
    Ghajar, A.
    Ghashghaee, A.
    Goginashvili, K.
    Haakenstad, A.
    Bidgoli, H. H.
    Hamidi, S.
    Harb, H. L.
    Hasanpoor, E.
    Hassen, H. Y.
    Hay, S. I.
    Hendrie, D.
    Henok, A.
    Heredia-Pi, I.
    Herteliu, C.
    Hoang, C. L.
    Hole, M. K.
    Rad, E. H.
    Hossain, N.
    Hosseinzadeh, M.
    Hostiuc, S.
    Ilesanmi, O. S.
    Irvani, S. S. N.
    Jakovljevic, M.
    Jalali, A.
    James, S. L.
    Jonas, J. B.
    JÃŒrisson, M.
    Kadel, R.
    Matin, B. K.
    Kasaeian, A.
    Kasaye, H. K.
    Kassaw, M. W.
    Karyani, A. K.
    Khabiri, R.
    Khan, J.
    Khan, M. N.
    Khang, Y. -H
    Kisa, A.
    Kissimova-Skarbek, K.
    Kohler, S.
    Koyanagi, A.
    Krohn, K. J.
    Leung, R.
    Lim, L. -L
    Lorkowski, S.
    Majeed, A.
    Malekzadeh, R.
    Mansourian, M.
    Mantovani, L. G.
    Massenburg, B. B.
    Mckee, M.
    Mehta, V.
    Meretoja, A.
    Meretoja, T. J.
    Kostova, N. M.
    Miller, T. R.
    Mirrakhimov, E. M.
    Mohajer, B.
    Darwesh, A. M.
    Mohammed, S.
    Mohebi, F.
    Mokdad, A. H.
    Morrison, S. D.
    Mousavi, S. M.
    Muthupandian, S.
    Nagarajan, A. J.
    Nangia, V.
    Negoi, I.
    Nguyen, C. T.
    Nguyen, H. L. T.
    Nguyen, S. H.
    Nosratnejad, S.
    Oladimeji, O.
    Olgiati, S.
    Olusanya, J. O.
    Onwujekwe, O. E.
    Otstavnov, S. S.
    Pana, A.
    Pereira, D. M.
    Piroozi, B.
    Prada, S. I.
    Qorbani, M.
    Rabiee, M.
    Rabiee, N.
    Rafiei, A.
    Rahim, F.
    Rahimi-Movaghar, V.
    Ram, U.
    Ranabhat, C. L.
    Ranta, A.
    Rawaf, D. L.
    Rawaf, S.
    Rezaei, S.
    Roro, E. M.
    Rostami, A.
    Rubino, S.
    Salahshoor, M.
    Samy, A. M.
    Sanabria, J.
    Santos, J. V.
    Milicevic, M. M. S.
    Jose, B. P. S.
    Savic, M.
    Schwendicke, F.
    Sepanlou, S. G.
    Sepehrimanesh, M.
    Sheikh, A.
    Shrime, M. G.
    Sisay, S.
    Soltani, S.
    Soofi, M.
    Srinivasan, V.
    Tabarés-Seisdedos, R.
    Torre, A.
    Tovani-Palone, M. R.
    Tran, B. X.
    Tran, K. B.
    Undurraga, E. A.
    Valdez, P. R.
    Van Boven, J. F. M.
    Vargas, V.
    Veisani, Y.
    Violante, F. S.
    Vladimirov, S. K.
    Vlassov, V.
    Vollmer, S.
    Vu, G. T.
    Wolfe, C. D. A.
    Yonemoto, N.
    Younis, M. Z.
    Yousefifard, M.
    Zaman, S. B.
    Zangeneh, A.
    Zegeye, E. A.
    Ziapour, A.
    Chew, A.
    Murray, C. J. L.
    Dieleman, J. L.
    Network, Global Burden of Disease Health Financing Collaborator
    Past, present, and future of global health financing: A review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-20502019In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10187, p. 2233-2260Article in journal (Refereed)
    Abstract [en]

    Background: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. Methods: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. Findings: Between 1995 and 2016, health spending grew at a rate of 4.00% (95% uncertainty interval 3.89-4.12) annually, although it grew slower in per capita terms (2.72% [2.61-2.84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5.55% [5.18-5.95]), mainly due to growth in government health spending, and in lower-middle-income countries (3.71% [3.10-4.34]), mainly from DAH. Health spending globally reached $8.0 trillion (7.8-8.1) in 2016 (comprising 8.6% [8.4-8.7] of the global economy and $10.3 trillion [10.1-10.6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0.4% (0.3-0.4) of health spending globally was in low-income countries, despite these countries comprising 10.0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9.5 billion, 24.3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6.27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China’s contribution to DAH ($644.7 million in 2018). Globally, health spending is projected to increase to $15.0 trillion (14.0-16.0) by 2050 (reaching 9.4% [7.6-11.3] of the global economy and $21.3 trillion [19.8-23.1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1.84% (1.68-2.02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0.6% (0.6-0.7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15.7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130.2 (122.9-136.9) in 2016 and is projected to remain at similar levels in 2050 (125.9 [113.7-138.1]). The decomposition analysis identified governments’ increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. Interpretation: Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. © 2019 The Author(s).

  • 3. Dieleman, J.
    et al.
    Campbell, M.
    Chapin, A.
    Eldrenkamp, E.
    Fan, V. Y.
    Haakenstad, A.
    Kates, J.
    Liu, Y.
    Matyasz, T.
    Micah, A.
    Reynolds, A.
    Sadat, N.
    Schneider, M. T.
    Sorensen, R.
    Evans, T.
    Evans, D.
    Kurowski, C.
    Tandon, A.
    Abbas, K. M.
    Abera, S. F.
    Ahmad Kiadaliri, A.
    Ahmed, K. Y.
    Ahmed, M. B.
    Alam, K.
    Alizadeh-Navaei, R.
    Alkerwi, A.
    Amini, E.
    Ammar, W.
    Amrock, S. M.
    Antonio, C. A. T.
    Atey, T. M.
    Avila-Burgos, L.
    Awasthi, A.
    Barac, A.
    Bernal, O. A.
    Beyene, A. S.
    Beyene, T. J.
    Birungi, C.
    Bizuayehu, H. M.
    Breitborde, N. J. K.
    Cahuana-Hurtado, L.
    Castro, R. E.
    Catalá-López, F.
    Dalal, Koustuv
    Dandona, L.
    Dandona, R.
    De Jager, P.
    Dharmaratne, S. D.
    Dubey, M.
    Farinha, C. S. E. S.
    Faro, A.
    Feigl, A. B.
    Fischer, F.
    Fitchett, J. R. A.
    Foigt, N.
    Giref, A. Z.
    Gupta, R.
    Hamidi, S.
    Harb, H. L.
    Hay, S. I.
    Hendrie, D.
    Horino, M.
    JÃŒrisson, M.
    Jakovljevic, M. B.
    Javanbakht, M.
    John, D.
    Jonas, J. B.
    Karimi, S. M.
    Khang, Y. -H
    Khubchandani, J.
    Kim, Y. J.
    Kinge, J. M.
    Krohn, K. J.
    Kumar, G. A.
    Magdy Abd El Razek, H.
    Magdy Abd El Razek, M.
    Majeed, A.
    Malekzadeh, R.
    Masiye, F.
    Meier, T.
    Meretoja, A.
    Miller, T. R.
    Mirrakhimov, E. M.
    Mohammed, S.
    Nangia, V.
    Olgiati, S.
    Osman, A. S.
    Owolabi, M. O.
    Patel, T.
    Paternina Caicedo, A. J.
    Pereira, D. M.
    Perelman, J.
    Polinder, S.
    Rafay, A.
    Rahimi-Movaghar, V.
    Rai, R. K.
    Ram, U.
    Ranabhat, C. L.
    Roba, H. S.
    Salama, J.
    Savic, M.
    Sepanlou, S. G.
    Shrime, M. G.
    Talongwa, R. T.
    Te Ao, B. J.
    Tediosi, F.
    Tesema, A. G.
    Thomson, A. J.
    Tobe-Gai, R.
    Topor-Madry, R.
    Undurraga, E. A.
    Vasankari, T.
    Violante, F. S.
    Werdecker, A.
    Wijeratne, T.
    Xu, G.
    Yonemoto, N.
    Younis, M. Z.
    Yu, C.
    Zaidi, Z.
    El Sayed Zaki, M.
    Murray, C. J. L.
    Network, Global Burden of Disease Health Financing Collaborator
    Evolution and patterns of global health financing 1995-2014: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no 10083, p. 1981-2004Article in journal (Refereed)
    Abstract [en]

    Background: An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. Methods: We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Findings: Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3.0%. The largest health spending growth rates were in upper-middle-income (5.9) and lower-middle-income groups (5.0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4.6%, and health spending increased from $51 to $120 per capita. In 2014, 59.2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29.1% and 58.0% of spending was OOP spending and 35.7% and 3.0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1.8%, and reached US$37.6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Interpretation: Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage. © The Author(s). Published by Elsevier Ltd.

  • 4. Dieleman, J. L.
    et al.
    Campbell, M.
    Chapin, A.
    Eldrenkamp, E.
    Fan, V. Y.
    Haakenstad, A.
    Kates, J.
    Li, Z.
    Matyasz, T.
    Micah, A.
    Reynolds, A.
    Sadat, N.
    Schneider, M. T.
    Sorensen, R.
    Abbas, K. M.
    Abera, S. F.
    Ahmad Kiadaliri, A.
    Ahmed, M. B.
    Alam, K.
    Alizadeh-Navaei, R.
    Alkerwi, A.
    Amini, E.
    Ammar, W.
    Antonio, C. A. T.
    Atey, T. M.
    Avila-Burgos, L.
    Awasthi, A.
    Barac, A.
    Berheto, T. M.
    Beyene, A. S.
    Beyene, T. J.
    Birungi, C.
    Bizuayehu, H. M.
    Breitborde, N. J. K.
    Cahuana-Hurtado, L.
    Castro, R. E.
    Catalá-López, F.
    Dalal, Koustuv
    Dandona, L.
    Dharmaratne, R. D. S. D.
    Dubey, M.
    Faro, A.
    Feigl, A. B.
    Fischer, F.
    Fitchett, J. R. A.
    Foigt, N.
    Giref, A. Z.
    Gupta, R.
    Hamidi, S.
    Harb, H. L.
    Hay, S. I.
    Hendrie, D.
    Horino, M.
    JÃŒrisson, M.
    Jakovljevic, M. B.
    Javanbakht, M.
    John, D.
    Jonas, J. B.
    Karimi, S. M.
    Khang, Y. -H
    Khubchandani, J.
    Kim, Y. J.
    Kinge, J. M.
    Krohn, K. J.
    Kumar, G. A.
    Leung, R.
    Magdy Abd El Razek, H.
    Magdy Abd El Razek, M.
    Majeed, A.
    Malekzadeh, R.
    Malta, D. C.
    Meretoja, A.
    Miller, T. R.
    Mirrakhimov, E. M.
    Mohammed, S.
    Molla, G.
    Nangia, V.
    Olgiati, S.
    Owolabi, M. O.
    Patel, T.
    Paternina Caicedo, A. J.
    Pereira, D. M.
    Perelman, J.
    Polinder, S.
    Rafay, A.
    Rahimi-Movaghar, V.
    Rai, R. K.
    Ram, U.
    Ranabhat, C. L.
    Roba, H. S.
    Savic, M.
    Sepanlou, S. G.
    Te Ao, B. J.
    Tesema, A. G.
    Thomson, A. J.
    Tobe-Gai, R.
    Topor-Madry, R.
    Undurraga, E. A.
    Vargas, V.
    Vasankari, T.
    Violante, F. S.
    Wijeratne, T.
    Xu, G.
    Yonemoto, N.
    Younis, M. Z.
    Yu, C.
    Zaidi, Z.
    El Sayed Zaki, M.
    Murray, C. J. L.
    Network, Global Burden of Disease Health Financing Collaborator
    Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no 10083, p. 2005-2030Article in journal (Refereed)
    Abstract [en]

    Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to $24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential. © The Author(s).

  • 5. Forouzanfar, Mohammad H
    et al.
    Alexander, Lily
    Anderson, H Ross
    Bachman, Victoria F
    Biryukov, Stan
    Brauer, Michael
    Burnett, Richard
    Casey, Daniel
    Coates, Matthew M
    Cohen, Aaron
    Delwiche, Kristen
    Estep, Kara
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    Murray, Christopher J
    Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10010, p. 2287-2323Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

    METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based 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 and high cholesterol.

    FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.

    INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

    FUNDING: Bill & Melinda Gates Foundation.

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  • 6. Global Burden of Disease Study 2013 Collaborators,
    et al.
    Rodriguez, Alina
    Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 9995, p. 743-800Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.

    METHODS: Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.

    FINDINGS: Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.

    INTERPRETATION: Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.

    FUNDING: Bill & Melinda Gates Foundation.

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    Varughese, S.
    Vasankari, T.
    Veerman, L. J.
    Venkatesh, S.
    Venketasubramanian, N.
    Vidavalur, R.
    Vijayakumar, L.
    Violante, F. S.
    Vishnu, A.
    Vladimirov, S. K.
    Vlassov, V. V.
    Vollset, S. E.
    Vos, T.
    Wadilo, F.
    Wakayo, T.
    Wallin, M. T.
    Wang, Y. -P
    Weichenthal, S.
    Weiderpass, E.
    Weintraub, R. G.
    Weiss, D. J.
    Werdecker, A.
    Westerman, R.
    Whiteford, H. A.
    Wijeratne, T.
    Williams, H. C.
    Wiysonge, C. S.
    Woldeyes, B. G.
    Wolfe, C. D. A.
    Woodbrook, R.
    Woolf, A. D.
    Workicho, A.
    Xavier, D.
    Xu, G.
    Yadgir, S.
    Yaghoubi, M.
    Yakob, B.
    Yan, L. L.
    Yano, Y.
    Ye, P.
    Yihdego, M. G.
    Yimam, H. H.
    Yip, P.
    Yonemoto, N.
    Yoon, S. -J
    Yotebieng, M.
    Younis, M. Z.
    Yu, C.
    Zaidi, Z.
    Zaki, M. E. S.
    Zegeye, E. A.
    Zenebe, Z. M.
    Zhang, X.
    Zheng, Y.
    Zhou, M.
    Zipkin, B.
    Zodpey, S.
    Zoeckler, L.
    Zuhlke, L. J.
    Murray, C. J. L.
    Adedji, I. A.
    Murdoch, M. E.
    Bryane, C. E. G.
    DALYs, G B D 2 0 1 6
    Collaborators, H A L E
    Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 20162017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10100, p. 1260-1344Article in journal (Refereed)
    Abstract [en]

    Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE difered from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs ofset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the fve lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs ofset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention eforts, and development assistance for health, including fnancial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

  • 8.
    Kivimaki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, England; Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
    Nyberg, Solja T.
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London, England; Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Fransson, Eleonor I.
    Karolinska Inst, Inst Environm Med, Sweden; School of Health Sciences, Jönköping University, Jönköping, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Borritz, Marianne
    Koege Hosp, Dept Occupat Med, Copenhagen, Denmark.
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany.
    Casini, Annalisa
    Univ Libre Bruxelles, Sch Publ Hlth, Brussels, Belgium.
    Clays, Els
    Univ Ghent, Dept Publ Hlth, Belgium.
    De Bacquer, Dirk
    Univ Ghent, Dept Publ Hlth, Belgium.
    Dragano, Nico
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany.
    Erbel, Raimund
    Univ Duisburg Essen, West German Heart Ctr Essen, Dept Cardiol, Essen, Germany.
    Geuskens, Goedele A.
    TNO, Hoofddorp, Netherlands.
    Hamer, Mark
    UCL, Dept Epidemiol & Publ Hlth, England.
    Hooftman, Wendela E.
    TNO, Hoofddorp, Netherlands.
    Houtman, Irene L.
    TNO, Hoofddorp, Netherlands.
    Jockel, Karl-Heinz
    Univ Duisburg Essen, Fac Med, Inst Med Informat Biometry & Epidemiol, Essen, Germany.
    Kittel, France
    Univ Libre Bruxelles, Sch Publ Hlth, Brussels, Belgium.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Lunau, Thorsten
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Nielsen, Martin L.
    Frederiksberg Univ Hosp, Unit Social Med, Denmark.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Sweden; Department of Psychology, Umeå University, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark.
    Pentti, Jaana
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark; Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland; Department of Psychology, University of Turku, Turku, Finland.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, England.
    Siegrist, Johannes
    Univ Dusseldorf, Fac Med, Inst Med Sociol, Dusseldorf, Germany.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, England.
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland; Folkhälsan Research Center, Helsinki, Finland; University of Skövde, Skövde, Sweden.
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, Sweden.
    Vahtera, Jussi
    Finnish Inst Occupat Hlth, Helsinki, Finland; Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.
    Westerholm, Peter J. M.
    Uppsala Univ, Occupat & Environm Med, Uppsala, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Sweden.
    O'Reilly, Dermot
    Queens Univ Belfast, Ctr Publ Hlth, Belfast, Antrim, Northern Ireland.
    Kumari, Meena
    UCL, Dept Epidemiol & Publ Hlth, England; Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, England; Centre for Cognitive Ageing and Cognitive Epidemiology, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, England; School of Community and Social Medicine, University of Bristol, Bristol, United Kingdom.
    Virtanen, Marianna
    UCL, Dept Epidemiol & Publ Hlth, England; IPD-Work Consortium.
    Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10005, p. 1739-1746Article in journal (Refereed)
    Abstract [en]

    Background Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. Methods We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5.1 million person-years (mean 8.5 years), in which 4768 events were recorded, and for stroke was 3.8 million person-years (mean 7.2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (>= 55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1.13, 95% CI 1.02-1.26; p=0.02) and incident stroke (1.33, 1.11-1.61; p=0.002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1.30-1.42). We recorded a dose-response association for stroke, with RR estimates of 1.10 (95% CI 0.94-1.28; p=0.24) for 41-48 working hours, 1.27 (1.03-1.56; p=0.03) for 49-54 working hours, and 1.33 (1.11-1.61; p=0.002) for 55 working hours or more per week compared with standard working hours (p(trend)<0.0001). Interpretation Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. Copyright (C) Kivimaki et al. Open Access article distributed under the terms of CC BY.

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  • 9.
    Kivimäki, M.
    et al.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Nyberg, S. T.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Batty, G. D.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Fransson, E. I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Heikkilä, K.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alfredsson, L.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bjorner, J. B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, M.
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Burr, H.
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
    Casini, A.
    School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
    Clays, E.
    Department of Public Health, Ghent University, Ghent, Belgium.
    De Bacquer, D.
    Department of Public Health, Ghent University, Ghent, Belgium.
    Dragano, N.
    Department of Medical Sociology, University of Düsseldorf, Düsseldorf, Germany.
    Ferrie, J. E.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Geuskens, G. A.
    TNO, Hoofddorp, Netherlands.
    Goldberg, M.
    Versailles-Saint Quentin University, Versailles, France.
    Hamer, M.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Hooftman, W. E.
    TNO, Hoofddorp, Netherlands.
    Houtman, I. L.
    TNO, Hoofddorp, Netherlands.
    Joensuu, M.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Jokela, M.
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Kittel, F.
    School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, M.
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Koskinen, A.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kouvonen, A.
    School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, United Kingdom.
    Kumari, M.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Madsen, I. E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Marmot, M. G.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Nielsen, M. L.
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Nordin, M.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Oksanen, T.
    Finnish Institute of Occupational Health, Turku, Finland.
    Pentti, J.
    Finnish Institute of Occupational Health, Turku, Finland.
    Rugulies, R.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Salo, P.
    Finnish Institute of Occupational Health, Turku, Finland.
    Siegrist, J.
    Department of Medical Sociology, University of Düsseldorf, Düsseldorf, Germany.
    Singh-Manoux, A.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Suominen, S. B.
    Department of Public Health, University of Turku, Turku, Finland.
    Väänänen, A.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Vahtera, J.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Virtanen, M.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Westerholm, P. J. M.
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Westerlund, H.
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, M.
    Versailles-Saint Quentin University, Versailles, France.
    Steptoe, A.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Theorell, T.
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Job strain as a risk factor for coronary heart disease: A collaborative meta-analysis of individual participant data2012In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 380, no 9852, p. 1491-1497Article in journal (Refereed)
    Abstract [en]

    Background Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. Methods We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. Findings 30 214 (15%) of 197 473 participants reported job strain. In 1•49 million person-years at risk (mean follow-up 7•5 years [SD 1•7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1•23 (95% CI 1•10-1•37). This effect estimate was higher in published (1•43, 1•15-1•77) than unpublished (1•16, 1•02-1•32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1•31, 1•15-1•48) and 5 years (1•30, 1•13-1•50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3•4%. Interpretation Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. Funding Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.

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  • 10.
    Micah, Angela E.
    et al.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Cogswell, Ian E.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Cunningham, Brandon
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Ezoe, Satoshi
    Univ Tokyo, Dept Global Hlth Policy, Tokyo, Japan..
    Harle, Anton C.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Maddison, Emilie R.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    McCracken, Darrah
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Nomura, Shuhei
    Univ Tokyo, Dept Global Hlth Policy, Tokyo, Japan.;Keio Univ, Dept Hlth Policy & Management, Tokyo, Japan..
    Simpson, Kyle E.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Stutzman, Hayley N.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Tsakalos, Golsum
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Wallace, Lindsey E.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Zhao, Yingxi
    Univ Oxford, Nuffield Dept Med, Oxford, England..
    Zende, Rahul R.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Abbafati, Cristiana
    Univ Roma La Sapienza, Dept Jurid & Econ Studies, Rome, Italy..
    Abdelmasseh, Michael
    Marshall Univ, Dept Surg, Huntington, WV USA..
    Abedi, Aidin
    Univ Southern Calif, Dept Orthopaed Surg, Los Angeles, CA 90007 USA..
    Abegaz, Kedir Hussein
    Near East Univ, Dept Biostat, Nicosia, Cyprus.;Madda Walabu Univ, Dept Biostat & Hlth Informat, Bale Robe, Ethiopia..
    Abhilash, E. S.
    Sree Narayana Guru Coll Chelannur, Dept Bot, Kozhikode, India..
    Abolhassani, Hassan
    Karolinska Univ Hosp, Dept Lab Med, Huddinge, Sweden.;Univ Tehran Med Sci, Res Ctr Immunodeficiencies, Tehran, Iran..
    Abrigo, Michael R. M.
    Philippine Inst Dev Studies, Dept Res, Quezon City, Philippines..
    Adhikari, Tara Ballav
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark.;Nepal Hlth Frontiers, Kathmandu, Nepal..
    Afzal, Saira
    King Edward Mem Hosp, Dept Community Med, Lahore, Pakistan.;Inst Publ Hlth, Dept Publ Hlth, Lahore, Pakistan..
    Ahinkorah, Bright Opoku
    Univ Technol Sydney, Australian Ctr Publ & Populat Hlth Res, Sydney, NSW, Australia..
    Ahmadi, Sepideh
    Shahid Beheshti Univ Med Sci, Sch Adv Technol Med, Tehran, Iran..
    Ahmed, Haroon
    COMSATS Inst Informat Technol, Dept Biosci, Islamabad, Pakistan..
    Ahmed, Muktar Beshir
    Jimma Univ, Dept Epidemiol, Jimma, Ethiopia.;Univ South Australia, Australian Ctr Precis Hlth, Adelaide, SA, Australia..
    Rashid, Tarik Ahmed
    Univ Kurdistan Hewler, Dept Comp Sci & Engn, Erbil, Iraq..
    Ajami, Marjan
    Shahid Beheshti Univ Med Sci, Natl Nutr & Food Technol Res Inst, Tehran, Iran.;Natl Inst Nutr, Dept Food & Nutr Policy & Planning Res, Tehran, Iran..
    Aji, Budi
    Jenderal Soedirman Univ, Fac Med & Publ Hlth, Purwokerto, Indonesia..
    Akalu, Yonas
    Univ Gondar, Dept Med Physiol, Gondar, Ethiopia..
    Akunna, Chisom Joyqueenet
    Intercountry Ctr Oral Hlth Afr, Dept Publ Hlth, Jos, Nigeria.;Fed Minist Hlth, Dept Publ Hlth, Garki, Nigeria..
    Al Hamad, Hanadi
    Hamad Med Corp, Geriatr & Long Term Care Dept, Doha, Qatar.;Hamad Med Corp, Rumailah Hosp, Doha, Qatar..
    Alam, Khurshid
    Murdoch Univ, Murdoch Business Sch, Perth, WA, Australia..
    Alanezi, Fahad Mashhour
    Imam Abdulrahman Bin Faisal Univ, Dammam, Saudi Arabia..
    Alanzi, Turki M.
    Imam Abdulrahman Bin Faisal Univ, Hlth Informat Management & Technol Dept, Dammam, Saudi Arabia..
    Alemayehu, Yosef
    Arba Minch Univ, Dept Midwifery, Arba Minch, Ethiopia..
    Alhassan, Robert Kaba
    Univ Hlth & Allied Sci, Inst Hlth Res, Ho, Ghana..
    Alinia, Cyrus
    Urmia Univ Med Sci, Dept Hlth Care Management & Econ, Orumiyeh, Iran..
    Aljunid, Syed Mohamed
    Kuwait Univ, Dept Hlth Policy & Management, Safat, Kuwait.;Natl Univ Malaysia, Int Ctr Casemix & Clin Coding, Bandar Tun Razak, Malaysia..
    Almustanyir, Sami Almustanyir
    Alfaisal Univ, Coll Med, Riyadh, Saudi Arabia.;Minist Hlth, Riyadh, Saudi Arabia..
    Alvis-Guzman, Nelson
    Univ Costa, Res Grp Hosp Management & Hlth Policies, Barranquilla, Colombia.;Univ Cartagena, Hlth Econ Res Grp, Cartagena, Colombia..
    Alvis-Zakzuk, Nelson J.
    Univ Costa, Dept Econ Sci, Barranquilla, Colombia.;Natl Inst Hlth, Natl Hlth Observ, Bogota, Colombia..
    Amini, Saeed
    Arak Univ Med Sci, Dept Hlth Serv Management, Arak, Iran.;Arak Univ Med Sci, Dept Hlth Serv Management, Arak, Iran..
    Amini-Rarani, Mostafa
    Isfahan Univ Med Sci, Hlth Management & Econ Reasearch Ctr, Esfahan, Iran..
    Amu, Hubert
    Univ Hlth & Allied Sci, Dept Populat & Behav Sci, Ho, Ghana..
    Ancuceanu, Robert
    Carol Davila Univ Med & Pharm, Dept Pharm, Bucharest, Romania..
    Andrei, Catalina Liliana
    Carol Davila Univ Med & Pharm, Dept Cardiol, Bucharest, Romania..
    Andrei, Tudorel
    Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania..
    Angell, Blake
    UCL, Inst Global Hlth, London, England.;George Inst Global Hlth, Hlth Syst Sci Program, Newtown, NSW, Australia..
    Anjomshoa, Mina
    Univ Tehran Med Sci, Dept Hlth Management & Econ, Tehran, Iran..
    Antonio, Carl Abelardo T.
    Univ Philippines Manila, Dept Hlth Policy & Adm, Manila, Philippines.;Hong Kong Polytech Univ, Dept Appl Social Sci, Hong Kong, Peoples R China..
    Antony, Catherine M.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Aqeel, Muhammad
    Fdn Univ Islamabad, Dept Psychol, Rawalpandi, Pakistan..
    Arabloo, Jalal
    Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, Iran..
    Arab-Zozani, Morteza
    Birjand Univ Med Sci, Social Determinants Hlth Res Ctr, Birjand, Iran..
    Aripov, Timur
    Tashkent Inst Postgrad Med Educ, Publ Hlth & Healthcare Management, Tashkent, Uzbekistan.;Boston Childrens Hosp, Boston, MA USA..
    Arrigo, Alessandro
    Univ Vita Salute San Raffaele, Sci Inst San Raffaele Hosp, Milan, Italy..
    Ashraf, Tahira
    Univ Lahore, Univ Inst Radiol Sci & Med Imaging Technol, Lahore, Pakistan..
    Atnafu, Desta Debalkie
    Bahir Dar Univ, Dept Hlth Syst & Hlth Econ, Bahir Dar, Ethiopia..
    Ausloos, Marcel
    Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania.;Univ Leicester, Sch Business, Leicester, Leics, England..
    Avila-Burgos, Leticia
    Natl Inst Publ Hlth, Ctr Hlth Syst Res, Cuernavaca, Morelos, Mexico..
    Awan, Asma Tahir
    Capella Univ, Sch Nursing & Hlth Sci, Minneapolis, MN USA.;Univ Nevada, Continuing Educ Writing Acad, Las Vegas, NV 89154 USA..
    Ayano, Getinet
    Curtin Univ, Sch Publ Hlth, Perth, WA, Australia..
    Ayanore, Martin Amogre
    Univ Hlth & Allied Sci, Dept Hlth Policy Planning & Management, Ho, Ghana..
    Azari, Samad
    Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, Iran..
    Azhar, Gulrez Shah
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;RAND Corp, Badan Pusat Stat Cent Bur Stat, Santa Monica, CA USA..
    Babalola, Tesleem Kayode
    Univ KwaZulu Natal, Discipline Publ Hlth Med, Durban, South Africa.;Univ Lagos, Dept Community Hlth & Primary Care, Lagos, Nigeria..
    Bahrami, Mohammad Amin
    Shiraz Univ Med Sci, Dept Healthcare Management & Educ, Shiraz, Iran..
    Baig, Atif Amin
    Univ Sultan Zainal Abidin Sultan Zainal Abidin Un, Biochem Unit, Kuala Terengganu, Malaysia..
    Banach, Maciej
    Med Univ Lodz, Dept Hypertens, Lodz, Poland.;Polish Mothers Mem Hosp Res Inst, Lodz, Poland..
    Barati, Nastaran
    Hamedan Univ Med Sci, Deputy Res & Technol, Hamadan, Hamadan, Iran..
    Barnighausen, Till Winfried
    Heidelberg Univ, Heidelberg Inst Global Hlth, Heidelberg, Germany.;Harvard Univ, TH Chan Sch Publ Hlth, Boston, MA 02115 USA..
    Barrow, Amadou
    Univ Gambia, Dept Publ & Environm Hlth, Brikama, Gambia.;Minist Hlth, Epidemiol & Dis Control Unit, Kotu, Gambia..
    Basu, Sanjay
    Harvard Univ, Ctr Primary Care, Boston, MA 02115 USA.;Imperial Coll London, Sch Publ Hlth, London, England..
    Baune, Bernhard T.
    Univ Munster, Dept Psychiat, Munster, Germany.;Melbourne Med Sch, Dept Psychiat, Melbourne, Vic, Australia..
    Bayati, Mohsen
    Shiraz Univ Med Sci, Hlth Human Resources Res Ctr, Shiraz, Iran..
    Benzian, Habib
    NYU, Dept Epidemiol & Hlth Promot, New York, NY USA..
    Berman, Adam E.
    Augusta Univ, Med Coll Georgia, Dept Med, Augusta, GA USA..
    Bhagavathula, Akshaya Srikanth
    Charles Univ Prague, Dept Social & Clin Pharm, Hradec Kralova, Czech Republic.;United Arab Emirates Univ, Inst Publ Hlth, Al Ain, U Arab Emirates..
    Bhardwaj, Nikha
    Govt Med Coll Pali, Dept Anat, Pali, India..
    Bhardwaj, Pankaj
    All India Inst Med Sci, Dept Community Med & Family Med, Jodhpur, Rajasthan, India.;All India Inst Med Sci, Sch Publ Hlth, Jodhpur, Rajasthan, India..
    Bhaskar, Sonu
    NSW Brain Clot Bank, Neurovasc Imaging Lab, Sydney, NSW, Australia.;South West Sydney Local Heath Dist & Liverpool Ho, Dept Neurol & Neurophysiol, Sydney, NSW, Australia..
    Bibi, Sadia
    Univ Agr Faisalabad, Inst Soil & Environm Sci, Faisalabad, Pakistan..
    Bijani, Ali
    Babol Univ Med Sci, Social Determinants Hlth Res Ctr, Babol, Iran..
    Bodolica, Virginia
    Amer Univ Sharjah, Sch Business Adm, Sharjah, U Arab Emirates..
    Bragazzi, Nicola Luigi
    Univ Genoa, Genoa, Italy..
    Braithwaite, Dejana
    Univ Florida, Dept Epidemiol, Gainesville, FL USA.;Univ Florida, Hlth Canc Ctr, Canc Populat Sci Program, Gainesville, FL USA..
    Breitborde, Nicholas J. K.
    Ohio State Univ, Psychiat & Behav Hlth Dept, Columbus, OH 43210 USA.;Ohio State Univ, Dept Psychol, Columbus, OH 43210 USA..
    Breusov, Alexey V.
    RUDN Univ, Inst Med, Moscow, Russia..
    Briko, Nikolay Ivanovich
    IM Sechenov First Moscow State Med Univ, Dept Epidemiol & Evidence Based Med, Moscow, Russia..
    Busse, Reinhard
    Tech Univ Berlin, Dept Hlth Care Management, Berlin, Germany..
    Cahuana-Hurtado, Lucero
    Peruvian Univ Cayetano Heredia, Sch Publ Hlth & Adm, Lima, Peru..
    Callander, Emily Joy
    Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia..
    Camera, Luis Alberto
    Hosp Italiano Buenos Aires, Dept Internal Med, Buenos Aires, DF, Argentina.;Argentine Soc Med, Buenos Aires, DF, Argentina..
    Castaneda-Orjuela, Carlos A.
    Natl Inst Hlth, Colombian Natl Hlth Observ, Bogota, Colombia.;Univ Nacl Colombia, Epidemiol & Publ Hlth Evaluat Grp, Bogota, Colombia..
    Catala-Lopez, Ferran
    Inst Hlth Carlos III, Natl Sch Publ Hlth, Madrid, Spain.;Ottawa Hosp Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada..
    Charan, Jaykaran
    All India Inst Med Sci, Dept Pharmacol, Jodhpur, Rajasthan, India..
    Chatterjee, Souranshu
    Medanta Medicity, Dept Microbiol & Infect Control, Gurugram, India..
    Chattu, Soosanna Kumary
    Texila Amer Univ, Dept Publ Hlth, Georgetown, Guyana..
    Chattu, Vijay Kumar
    Univ Toronto, Dept Med, Toronto, ON, Canada.;Global Inst Publ Hlth, Thiruvananthapuram, Kerala, India..
    Chen, Simiao
    Heidelberg Univ, Heidelberg Inst Global Hlth, Heidelberg, Germany..
    Cicero, Arrigo Francesco Giuseppe
    Univ Bologna, Dept Med & Surg Sci, Bologna, Italy..
    Dadras, Omid
    Kyoto Univ, Dept Hlth Informat, Kyoto, Japan.;Kyoto Univ, Grad Sch Med, Kyoto, Japan..
    Dahlawi, Saad M. A.
    Imam Abdulrahman Bin Faisal Univ, Dept Environm Hlth, Dammam, Saudi Arabia..
    Dai, Xiaochen
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Dalal, Koustuv
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Mid Sweden Univ, Div Publ Hlth Sci, Sundsvall, Sweden.;Al Farabi Kazakh Natl Univ, Higher Sch Publ Hlth, Alma Ata, Kazakhstan..
    Dandona, Lalit
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Publ Hlth Fdn India, Gurugram, India.;Indian Council Med Res, New Delhi, India..
    Dandona, Rakhi
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA.;Publ Hlth Fdn India, Gurugram, India..
    Davitoiu, Dragos Virgil
    Carol Davila Univ Med & Pharm, Dept Gen Surg, Bucharest, Romania.;Clin Emergency Hosp Sf Pantelimon, Dept Surg, Bucharest, Romania..
    De Neve, Jan-Walter
    Heidelberg Univ, Heidelberg Inst Global Hlth, Heidelberg, Germany..
    de Sa-Junior, Antonio Reis
    Univ Fed Santa Catarina, Dept Clin Med, Florianopolis, SC, Brazil..
    Denova-Gutierrez, Edgar
    Natl Inst Publ Hlth, Ctr Nutr & Hlth Res, Cuernavaca, Morelos, Mexico..
    Dhamnetiya, Deepak
    Dharmaratne, Samath Dhamminda
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA.;Dr Baba Sahib Ambedkar Med Coll & Hosp, Dept Community Med, Delhi, India.;Univ Peradeniya, Dept Community Med, Peradeniya, Sri Lanka..
    Doshmangir, Leila
    Tabriz Univ Med Sci, Dept Hlth Policy & Management, Tabriz, Iran..
    Dube, John
    Univ Windsor, Off Inst Anal, Windsor, ON, Canada..
    Ehsani-Chimeh, Elham
    Univ Tehran Med Sci, Natl Inst Hlth Res, Tehran, Iran..
    Zaki, Maysaa El Sayed
    Cairo Univ, Reference Lab Egyptian, Minist Higher Educ & Sci Res, Cairo, Egypt..
    El Tantawi, Maha
    Alexandria Univ, Pediat Dent & Dent Publ Hlth Dept, Alexandria, Egypt..
    Eskandarieh, Sharareh
    Univ Tehran Med Sci, Multiple Sclerosis Res Ctr, Tehran, Iran..
    Farzadfar, Farshad
    Univ Tehran Med Sci, Noncommunicable Dis Res Ctr, Tehran, Iran..
    Ferede, Tomas Y.
    Hawassa Univ, Sch Nursing, Hawassa, Ethiopia..
    Fischer, Florian
    Ravensburg Weingarten Univ Appl Sci, Inst Gerontol Hlth Serv & Nursing Res, Weingarten, Germany..
    Foigt, Nataliya A.
    Natl Acad Med Sci Ukraine, Inst Gerontol, Kiev, Ukraine..
    Freitas, Alberto
    Univ Porto, Dept Community Med Informat & Hlth Decis Sci, Porto, Portugal.;Ctr Hlth Technol & Serv Res, Porto, Portugal..
    Friedman, Sara D.
    NYU, Sch Global Publ Hlth, New York, NY USA..
    Fukumoto, Takeshi
    Kobe Univ, Dept Dermatol, Kobe, Hyogo, Japan..
    Fullman, Nancy
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Gaal, Peter Andras
    Semmelweis Univ, Hlth Serv Management Training Ctr, Budapest, Hungary.;Sapientia Hungarian Univ Transylvania, Dept Appl Social Sci, Targu Mures, Romania..
    Gad, Mohamed M.
    Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USA.;Univ N Carolina, Gillings Sch Global Publ Hlth, Chapel Hill, NC 27515 USA..
    Garcia-Gordillo, M. A.
    Univ Autonoma Chile, Fac Business & Management, Talca, Chile..
    Garg, Tushar
    King Edward Mem Hosp, Dept Radiol, Mumbai, Maharashtra, India..
    Ghafourifard, Mansour
    Tabriz Univ Med Sci, Dept Med Surg Nursing, Tabriz, Iran..
    Ghashghaee, Ahmad
    Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, Iran.;Iran Univ Med Sci, Student Res Comm, Tehran, Iran..
    Gholamian, Asadollah
    Islamic Azad Univ, Young Researchers & Elite Club, Rasht, Iran.;Islamic Azad Univ, Dept Biol, Tehran, Iran..
    Gholamrezanezhad, Ali
    Univ Southern Calif, Radiol, Los Angeles, CA 90007 USA..
    Ghozali, Ghozali
    Univ Muhammadiyah Kalimantan Timur, Dept Publ Hlth, Samarinda, Indonesia..
    Gilani, Syed Amir
    Univ Lahore, Fac Allied Hlth Sci, Lahore, Pakistan.;Afro Asian Inst, Lahore, Pakistan..
    Glavan, Ionela-Roxana
    Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania..
    Glushkova, Ekaterina Vladimirovna
    IM Sechenov First Moscow State Med Univ, Dept Epidemiol & Evidence Based Med, Moscow, Russia..
    Goharinezhad, Salime
    Iran Univ Med Sci, Prevent Med & Publ Hlth Res Ctr, Tehran, Iran..
    Golechha, Mahaveer
    Indian Inst Publ Hlth, Hlth Syst & Policy Res, Gandhinagar, India..
    Goli, Srinivas
    Univ Western Australia, Australia India Inst New Generat Network, Perth, WA, Australia.;Univ Western Australia, UWA Publ Policy Inst, Perth, WA, Australia..
    Guha, Avirup
    Ohio State Univ, Div Cardiovasc Med, Columbus, OH USA.;Case Western Reserve Univ, Harrington Heart & Vasc Inst, Cleveland, OH 44106 USA..
    Gupta, Veer Bala
    Deakin Univ, Sch Med, Geelong, Vic, Australia..
    Gupta, Vivek Kumar
    Macquarie Univ, Dept Clin Med, Sydney, NSW, Australia..
    Haakenstad, Annie
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;TH Chan Sch Publ Hlth, Dept Global Hlth & Populat, Boston, MA USA..
    Haider, Mohammad Rifat
    Ohio Univ, Dept Social & Publ Hlth, Athens, OH 45701 USA..
    Hailu, Alemayehu
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
    Hamidi, Samer
    Hamdan Bin Mohammed Smart Univ, Sch Hlth & Environm Studies, Dubai, U Arab Emirates..
    Hanif, Asif
    Univ Lahore, Univ Inst Publ Hlth, Lahore, Pakistan..
    Harapan, Harapan
    Univ Syiah Kuala Syiah Kuala Univ, Med Res Unit, Banda Aceh, Indonesia..
    Hartono, Risky Kusuma
    Inst Publ Hlth Sci, Sekolah Tinggi Ilmu Kesehatan Indonesia Maju, Indonesian Adv Coll Hlth Sci, Jakarta, Indonesia..
    Hasaballah, Ahmed I.
    Al Azhar Univ, Dept Zool & Entomol, Cairo, Egypt..
    Hassan, Shoaib
    Univ Bergen, Ctr Int Hlth, Bergen, Norway.;Univ Bergen, Bergen Ctr Ethics & Prior Setting, Bergen, Norway..
    Hassanein, Mohamed H.
    Cleveland Clin, Dept Hypertens & Nephrol, Cleveland, OH 44106 USA..
    Hayat, Khezar
    Univ Vet & Anim Sci, Inst Pharmaceut Sci, Lahore, Pakistan.;Xi An Jiao Tong Univ, Dept Pharm Adm & Clin Pharm, Xian, Shaanxi, Peoples R China..
    Hegazy, Mohamed I.
    Cairo Univ, Dept Neurol, Cairo, Egypt..
    Heidari, Golnaz
    Hendrie, Delia
    Curtin Univ, Sch Publ Hlth, Perth, WA, Australia..
    Heredia-Pi, Ileana
    Natl Inst Publ Hlth, Ctr Hlth Syst Res, Cuernavaca, Morelos, Mexico..
    Herteliu, Claudiu
    Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania.;London South Bank Univ, Sch Business, London, England..
    Hezam, Kamal
    Taiz Univ, Dept Appl Microbiol, Taizi, Yemen.;Nankai Univ, Dept Microbiol, Tianjin, Peoples R China..
    Holla, Ramesh
    Kasturba Med Coll & Hosp, Mangalore, India..
    Hossain, Sheikh Jamal
    Int Ctr Diarrhoeal Dis Res, Maternal & Child Hlth Div, Dhaka, Bangladesh..
    Hosseinzadeh, Mehdi
    Iran Univ Med Sci, Hlth Management & Econ Res Ctr, Tehran, Iran..
    Hostiuc, Sorin
    Carol Davila Univ Med & Pharm, Dept Legal Med & Bioeth, Bucharest, Romania.;Natl Inst Legal Med Mina Minovici, Clin Legal Med Dept, Bucharest, Romania..
    Huda, Tanvir M.
    Int Ctr Diarrhoeal Dis Res, Maternal & Child Hlth Div, Dhaka, Bangladesh.;Univ Sydney, Sch Publ Hlth, Sydney, NSW, Australia..
    Hwang, Bing-Fang
    China Med Univ, Dept Occupat Safety & Hlth, Taichung, Taiwan..
    Iavicoli, Ivo
    Univ Naples Federico II, Dept Publ Hlth, Naples, Italy..
    Idrisov, Bulat
    Bashkir State Med Univ, Dept Infect Dis, Ufa, Russia.;Moscow Inst Phys & Technol, Lab Publ Hlth Indicators Anal & Hlth Digitalizat, Moscow, Russia..
    Ilesanmi, Olayinka Stephen
    Univ Ibadan, Dept Community Med, Ibadan, Nigeria.;Univ Coll Hosp, Dept Community Med, Ibadan, Nigeria..
    Irvani, Seyed Sina Naghibi
    Islam, Sheikh Mohammed Shariful
    Univ Sydney, Sydney Med Sch, Sydney, NSW, Australia.;Deakin Univ, Inst Phys Activ & Nutr, Burwood, Vic, Australia..
    Ismail, Nahlah Elkudssiah
    MAHSA Univ, Dept Clin Pharm, Bandar Saujana Putra, Malaysia..
    Isola, Gaetano
    Univ Catania, Dept Gen Surg & Surg Med Specialties, Catania, Italy..
    Jahani, Mohammad Ali
    Babol Univ Med Sci, Social Determinants Hlth Res Ctr, Babol, Iran..
    Jahanmehr, Nader
    Shahid Beheshti Univ Med Sci, Virtual Sch Med Educ & Management, Tehran, Iran.;Shahid Beheshti Univ Med Sci, Prevent Cardiovasc Dis Res Ctr, Tehran, Iran..
    Jakovljevic, Mihajlo
    Hosei Univ, Inst Comparat Econ Studies, Tokyo, Japan.;Univ Kragujevac, Dept Global Hlth Econ & Policy, Kragujevac, Serbia..
    Janodia, Manthan Dilipkumar
    Manipal Coll Pharmaceut Sci, Manipal, India..
    Javaheri, Tahereh
    Boston Univ, Hlth Informat Lab, Boston, MA 02215 USA..
    Jayapal, Sathish Kumar
    Minist Hlth, Ctr Studies & Res, Muscat, Oman..
    Jayawardena, Ranil
    Univ Colombo, Dept Physiol, Colombo, Sri Lanka.;Queensland Univ Technol, Sch Exercise & Nutr Sci, Brisbane, Qld, Australia..
    Jazayeri, Seyed Behzad
    Univ Florida, Dept Urol, Jacksonville, FL USA..
    Jha, Ravi Prakash
    Dr Baba Saheb Ambedkar Med Coll & Hosp, Dept Community Med, Delhi, India.;Banaras Hindu Univ, Dept Community Med, Varanasi, Uttar Pradesh, India..
    Jonas, Jost B.
    Heidelberg Univ, Dept Ophthalmol, Heidelberg, Germany.;Beijing Tongren Hosp, Beijing Inst Ophthalmol, Beijing, Peoples R China..
    Joo, Tamas
    Semmelweis Univ, Hlth Serv Management Training Ctr, Budapest, Hungary..
    Joukar, Farahnaz
    Guilan Univ Med Sci, Gastrointestinal & Liver Dis Res Ctr, Rasht, Iran.;Guilan Univ Med Sci, Caspian Digest Dis Res Ctr, Rasht, Iran..
    Jurisson, Mikk
    Univ Tartu, Inst Family Med & Publ Hlth, Tartu, Estonia..
    Kaambwa, Billingsley
    Flinders Univ S Australia, Hlth Econ Unit, Adelaide, SA, Australia.;Flinders Univ S Australia, Coll Med & Publ Hlth, Adelaide, SA, Australia..
    Kalhor, Rohollah
    Qazvin Univ Med Sci, Inst Prevent Noncommunicable Dis, Qazvin, Iran.;Qazvin Univ Med Sci, Hlth Serv Management Dept, Qazvin, Iran..
    Kanchan, Tanuj
    All India Inst Med Sci, Dept Forens Med & Toxicol, Jodhpur, Rajasthan, India..
    Kandel, Himal
    Univ Sydney, Save Sight Inst, Sydney, NSW, Australia.;South Eastern Sydney Local Hlth Dist, Sydney Eye Hosp, Sydney, NSW, Australia..
    Matin, Behzad Karami
    Kermanshah Univ Med Sci, Res Ctr Environm Determinants Hlth, Kermanshah, Iran..
    Karimi, Salah Eddin
    Tabriz Univ Med Sci, Social Determinants Hlth Res Ctr, Tabriz, Iran..
    Kassahun, Getinet
    Hawassa Univ, Sch Midwifery, Hawassa, Ethiopia..
    Kayode, Gbenga A.
    Inst Human Virol Nigeria, Int Res Ctr Excellence, Abuja, Nigeria.;Univ Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands..
    Karyani, Ali Kazemi
    Kermanshah Univ Med Sci, Res Ctr Environm Determinants Hlth, Kermanshah, Iran..
    Keikavoosi-Arani, Leila
    Alborz Univ Med Sci, Sch Hlth, Karaj, Iran..
    Khader, Yousef Saleh
    Jordan Univ Sci & Technol, Dept Publ Hlth, Irbid, Jordan..
    Khajuria, Himanshu
    Amity Univ, Amity Inst Forens Sci, Noida, India..
    Khalilov, Rovshan
    Baku State Univ, Dept Biophys & Biochem, Baku, Azerbaijan.;Moscow State Pedag Univ, Russian Inst Adv Study, Moscow, Russia..
    Khammarnia, Mohammad
    Zahedan Univ Med Sci, Hlth Promot Res Ctr, Zahedan, Iran..
    Khan, Junaid
    Int Inst Populat Sci, Dept Populat Studies, Mumbai, Maharashtra, India..
    Khubchandani, Jagdish
    New Mexico State Univ, Dept Publ Hlth, Las Cruces, NM 88003 USA..
    Kianipour, Neda
    Kermanshah Univ Med Sci, Dept Publ Hlth, Kermanshah, Iran..
    Kim, Gyu Ri
    Yonsei Univ, Dept Prevent Med, Seoul, South Korea..
    Kim, Yun Jin
    Xiamen Univ Malaysia, Sch Tradit Chinese Med, Sepang, Malaysia..
    Kisa, Adnan
    Kristiania Univ Coll, Sch Hlth Sci, Oslo, Norway.;Tulane Univ, Dept Global Community Hlth & Behav Sci, New Orleans, LA 70118 USA..
    Kisa, Sezer
    Oslo Metropolitan Univ, Dept Nursing & Hlth Promot, Oslo, Norway..
    Kohler, Stefan
    Heidelberg Univ, Heidelberg Inst Global Hlth, Heidelberg, Germany..
    Kosen, Soewarta
    Koteeswaran, Rajasekaran
    Eastern Virginia Med Sch, Microbiol & Mol Cell Biol Dept, Norfolk, VA 23501 USA..
    Laxminarayana, Sindhura Lakshmi Koulmane
    Kasturba Med Coll & Hosp, Udupi, India..
    Koyanagi, Ai
    CIBERSAM, San Juan de Dios Sanit Pk, Sant Boi De Llobregat, Spain.;Catalan Inst Res & Adv Studies, Barcelona, Spain..
    Krishan, Kewal
    Panjab Univ, Dept Anthropol, Chandigarh, India..
    Kumar, G. Anil
    Publ Hlth Fdn India, Gurugram, India..
    Kusuma, Dian
    Imperial Coll London, Imperial Coll Business Sch, London, England.;Univ Indonesia, Fac Publ Hlth, Depok, Indonesia..
    Lamnisos, Demetris
    European Univ Cyprus, Dept Hlth Sci, Nicosia, Cyprus..
    Lansingh, Van Charles
    HelpMeSee, New York, NY USA.;Mexican Inst Ophthalmol, Queretaro, Mexico..
    Larsson, Anders O.
    Uppsala Univ, Dept Med Sci, Uppsala, Sweden.;Uppsala Univ Hosp, Dept Clin Chem & Pharmacol, Uppsala, Sweden..
    Lasrado, Savita
    Father Muller Med Coll, Dept Otorhinolaryngol, Mangalore, India..
    Le, Long Khanh Dao
    Deakin Univ, Dept Econ, Burwood, Vic, Australia..
    Lee, Shaun Wen Huey
    Monash Univ, Sch Pharm, Bandar Sunway, Malaysia.;Taylors Univ Lakeside Campus, Sch Pharm, Subang Jaya, Malaysia..
    Lee, Yeong Yeh
    Univ Sci Malaysia, Dept Med, Kota Baharu, Kelantan, Malaysia.;Univ Sci Malaysia, Sch Med Sci, Kota Baharu, Kelantan, Malaysia.;Univ Sci Malaysia, Sch Med Sci, Kota Baharu, Kelantan, Malaysia..
    Lim, Stephen S.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA..
    Lobo, Stany W.
    Meharry Med Coll, Dept Profess & Med Educ, Nashville, TN 37208 USA.;Mercer Univ, Dept Biomed Sci, Macon, GA 31207 USA..
    Lozano, Rafael
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA..
    Abd El Razek, Hassan Magdy
    Egypt Minist Hlth & Populat, Dept Radiol, Mansoura, Egypt..
    Abd El Razek, Muhammed Magdy
    Minist Hlth & Populat, Dept Ophthalmol, Aswan, Egypt..
    Mahdavi, Mokhtar Mahdavi
    Saveh Univ Med Sci, Social Determinants Hlth Res Ctr, Saveh, Iran..
    Majeed, Azeem
    Imperial Coll London, Dept Primary Care & Publ Hlth, London, England..
    Makki, Alaa
    Univ Sharjah, Mass Commun Dept, Sharjah, U Arab Emirates..
    Maleki, Afshin
    Univ Tehran Med Sci, Dept Environm Hlth Engn, Tehran, Iran.;Kurdistan Univ Med Sci, Environm Hlth Res Ctr, Sanandaj, Iran..
    Malekzadeh, Reza
    Univ Tehran Med Sci, Digest Dis Res Inst, Tehran, Iran.;Shiraz Univ Med Sci, Noncommunicable Dis Res Ctr, Shiraz, Iran..
    Manda, Ana Laura
    Carol Davila Univ Med & Pharm, Dept Gen Surg, Bucharest, Romania.;Emergency Univ Hosp Bucharest, Gen Surg Dept 1, Bucharest, Romania..
    Mansour-Ghanaei, Fariborz
    Guilan Univ Med Sci, Gastrointestinal & Liver Dis Res Ctr, Rasht, Iran.;Guilan Univ Med Sci, Caspian Digest Dis Res Ctr, Rasht, Iran..
    Mansournia, Mohammad Ali
    Univ Tehran Med Sci, Dept Epidemiol & Biostat, Tehran, Iran..
    Arnedo, Carlos Alberto Marrugo
    Univ Cartagena, Hlth Econ Res Grp, Cartagena, Colombia.;Technol Inst Coll Bolivar, Inst Tecnol Colegio Mayor de Bolivar, Cartagena, Colombia..
    Martinez-Valle, Adolfo
    Univ Nacl Autonoma Mexico, Hlth Policy & Populat Res Ctr, Mexico City, DF, Mexico.;Univ Coverage, Joint Learning Network, Arlington, VA USA..
    Masoumi, Seyedeh Zahra
    Hamadan Univ Med Sci, Dept Midwifery, Hamadan, Hamadan, Iran..
    Maude, Richard James
    Univ Oxford, Ctr Trop Med & Global Hlth, Oxford, England.;Mahidol Univ, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand..
    Mckee, Martin
    London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London, England..
    Medina-Solis, Carlo Eduardo
    Autonomous Univ Hidalgo State, Dept Dent, Pachuca, Hidalgo, Mexico..
    Menezes, Ritesh G.
    Imam Abdulrahman Bin Faisal Univ, Forens Med Div, Dammam, Saudi Arabia..
    Meretoja, Atte
    Helsinki Univ Hosp, Neurol Unit, Helsinki, Finland.;Univ Melbourne, Sch Hlth Sci, Melbourne, Vic, Australia..
    Meretoja, Tuomo J.
    Helsinki Univ Hosp, Breast Surg Unit, Helsinki, Finland.;Univ Helsinki, Helsinki, Finland..
    Mesregah, Mohamed Kamal
    Univ Southern Calif, Dept Orthopaed Surg, Los Angeles, CA 90007 USA.;Menoufia Univ, Dept Orthopaed Surg, Shibin Al Kawm, Egypt..
    Mestrovic, Tomislav
    Dr Zora Profoz Polyclin, Clin Microbiol & Parasitol Unit, Zagreb, Croatia.;Univ North, Univ Ctr Varazdin, Varazhdin, Croatia..
    Kostova, Neda Milevska
    Inst Social Innovat, Skopje, North Macedonia.;Ctr Reg Policy Res & Cooperat Studiorum, Hlth Policy & Management, Calverton, MD USA..
    Miller, Ted R.
    Curtin Univ, Sch Publ Hlth, Perth, WA, Australia.;Pacific Inst Res & Evaluat, Calverton, MD USA..
    Mini, G. K.
    Ananthapuri Hosp & Res Inst, Global Inst Publ Hlth, Trivandrum, Kerala, India.;Womens Social & Hlth Studies Fdn, Trivandrum, Kerala, India..
    Mirica, Andreea
    Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania..
    Mirrakhimov, Erkin M.
    Kyrgyz State Med Acad, Internal Med Programme, Bishkek, Kyrgyzstan.;Natl Ctr Cardiol & Internal Dis, Dept Atherosclerosis & Coronary Heart Dis, Bishkek, Kyrgyzstan..
    Mohajer, Bahram
    Univ Tehran Med Sci, Noncommunicable Dis Res Ctr, Tehran, Iran..
    Mohamed, Teroj Abdulrahman
    Univ Duhok, Coll Dent, Duhok, Iraq..
    Mohammadi, Mokhtar
    Lebanese French Univ, Dept Informat Technol, Erbil, Iraq..
    Mohammadian-Hafshejani, Abdollah
    Shahrekord Univ Med Sci, Dept Epidemiol & Biostat, Shahrekord, Iran..
    Mohammed, Shafiu
    Heidelberg Univ, Heidelberg Inst Global Hlth, Heidelberg, Germany.;Ahmadu Bello Univ, Hlth Syst & Policy Res Unit, Zaria, Nigeria..
    Moitra, Modhurima
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Mokdad, Ali H.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA..
    Molokhia, Mariam
    Kings Coll London, Fac Life Sci & Med, London, England..
    Moni, Mohammad Ali
    Pabna Univ Sci & Technol, Dept Comp Sci & Engn, Pabna, Bangladesh..
    Moradi, Yousef
    Kurdistan Univ Med Sci, Social Determinants Hlth Res Ctr, Sanandaj, Iran..
    Morze, Jakub
    Univ Warmia & Mazury, Dept Cardiol & Cardiac Surg, Olsztyn, Poland..
    Mousavi, Seyyed Meysam
    Kerman Univ Med Sci, Management & Leadership Med Educ Res Ctr, Kerman, Iran..
    Mpundu-Kaambwa, Christine
    Flinders Univ S Australia, Hlth & Social Care Econ Grp, Adelaide, SA, Australia..
    Muriithi, Moses K.
    Univ Nairobi, Sch Econ, Nairobi, Kenya..
    Muthupandian, Saravanan
    Mekelle Univ, Dept Med Microbiol & Immunol, Mekelle, Ethiopia.;Saveetha Inst Med & Tech Sci, Saveetha Dent Coll, Chennai, Tamil Nadu, India..
    Nagarajan, Ahamarshan Jayaraman
    Initiat Financing Hlth & Human Dev, Res & Analyt Dept, Chennai, Tamil Nadu, India.;Bioinsilico Technol, Dept Res & Analyt, Chennai, Tamil Nadu, India..
    Naimzada, Mukhammad David
    Natl Res Univ Higher Sch Econ, Grad Sch Business, Moscow, Russia..
    Nangia, Vinay
    Suraj Eye Inst, Nagpur, Maharashtra, India..
    Naqvi, Atta Abbas
    Imam Abdulrahman Bin Faisal Univ, Dept Pharm Practice, Dammam, Saudi Arabia.;Univ Sci Malaysia, Discipline Social & Adm, Petaling Jaya, Penang, Malaysia..
    Narayana, Aparna Ichalangod
    Manipal Coll Dent Sci, Manipal, India..
    Nascimento, Bruno Ramos
    Univ Fed Minas Gerais, Dept Clin Med, Belo Horizonte, MG, Brazil.;Univ Fed Minas Gerais, Clin Hosp, Belo Horizonte, MG, Brazil..
    Naveed, Muhammad
    Univ Cent Punjab, Dept Biotechnol, Lahore, Pakistan..
    Nayak, Biswa Prakash
    Amity Univ, Amity Inst Forens Sci, Noida, India..
    Nazari, Javad
    Arak Univ Med Sci, Dept Pediat, Arak, Iran..
    Ndejjo, Rawlance
    Makerere Univ, Dept Dis Control & Environm Hlth, Kampala, Uganda..
    Negoi, Ionut
    Carol Davila Univ Med & Pharm, Dept Gen Surg, Bucharest, Romania.;Emergency Hosp Bucharest, Dept Gen Surg, Bucharest, Romania..
    Kandel, Sandhya Neupane
    Bupa, Bupa Clemton Pk, Sydney, NSW, Australia..
    Nguyen, Trang Huyen
    Nonvignon, Justice
    Univ Ghana, Sch Publ Hlth, Accra, Ghana..
    Noubiap, Jean Jacques
    Univ Adelaide, Ctr Heart Rhythm Disorders, Adelaide, SA, Australia..
    Nwatah, Vincent Ebuka
    Natl Hosp, Dept Pediat, Abuja, Nigeria.;Univ Liverpool, Dept Int Publ Hlth, Liverpool, Merseyside, England..
    Oancea, Bogdan
    Univ Bucharest, Adm & Econ Sci Dept, Bucharest, Romania..
    Ojelabi, Foluke Adetola Ogunyemi
    United Nations Childrens Fund, Social Policy Program, Abuja, Nigeria..
    Olagunju, Andrew T.
    Univ Lagos, Dept Psychiat, Lagos, Nigeria.;McMaster Univ, Dept Psychiat & Behav Neurosci, Hamilton, ON, Canada..
    Olakunde, Babayemi Oluwaseun
    Natl AIDS Control Comm, Community Prevent & Care Serv, Abuja, Nigeria..
    Olgiati, Stefano
    Univ Bergamo, Dept Management Econ & Quantitat Methods, Bergame, Italy..
    Olusanya, Jacob Olusegun
    Ctr Healthy Start Initiat, Lagos, Nigeria..
    Onwujekwe, Obinna E.
    Univ Nigeria Nsukka, Dept Pharmacol & Therapeut, Enugu, Nigeria..
    Otoiu, Adrian
    Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania..
    Otstavnov, Nikita
    Natl Res Univ Higher Sch Econ, Grad Sch Business, Moscow, Russia..
    Otstavnov, Stanislav S.
    Natl Res Univ Higher Sch Econ, Grad Sch Business, Moscow, Russia..
    Owolabi, Mayowa O.
    Univ Ibadan, Dept Med, Ibadan, Nigeria.;Univ Coll Hosp, Dept Med, Ibadan, Nigeria..
    Padubidri, Jagadish Rao
    Kasturba Med Coll & Hosp, Mangalore, India..
    Palladino, Raffaele
    Imperial Coll London, Dept Primary Care & Publ Hlth, London, England.;Univ Naples Federico II, Dept Publ Hlth, Naples, Italy..
    Panda-Jonas, Songhomitra
    Heidelberg Univ, Dept Ophthalmol, Heidelberg, Germany..
    Park, Eun-Cheol
    Yonsei Univ, Dept Prevent Med, Seoul, South Korea.;Yonsei Univ, Inst Hlth Serv Res, Seoul, South Korea..
    Kan, Fatemeh Pashazadeh
    Iran Univ Med Sci, Tehran, Iran..
    Pawar, Shrikant
    Yale Univ, Dept Genet, New Haven, CT USA..
    Toroudi, Hamidreza Pazoki
    Iran Univ Med Sci, Dept Physiol, Tehran, Iran.;Iran Univ Med Sci, Physiol Res Ctr, Tehran, Iran..
    Pereira, David M.
    Univ Porto, Associated Lab Green Chem, Porto, Portugal..
    Perianayagam, Arokiasamy
    Int Inst Populat Sci, Dept Dev Studies, Mumbai, Maharashtra, India..
    Pesudovs, Konrad
    Univ New South Wales, Sch Optometry & Vis Sci, Sydney, NSW, Australia..
    Piccinelli, Cristiano
    City Hlth & Sci Univ Hosp Turin, SSD Epidemiol Screening, Turin, Italy..
    Postma, Maarten J.
    Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands.;Univ Groningen, Sch Business & Econ, Groningen, Netherlands..
    Prada, Sergio I.
    Fdn Valle del Lili, Clin Res Ctr, Cali, Colombia.;Univ ICESI, Ctr PROESA, Cali, Colombia..
    Rabiee, Mohammad
    Amirkabir Univ Technol, Dept Biomed Engn, Tehran, Iran..
    Rabiee, Navid
    Sharif Univ Technol, Dept Chem, Tehran, Iran..
    Rahim, Fakher
    Univ Tehran Med Sci, Metabol & Genom Res Ctr, Tehran, Iran.;Ahvaz Jundishapur Univ Med Sci, Thalassemia & Hemoglobinopathy Res Ctr, Ahvaz, Iran..
    Rahimi-Movaghar, Vafa
    Univ Tehran Med Sci, Sina Trauma & Surg Res Ctr, Tehran, Iran..
    Rahman, Mohammad Hifz Ur
    Maharishi Markandeshwar Med Coll & Hosp, Dept Community Med, Solan, India..
    Rahman, Mosiur
    Rajshahi Univ, Dept Populat Sci & Human Resource Dev, Rajshahi, Bangladesh..
    Rahmani, Amir Masoud
    Duy Tan Univ, Inst Res & Dev, Da Nang, Vietnam.;Natl Yunlin Univ Sci & Technol, Future Technol Res Ctr, Touliu, Yunlin, Taiwan..
    Ram, Usha
    Int Inst Populat Sci, Dept Publ Hlth & Mortal Studies, Mumbai, Maharashtra, India..
    Ranabhat, Chhabi Lal
    Policy Res Inst, Res Dept, Kathmandu, Nepal.;Global Ctr Res & Dev, Hlth & Publ Policy Dept, Kathmandu, Nepal..
    Ranasinghe, Priyanga
    Univ Colombo, Dept Pharmacol, Colombo, Sri Lanka..
    Rao, Chythra R.
    Manipal Acad Higher Educ, Dept Community Med, Manipal, India..
    Rathi, Priya
    Kasturba Med Coll & Hosp, Mangalore, India..
    Rawaf, David Laith
    Imperial Coll London, WHO Collaborating Ctr Publ Hlth Educ & Training, London, England.;Univ Coll London Hosp, London, England..
    Rawaf, Salman
    Imperial Coll London, Dept Primary Care & Publ Hlth, London, England.;Publ Hlth England, Acad Publ Hlth England, London, England..
    Rawal, Lal
    CQ Univ, Sch Hlth Med & Appl Sci, Sydney, NSW, Australia..
    Rawassizadeh, Reza
    Boston Univ, Dept Comp Sci, Boston, MA 02215 USA..
    Reiner, Robert C., Jr.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA..
    Renzaho, Andre M. N.
    Western Sydney Univ, Sch Med, Campbelltown, NSW, Australia.;Western Sydney Univ, Translat Hlth Res Inst, Campbelltown, NSW, Australia..
    Reshmi, Bhageerathy
    Manipal Acad Higher Educ, Dept Hlth Informat Management, Manipal, India..
    Riaz, Mavra A.
    Univ Sultan Zainal Abidin Sultan Zainal Abidin Un, Fac Business & Management, Kuala Terengganu, Malaysia..
    Ripon, Rezaul Karim
    Jahangirnagar Univ, Dept Publ Hlth & Informat, Dhaka, Bangladesh..
    Saad, Anas M.
    Cleveland Clin, Inst Heart & Vasc, Cleveland, OH 44106 USA..
    Sahraian, Mohammad Ali
    Univ Tehran Med Sci, Multiple Sclerosis Res Ctr, Tehran, Iran..
    Sahu, Maitreyi
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Salama, Joseph S.
    Univ Calif San Francisco, Hlth Hub, San Francisco, CA 94143 USA..
    Salehi, Sana
    Univ Southern Calif, Dept Radiol, Los Angeles, CA 90007 USA..
    Samy, Abdallah M.
    Ain Shams Univ, Dept Entomol, Cairo, Egypt..
    Sanabria, Juan
    Marshall Univ, Dept Surg, Huntington, WV USA.;Case Western Reserve Univ, Dept Nutr & Prevent Med, Cleveland, OH 44106 USA..
    Sanmarchi, Francesco
    Univ Bologna, Dept Biomed & Neuromotor Sci, Bologna, Italy..
    Santos, Joao Vasco
    Univ Porto, Ctr Hlth Technol & Serv Res, Porto, Portugal.;Northern Reg Hlth Adm, Publ Hlth Unit, Vila Nova De Gaia, Portugal..
    Santric-Milicevic, Milena M.
    Univ Belgrade, Fac Med, Belgrade, Serbia.;Univ Belgrade, Sch Publ Hlth & Hlth Management, Belgrade, Serbia..
    Sathian, Brijesh
    Hamad Med Corp, Geriatr & Long Term Care Dept, Doha, Qatar.;Bournemouth Univ, Fac Hlth & Social Sci, Bournemouth, Dorset, England..
    Savic, Miloje
    GlaxoSmithKline Biol, Wavre, Belgium..
    Saxena, Deepak
    Indian Inst Publ Hlth, Dept Epidemiol, Gandhinagar, India.;Datta Meghe Inst Med Sci, Dept Community Med, Wardha, India..
    Sayyah, Mehdi
    Ahvaz Jundishapur Univ Med Sci, Educ Dev Ctr, Ahvaz, Iran..
    Schwendicke, Falk
    Charite Univ Med Ctr Berlin, Oral Diag Digital Hlth & Hlth Serv Res, Berlin, Germany..
    Senthilkumaran, Subramanian
    Manian Med Ctr, Emergency Dept, Erode, India..
    Sepanlou, Sadaf G.
    Univ Tehran Med Sci, Digest Dis Res Inst, Tehran, Iran.;Shiraz Univ Med Sci, Noncommunicable Dis Res Ctr, Shiraz, Iran..
    Seylani, Allen
    NHLBI, NIH, Rockville, MD USA..
    Shahabi, Saeed
    Shiraz Univ Med Sci, Ctr Hlth Policy Res, Shiraz, Iran..
    Shaikh, Masood Ali
    Sheikh, Aziz
    Harvard Univ, Div Gen Internal Med, Boston, MA 02115 USA.;Univ Edinburgh, Med Informat Ctr, Edinburgh, Midlothian, Scotland..
    Shetty, Adithi
    Manipal Acad Higher Educ, Dept Obstet & Gynaecol, Mangalore, India..
    Shetty, Pavanchand H.
    Manipal Acad Higher Educ, Dept Forens Med, Mangalore, India..
    Shibuya, Kenji
    Univ Tokyo, Tokyo, Japan..
    Shrime, Mark G.
    Royal Coll Surgeons Ireland, Inst Global Surg, Dublin, Ireland..
    Shuja, Kanwar Hamza
    Quaid I Azam Univ, Natl Inst Psychol, Islamabad, Pakistan..
    Singh, Jasvinder A.
    Univ Alabama Birmingham, Sch Med, Birmingham, AL USA.;US Dept Vet Affairs VA, Med Serv, Birmingham, AL USA..
    Skryabin, Valentin Yurievich
    Moscow Res & Pract Ctr Addict, Dept 16, Moscow, Russia..
    Skryabina, Anna Aleksandrovna
    Balashiha Cent Hosp, Dept Therapeut, Balashikha, Russia..
    Soltani, Shahin
    Kermanshah Univ Med Sci, Res Ctr Environm Determinants Hlth, Kermanshah, Iran..
    Soofi, Moslem
    Kermanshah Univ Med Sci, Social Dev & Hlth Promot Res Ctr, Kermanshah, Iran..
    Spurlock, Emma Elizabeth
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA..
    Stefan, Simona Catalina
    Bucharest Univ Econ Studies, Dept Management, Bucharest, Romania..
    Szerencses, Viktoria
    Semmelweis Univ, Hlth Serv Management Training Ctr, Budapest, Hungary..
    Szocska, Miklos
    Semmelweis Univ, Fac Hlth & Publ Adm, Budapest, Hungary..
    Tabares-Seisdedos, Rafael
    Univ Valencia, Dept Med, Valencia, Spain.;Carlos III Hlth Inst, Biomed Res Networking Ctr Mental Hlth Network CIB, Madrid, Spain..
    Taddele, Biruk Wogayehu
    Arbaminch Coll Hlth Sci, Dept Pharm, Arba Minch, Ethiopia..
    Tefera, Yonas Getaye
    Univ Gondar, Dept Clin Pharm, Gondar, Ethiopia..
    Thavamani, Aravind
    Case Western Reserve Univ, Div Pediat Gastroenterol, Cleveland, OH 44106 USA.;Univ Hosp Rainbow Babies, Dept Pediat, Cleveland, OH USA. Childrens Hosp, Cleveland, OH USA..
    Tobe-Gai, Ruoyan
    Natl Inst Populat & Social Secur Res, Dept Social Secur Empir Res, Tokyo, Japan..
    Topor-Madry, Roman
    Jagiellonian Univ Med Coll, Inst Publ Hlth, Krakow, Poland.;Agcy Hlth Technol Assessment & Tariff Syst, Warsaw, Poland..
    Tovani-Palone, Marcos Roberto
    Univ Sao Paulo, Dept Pathol & Legal Med, Ribeirao Preto, Brazil.;Modestum, London, England..
    Tran, Bach Xuan
    Car, Lorainne Tudor
    Nanyang Technol Univ, Lee Kong Chian Sch Med, Singapore, Singapore..
    Ullah, Anayat
    Natl Univ Med Sci, Multidisciplinary Dept, Rawalpindi, Pakistan..
    Ullah, Saif
    Univ Agr Faisalabad, Inst Soil & Environm Sci, Faisalabad, Pakistan..
    Umar, Nasir
    London Sch Hyg Trop Med, Dept Dis Control, London, England..
    Undurraga, Eduardo A.
    Pontificia Univ Catolica Chile, Sch Govt, Santiago, Chile..
    Valdez, Pascual R.
    Argentine Soc Med, Buenos Aires, DF, Argentina.;Velez Sarsfield Hosp, Buenos Aires, DF, Argentina..
    Vasankari, Tommi Juhani
    UKK Inst, Tampere, Finland..
    Villafane, Jorge Hugo
    IRCCS Fdn Don Carlo Gnocchi, Don Carlo Gnocchi Fdn, Dept Clin Res, Milan, Italy..
    Violante, Francesco S.
    St Orsola Malpighi Hosp, Occupat Hlth Unit, Bologna, Italy..
    Vlassov, Vasily
    Natl Res Univ Higher Sch Econ, Dept Hlth Care Adm & Econ, Moscow, Russia..
    Vo, Bay
    Vollmer, Sebastian
    Univ Gottingen, Dept Econ, Gottingen, Germany..
    Vos, Theo
    Vu, Giang Thu
    Vu, Linh Gia
    Wamai, Richard G.
    Univ Nairobi, Sch Publ Hlth, Nairobi, Kenya.;Northeastern Univ, Cultures Societies & Global Studies & Integrated, Boston, MA 02115 USA..
    Werdecker, Andrea
    Fed Inst Populat Res, Demog Change & Aging Res Area, Wiesbaden, Germany..
    Woldekidan, Mesfin Agachew
    Ethiopian Publ Hlth Inst, Natl Data Management Ctr Hlth, Addis Ababa, Ethiopia..
    Wubishet, Befikadu Legesse
    Mekelle Univ, Sch Pharm, Mekelle, Ethiopia.;Univ Newcastle, Res Ctr Generat Hlth & Ageing, Newcastle, NSW, Australia..
    Xu, Gelin
    Nanjing Univ, Sch Med, Nanjing, Jiangsu, Peoples R China..
    Yaya, Sanni
    Univ Oxford, George Inst Global Hlth, Oxford, England.;Univ Ottawa, Sch Int Dev & Global Studies, Ottawa, ON, Canada..
    Yazdi-Feyzabadi, Vahid
    Kerman Univ Med Sci, Hlth Serv Management Res Ctr, Kerman, Iran.;Kerman Univ Med Sci, Dept Hlth Management Policy & Econ, Kerman, Iran..
    Yigit, Vahit
    Suleyman Demirel Univ, Dept Hlth Management, Isparta, Turkey..
    Yip, Paul
    Univ Hong Kong, Ctr Suicide Res & Prevent, Hong Kong, Peoples R China.;Univ Hong Kong, Dept Social Work & Social Adm, Hong Kong, Peoples R China..
    Yirdaw, Birhanu Wubale
    Univ Gondar, Dept Midwifery, Gondar, Ethiopia..
    Yonemoto, Naohiro
    Natl Ctr Neurol & Psychiat, Dept Neuropsychopharmacol, Kodaira, Tokyo, Japan.;Juntendo Univ, Dept Publ Hlth, Tokyo, Japan..
    Younis, Mustafa Z.
    Jackson State Univ, Dept Hlth Policy & Management, Jackson, MS USA.;Tsinghua Univ, Sch Med, Beijing, Peoples R China..
    Yu, Chuanhua
    Wuhan Univ, Dept Epidemiol & Biostat, Wuhan, Hubei, Peoples R China..
    Yunusa, Ismaeel
    Harvard Univ, TH Chan Sch Publ Hlth, Boston, MA 02115 USA.;Univ South Carolina, Dept Clin Pharm & Outcomes Sci, Columbia, SC 29208 USA..
    Moghadam, Telma Zahirian
    Ardabil Univ Med Sci, Social Determinants Hlth Res Ctr, Ardebil, Iran..
    Zandian, Hamed
    Ardabil Univ Med Sci, Social Determinants Hlth Res Ctr, Ardebil, Iran.;Ardabil Univ Med Sci, Dept Community Med, Ardebil, Iran..
    Zastrozhin, Mikhail Sergeevich
    Moscow Res & Pract Ctr Addict, Lab Genet & Genom, Moscow, Russia.;Russian Med Acad Continuous Profess Educ, Addictol Dept, Moscow, Russia..
    Zastrozhina, Anasthasia
    Russian Med Acad Continuous Profess Educ, Dept Pediat, Moscow, Russia..
    Zhang, Zhi-Jiang
    Wuhan Univ, Sch Med, Wuhan, Hubei, Peoples R China..
    Ziapour, Arash
    Kermanshah Univ Med Sci, Dept Hlth Educ & Hlth Promot, Kermanshah, Iran..
    Zuniga, Yves Miel H.
    Dept Hlth Philippines, Hlth Technol Assessment Unit, Manila, Philippines.;MentalHealthPH, Quezon City, Philippines..
    Hay, Simon I.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA..
    Murray, Christopher J. L.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA..
    Dieleman, Joseph L.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA..
    Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-20502021In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 398, no 10308, p. 1317-1343Article, review/survey (Refereed)
    Abstract [en]

    Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

  • 11.
    Mosleh, Marwan
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Al Jeesh, Yousef
    Dalal, Koustuv
    University of Skövde.
    Carlerby, Heidi
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Perceptions of health-care professionals about quality of care and barriers to management of war injuries in Gaza Strip: a qualitative analysis2021In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 398Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: War-related injury is a growing clinical and public health concern in occupied Palestinian territory, especially in the Gaza Strip. However, little research has been done into the quality of care and management of war injuries in public hospitals. We explored the perceptions of health-care workers about these factors in Palestinian health-care facilities in Gaza. METHODS: This was a qualitative descriptive study. Data were obtained in four focus group discussions attended at public health facilities by 30 purposively selected health-care providers, comprising 14 head surgeons, and 16 head nurses, aged 38-55 years. A semi-structured topic guide was developed by the authors for the study based on earliest literature, and was critically reviewed by a panel of experts to ensure the trustworthiness of the qualitative guide and to minimise complexity and enhance clarity of the questions for participants. Audio recordings of discussions were transcribed verbatim, translated, and analysed with a thematic analysis approach. The study was approved by the Palestinian Health Research Council and facilitated by the Ministry of Health. FINDINGS: A consensus was expressed that, despite some positive aspects in the system, fundamental changes and essential improvements were needed to advance the care and facilitation of war injury management. Some respondents had serious concerns about the health-care system, suggesting that it needs to be comprehensively rebuilt. Unanimous views were expressed about the important barriers to effective management and quality of care: shortages of resources, medicines, and funding; underuse or absence of specific and unified clinical practice guidelines; no official commitment by the Ministry of Health to adopt updated clinical guidelines; few incentives and poor motivation, poor communications; blockade and siege; division of health systems in the country; overcrowding of patients with war injuries in hospitals with limited capacity; spreading of infection due to poor cleanliness; shortages in fuel and power supply; and low wages, which negatively affected staff motivation. Respondents also reported inadequate sharing of care and cooperation between different health-care facilities. INTERPRETATION: The perceptions about barriers to management of war injuries and the quality of care provided were similar across Palestinian health-care facilities in the Gaza strip. Our findings suggest that fundamental changes and comprehensive reform of the health-care system are needed to make the care of patients with war injuries more effective and efficient. One of the important strengths of this study is that it addressed the perspective and opinions of different key health professionals, which made it possible gain deeper and better understanding of how war injuries are managed in the Palestinian health system. In addition, the outcomes of the study were based on diverse information. However, the analysis of the qualitative data may represent challenges, and be more complicated and time consuming than a quantitative approach.None. 

  • 12.
    Newton, J. N.
    et al.
    Public Health England, London, UK; London Sch Econ, London WC2A 2AE, England.
    Briggs, A. D. M.
    Univ Oxford, Oxford, England.
    Murray, C. J. L.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Dicker, D.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Foreman, K. J.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Wang, H.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Naghavi, M.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Forouzanfar, M. H.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Ohno, S. L.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Barber, R. M.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Vos, T.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Stanaway, J. D.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Schmidt, J. C.
    London Sch Econ, London WC2A 2AE, England.
    Hughes, A. J.
    London Sch Econ, London WC2A 2AE, England.
    Fay, D. F. J.
    London Sch Econ, London WC2A 2AE, England.
    Ecob, R.
    London Sch Econ, London WC2A 2AE, England.
    Gresser, C.
    London Sch Econ, London WC2A 2AE, England.
    McKee, M.
    London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London WC1, England.
    Rutter, H.
    Univ Oxford, London Sch Hyg & Trop Med, Oxford, England.
    Abubakar, I.
    MRC Clin Trials Unit, London, England.
    Ali, R.
    INDOX Canc Res Network, Oxford, England.
    Anderson, H. R.
    Publ Hlth Res Inst, Hamilton, ON, Canada.
    Banerjee, A.
    Univ Birmingham, Birmingham, West Midlands, England.
    Bennett, D. A.
    Univ Oxford, Clin Trials Serv Unit, Oxford, England.
    Bernabé, E.
    Kings Coll London, Inst Dent, London WC2R 2LS, England.
    Bhui, K. S.
    Queen Mary Univ London, Wolfson Inst Prevent Med, Barts & London Sch Med, London, England.
    Biryukov, S. M.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Bourne, R. R.
    Anglia Ruskin Univ, Vis & Eye Res Unit, Cambridge, England.
    Brayne, C. E. G.
    Univ Cambridge, Cambridge Inst Publ Hlth, Cambridge, England.
    Bruce, N. G.
    Univ Liverpool, Liverpool L69 3BX, Merseyside, England.
    Brugha, T. S.
    Univ Leicester, Leicester, Leics, England.
    Burch, M.
    Great Ormond St Hosp Sick Children, London WC1N 3JH, England.
    Capewell, S.
    Univ Liverpool, Liverpool L69 3BX, Merseyside, England.
    Casey, D.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Chowdhury, R.
    Univ Cambridge, Cambridge, England.
    Coates, M. M.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Cooper, C.
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, England.
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    Guys & St Thomas NHS Fdn Trust, London, England.
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    Univ Liverpool, Liverpool L69 3BX, Merseyside, England.
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    Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, MRC PHE Ctr Environm & Hlth, London, England.
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    Univ London Imperial Coll Sci Technol & Med, Sch Publ Hlth, MRC PHE Ctr Populat Hlth, London, England.
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    London Sch Econ, London WC2A 2AE, England.
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    Inst Hlth Metr & Evaluat, Seattle, WA USA.
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    Univ London Imperial Coll Sci Technol & Med, Dept Infect Dis Epidemiol, London, England.
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    London Sch Econ, London WC2A 2AE, England.
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    Univ Sheffield, Sch Hlth & Related Res ScHARR, Sheffield, S Yorkshire, England.
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    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.
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    London Sch Econ, London WC2A 2AE, England.
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    Int Fdn Dermatol, London, England.
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    Inst Hlth Metr & Evaluat, Seattle, WA USA.
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    Inst Hlth Metr & Evaluat, Seattle, WA USA.
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    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.
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    Univ Liverpool, Aintree Univ Hosp NHS Fdn Trust, Liverpool L69 3BX, Merseyside, England.
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    Swansea Univ, Coll Med, Farr Inst, Swansea, W Glam, Wales.
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    Queen Mary Univ London, London, England.
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    Univ York, Dept Hlth Sci, York YO10 5DD, N Yorkshire, England.
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    Newcastle Univ, Inst Hlth & Soc, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England.
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    Kings Coll London, Canc Epidemiol & Populat Hlth, London, England.
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    West Hertfordshire Hosp NHS Trust, Watford, Herts, England.
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    Univ Oxford, Oxford, England.
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    Univ Oxford, London Sch Hyg & Trop Med, Oxford, England.
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    Univ Liverpool, Liverpool L69 3BX, Merseyside, England.
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    Univ Oxford, George Inst Global Hlth, Oxford, England.
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    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, MRC PHE Ctr Environm & Hlth, London, England.
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    Univ Oxford, British Heart Fdn Ctr Populat Approaches NCD Prev, Oxford, England.
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    Inst Hlth Metr & Evaluat, Seattle, WA USA.
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    Univ Edinburgh, Edinburgh, Midlothian, Scotland.
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    Univ Oxford, London Sch Hyg & Trop Med, Oxford, England.
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    London Sch Econ, London WC2A 2AE, England.
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    Univ London Imperial Coll Sci Technol & Med, London, England.
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    Univ Nottingham, Nottingham NG7 2RD, England.
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    Kings Coll London, London WC2R 2LS, England.
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    Royal Cornwall Hosp, Treliske, Cornwall, England.
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    London Sch Econ, London WC2A 2AE, England.
    Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: A systematic analysis for the Global Burden of Disease Study 20132015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10010, p. 2257-2274Article in journal (Refereed)
    Abstract [en]

    Background In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. Methods We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. Findings Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3-43·6), whereas DALYs were reduced by 23·8% (20·9-27·1), and YLDs by 1·4% (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1-12·7]) and tobacco (10·7% [9·4-12·0]). Interpretation Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. Funding Bill & Melinda Gates Foundation and Public Health England. © 2015 Newton et al. Open Access article distributed under the terms of CC BY.

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  • 13. Rodriguez, Alina
    Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 20132015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 385, no 9963, p. 117-171Article in journal (Refereed)
    Abstract [en]

    Background

    Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries.

    Methods

    We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions.

    Findings

    Global life expectancy for both sexes increased from 65·3 years (UI 65·0–65·6) in 1990, to 71·5 years (UI 71·0–71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8–48·2) to 54·9 million (UI 53·6–56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions.

    Interpretation

    For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

    Funding

    Bill & Melinda Gates Foundation.

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    Disease, G B D 2 0 1 6
    Incidence, Injury
    Collaborators, Prevalence
    Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 20162017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10100, p. 1211-1259Article in journal (Refereed)
    Abstract [en]

    Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer’s disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228). Interpretation The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-todate information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. © The Author(s). Published by Elsevier Ltd.

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