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  • 1. 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
    Frostad, Joseph J
    Astha, K C
    Kyu, Hmwe H
    Moradi-Lakeh, Maziar
    Ng, Marie
    Slepak, Erica Leigh
    Thomas, Bernadette A
    Wagner, Joseph
    Aasvang, Gunn Marit
    Abbafati, Cristiana
    Abbasoglu Ozgoren, Ayse
    Abd-Allah, Foad
    Abera, Semaw F
    Aboyans, Victor
    Abraham, Biju
    Abraham, Jerry Puthenpurakal
    Abubakar, Ibrahim
    Abu-Rmeileh, Niveen M E
    Aburto, Tania C
    Achoki, Tom
    Adelekan, Ademola
    Adofo, Koranteng
    Adou, Arsène K
    Adsuar, José C
    Afshin, Ashkan
    Agardh, Emilie E
    Al Khabouri, Mazin J
    Al Lami, Faris H
    Alam, Sayed Saidul
    Alasfoor, Deena
    Albittar, Mohammed I
    Alegretti, Miguel A
    Aleman, Alicia V
    Alemu, Zewdie A
    Alfonso-Cristancho, Rafael
    Alhabib, Samia
    Ali, Raghib
    Ali, Mohammed K
    Alla, François
    Allebeck, Peter
    Allen, Peter J
    Alsharif, Ubai
    Alvarez, Elena
    Alvis-Guzman, Nelson
    Amankwaa, Adansi A
    Amare, Azmeraw T
    Ameh, Emmanuel A
    Ameli, Omid
    Amini, Heresh
    Ammar, Walid
    Anderson, Benjamin O
    Antonio, Carl Abelardo T
    Anwari, Palwasha
    Argeseanu Cunningham, Solveig
    Arnlöv, Johan
    Arsenijevic, Valentina S Arsic
    Artaman, Al
    Asghar, Rana J
    Assadi, Reza
    Atkins, Lydia S
    Atkinson, Charles
    Avila, Marco A
    Awuah, Baffour
    Badawi, Alaa
    Bahit, Maria C
    Bakfalouni, Talal
    Balakrishnan, Kalpana
    Balalla, Shivanthi
    Balu, Ravi Kumar
    Banerjee, Amitava
    Barber, Ryan M
    Barker-Collo, Suzanne L
    Barquera, Simon
    Barregard, Lars
    Barrero, Lope H
    Barrientos-Gutierrez, Tonatiuh
    Basto-Abreu, Ana C
    Basu, Arindam
    Basu, Sanjay
    Basulaiman, Mohammed O
    Batis Ruvalcaba, Carolina
    Beardsley, Justin
    Bedi, Neeraj
    Bekele, Tolesa
    Bell, Michelle L
    Benjet, Corina
    Bennett, Derrick A
    Benzian, Habib
    Bernabé, Eduardo
    Beyene, Tariku J
    Bhala, Neeraj
    Bhalla, Ashish
    Bhutta, Zulfiqar A
    Bikbov, Boris
    Bin Abdulhak, Aref A
    Blore, Jed D
    Blyth, Fiona M
    Bohensky, Megan A
    Bora Başara, Berrak
    Borges, Guilherme
    Bornstein, Natan M
    Bose, Dipan
    Boufous, Soufiane
    Bourne, Rupert R
    Brainin, Michael
    Brazinova, Alexandra
    Breitborde, Nicholas J
    Brenner, Hermann
    Briggs, Adam D M
    Broday, David M
    Brooks, Peter M
    Bruce, Nigel G
    Brugha, Traolach S
    Brunekreef, Bert
    Buchbinder, Rachelle
    Bui, Linh N
    Bukhman, Gene
    Bulloch, Andrew G
    Burch, Michael
    Burney, Peter G J
    Campos-Nonato, Ismael R
    Campuzano, Julio C
    Cantoral, Alejandra J
    Caravanos, Jack
    Cárdenas, Rosario
    Cardis, Elisabeth
    Carpenter, David O
    Caso, Valeria
    Castañeda-Orjuela, Carlos A
    Castro, Ruben E
    Catalá-López, Ferrán
    Cavalleri, Fiorella
    Çavlin, Alanur
    Chadha, Vineet K
    Chang, Jung-Chen
    Charlson, Fiona J
    Chen, Honglei
    Chen, Wanqing
    Chen, Zhengming
    Chiang, Peggy P
    Chimed-Ochir, Odgerel
    Chowdhury, Rajiv
    Christophi, Costas A
    Chuang, Ting-Wu
    Chugh, Sumeet S
    Cirillo, Massimo
    Claßen, Thomas K D
    Colistro, Valentina
    Colomar, Mercedes
    Colquhoun, Samantha M
    Contreras, Alejandra G
    Cooper, Cyrus
    Cooperrider, Kimberly
    Cooper, Leslie T
    Coresh, Josef
    Courville, Karen J
    Criqui, Michael H
    Cuevas-Nasu, Lucia
    Damsere-Derry, James
    Danawi, Hadi
    Dandona, Lalit
    Dandona, Rakhi
    Dargan, Paul I
    Davis, Adrian
    Davitoiu, Dragos V
    Dayama, Anand
    de Castro, E Filipa
    De la Cruz-Góngora, Vanessa
    De Leo, Diego
    de Lima, Graça
    Degenhardt, Louisa
    del Pozo-Cruz, Borja
    Dellavalle, Robert P
    Deribe, Kebede
    Derrett, Sarah
    Des Jarlais, Don C
    Dessalegn, Muluken
    deVeber, Gabrielle A
    Devries, Karen M
    Dharmaratne, Samath D
    Dherani, Mukesh K
    Dicker, Daniel
    Ding, Eric L
    Dokova, Klara
    Dorsey, E Ray
    Driscoll, Tim R
    Duan, Leilei
    Durrani, Adnan M
    Ebel, Beth E
    Ellenbogen, Richard G
    Elshrek, Yousef M
    Endres, Matthias
    Ermakov, Sergey P
    Erskine, Holly E
    Eshrati, Babak
    Esteghamati, Alireza
    Fahimi, Saman
    Faraon, Emerito Jose A
    Farzadfar, Farshad
    Fay, Derek F J
    Feigin, Valery L
    Feigl, Andrea B
    Fereshtehnejad, Seyed-Mohammad
    Ferrari, Alize J
    Ferri, Cleusa P
    Flaxman, Abraham D
    Fleming, Thomas D
    Foigt, Nataliya
    Foreman, Kyle J
    Paleo, Urbano Fra
    Franklin, Richard C
    Gabbe, Belinda
    Gaffikin, Lynne
    Gakidou, Emmanuela
    Gamkrelidze, Amiran
    Gankpé, Fortuné G
    Gansevoort, Ron T
    García-Guerra, Francisco A
    Gasana, Evariste
    Geleijnse, Johanna M
    Gessner, Bradford D
    Gething, Pete
    Gibney, Katherine B
    Gillum, Richard F
    Ginawi, Ibrahim A M
    Giroud, Maurice
    Giussani, Giorgia
    Goenka, Shifalika
    Goginashvili, Ketevan
    Gomez Dantes, Hector
    Gona, Philimon
    Gonzalez de Cosio, Teresita
    González-Castell, Dinorah
    Gotay, Carolyn C
    Goto, Atsushi
    Gouda, Hebe N
    Guerrant, Richard L
    Gugnani, Harish C
    Guillemin, Francis
    Gunnell, David
    Gupta, Rahul
    Gupta, Rajeev
    Gutiérrez, Reyna A
    Hafezi-Nejad, Nima
    Hagan, Holly
    Hagstromer, Maria
    Halasa, Yara A
    Hamadeh, Randah R
    Hammami, Mouhanad
    Hankey, Graeme J
    Hao, Yuantao
    Harb, Hilda L
    Haregu, Tilahun Nigatu
    Haro, Josep Maria
    Havmoeller, Rasmus
    Hay, Simon I
    Hedayati, Mohammad T
    Heredia-Pi, Ileana B
    Hernandez, Lucia
    Heuton, Kyle R
    Heydarpour, Pouria
    Hijar, Martha
    Hoek, Hans W
    Hoffman, Howard J
    Hornberger, John C
    Hosgood, H Dean
    Hoy, Damian G
    Hsairi, Mohamed
    Hu, Guoqing
    Hu, Howard
    Huang, Cheng
    Huang, John J
    Hubbell, Bryan J
    Huiart, Laetitia
    Husseini, Abdullatif
    Iannarone, Marissa L
    Iburg, Kim M
    Idrisov, Bulat T
    Ikeda, Nayu
    Innos, Kaire
    Inoue, Manami
    Islami, Farhad
    Ismayilova, Samaya
    Jacobsen, Kathryn H
    Jansen, Henrica A
    Jarvis, Deborah L
    Jassal, Simerjot K
    Jauregui, Alejandra
    Jayaraman, Sudha
    Jeemon, Panniyammakal
    Jensen, Paul N
    Jha, Vivekanand
    Jiang, Fan
    Jiang, Guohong
    Jiang, Ying
    Jonas, Jost B
    Juel, Knud
    Kan, Haidong
    Kany Roseline, Sidibe S
    Karam, Nadim E
    Karch, André
    Karema, Corine K
    Karthikeyan, Ganesan
    Kaul, Anil
    Kawakami, Norito
    Kazi, Dhruv S
    Kemp, Andrew H
    Kengne, Andre P
    Keren, Andre
    Khader, Yousef S
    Khalifa, Shams Eldin Ali Hassan
    Khan, Ejaz A
    Khang, Young-Ho
    Khatibzadeh, Shahab
    Khonelidze, Irma
    Kieling, Christian
    Kim, Daniel
    Kim, Sungroul
    Kim, Yunjin
    Kimokoti, Ruth W
    Kinfu, Yohannes
    Kinge, Jonas M
    Kissela, Brett M
    Kivipelto, Miia
    Knibbs, Luke D
    Knudsen, Ann Kristin
    Kokubo, Yoshihiro
    Kose, M Rifat
    Kosen, Soewarta
    Kraemer, Alexander
    Kravchenko, Michael
    Krishnaswami, Sanjay
    Kromhout, Hans
    Ku, Tiffany
    Kuate Defo, Barthelemy
    Kucuk Bicer, Burcu
    Kuipers, Ernst J
    Kulkarni, Chanda
    Kulkarni, Veena S
    Kumar, G Anil
    Kwan, Gene F
    Lai, Taavi
    Lakshmana Balaji, Arjun
    Lalloo, Ratilal
    Lallukka, Tea
    Lam, Hilton
    Lan, Qing
    Lansingh, Van C
    Larson, Heidi J
    Larsson, Anders
    Laryea, Dennis O
    Lavados, Pablo M
    Lawrynowicz, Alicia E
    Leasher, Janet L
    Lee, Jong-Tae
    Leigh, James
    Leung, Ricky
    Levi, Miriam
    Li, Yichong
    Li, Yongmei
    Liang, Juan
    Liang, Xiaofeng
    Lim, Stephen S
    Lindsay, M Patrice
    Lipshultz, Steven E
    Liu, Shiwei
    Liu, Yang
    Lloyd, Belinda K
    Logroscino, Giancarlo
    London, Stephanie J
    Lopez, Nancy
    Lortet-Tieulent, Joannie
    Lotufo, Paulo A
    Lozano, Rafael
    Lunevicius, Raimundas
    Ma, Jixiang
    Ma, Stefan
    Machado, Vasco M P
    MacIntyre, Michael F
    Magis-Rodriguez, Carlos
    Mahdi, Abbas A
    Majdan, Marek
    Malekzadeh, Reza
    Mangalam, Srikanth
    Mapoma, Christopher C
    Marape, Marape
    Marcenes, Wagner
    Margolis, David J
    Margono, Christopher
    Marks, Guy B
    Martin, Randall V
    Marzan, Melvin B
    Mashal, Mohammad T
    Masiye, Felix
    Mason-Jones, Amanda J
    Matsushita, Kunihiro
    Matzopoulos, Richard
    Mayosi, Bongani M
    Mazorodze, Tasara T
    McKay, Abigail C
    McKee, Martin
    McLain, Abigail
    Meaney, Peter A
    Medina, Catalina
    Mehndiratta, Man Mohan
    Mejia-Rodriguez, Fabiola
    Mekonnen, Wubegzier
    Melaku, Yohannes A
    Meltzer, Michele
    Memish, Ziad A
    Mendoza, Walter
    Mensah, George A
    Meretoja, Atte
    Mhimbira, Francis Apolinary
    Micha, Renata
    Miller, Ted R
    Mills, Edward J
    Misganaw, Awoke
    Mishra, Santosh
    Mohamed Ibrahim, Norlinah
    Mohammad, Karzan A
    Mokdad, Ali H
    Mola, Glen L
    Monasta, Lorenzo
    Montañez Hernandez, Julio C
    Montico, Marcella
    Moore, Ami R
    Morawska, Lidia
    Mori, Rintaro
    Moschandreas, Joanna
    Moturi, Wilkister N
    Mozaffarian, Dariush
    Mueller, Ulrich O
    Mukaigawara, Mitsuru
    Mullany, Erin C
    Murthy, Kinnari S
    Naghavi, Mohsen
    Nahas, Ziad
    Naheed, Aliya
    Naidoo, Kovin S
    Naldi, Luigi
    Nand, Devina
    Nangia, Vinay
    Narayan, K M Venkat
    Nash, Denis
    Neal, Bruce
    Nejjari, Chakib
    Neupane, Sudan P
    Newton, Charles R
    Ngalesoni, Frida N
    Ngirabega, Jean de Dieu
    Nguyen, Grant
    Nguyen, Nhung T
    Nieuwenhuijsen, Mark J
    Nisar, Muhammad I
    Nogueira, José R
    Nolla, Joan M
    Nolte, Sandra
    Norheim, Ole F
    Norman, Rosana E
    Norrving, Bo
    Nyakarahuka, Luke
    Oh, In-Hwan
    Ohkubo, Takayoshi
    Olusanya, Bolajoko O
    Omer, Saad B
    Opio, John Nelson
    Orozco, Ricardo
    Pagcatipunan, Rodolfo S
    Pain, Amanda W
    Pandian, Jeyaraj D
    Panelo, Carlo Irwin A
    Papachristou, Christina
    Park, Eun-Kee
    Parry, Charles D
    Paternina Caicedo, Angel J
    Patten, Scott B
    Paul, Vinod K
    Pavlin, Boris I
    Pearce, Neil
    Pedraza, Lilia S
    Pedroza, Andrea
    Pejin Stokic, Ljiljana
    Pekericli, Ayfer
    Pereira, David M
    Perez-Padilla, Rogelio
    Perez-Ruiz, Fernando
    Perico, Norberto
    Perry, Samuel A L
    Pervaiz, Aslam
    Pesudovs, Konrad
    Peterson, Carrie B
    Petzold, Max
    Phillips, Michael R
    Phua, Hwee Pin
    Plass, Dietrich
    Poenaru, Dan
    Polanczyk, Guilherme V
    Polinder, Suzanne
    Pond, Constance D
    Pope, C Arden
    Pope, Daniel
    Popova, Svetlana
    Pourmalek, Farshad
    Powles, John
    Prabhakaran, Dorairaj
    Prasad, Noela M
    Qato, Dima M
    Quezada, Amado D
    Quistberg, D Alex A
    Racapé, Lionel
    Rafay, Anwar
    Rahimi, Kazem
    Rahimi-Movaghar, Vafa
    Rahman, Sajjad Ur
    Raju, Murugesan
    Rakovac, Ivo
    Rana, Saleem M
    Rao, Mayuree
    Razavi, Homie
    Reddy, K Srinath
    Refaat, Amany H
    Rehm, Jürgen
    Remuzzi, Giuseppe
    Ribeiro, Antonio L
    Riccio, Patricia M
    Richardson, Lee
    Riederer, Anne
    Robinson, Margaret
    Roca, Anna
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Rojas-Rueda, David
    Romieu, Isabelle
    Ronfani, Luca
    Room, Robin
    Roy, Nobhojit
    Ruhago, George M
    Rushton, Lesley
    Sabin, Nsanzimana
    Sacco, Ralph L
    Saha, Sukanta
    Sahathevan, Ramesh
    Sahraian, Mohammad Ali
    Salomon, Joshua A
    Salvo, Deborah
    Sampson, Uchechukwu K
    Sanabria, Juan R
    Sanchez, Luz Maria
    Sánchez-Pimienta, Tania G
    Sanchez-Riera, Lidia
    Sandar, Logan
    Santos, Itamar S
    Sapkota, Amir
    Satpathy, Maheswar
    Saunders, James E
    Sawhney, Monika
    Saylan, Mete I
    Scarborough, Peter
    Schmidt, Jürgen C
    Schneider, Ione J C
    Schöttker, Ben
    Schwebel, David C
    Scott, James G
    Seedat, Soraya
    Sepanlou, Sadaf G
    Serdar, Berrin
    Servan-Mori, Edson E
    Shaddick, Gavin
    Shahraz, Saeid
    Levy, Teresa Shamah
    Shangguan, Siyi
    She, Jun
    Sheikhbahaei, Sara
    Shibuya, Kenji
    Shin, Hwashin H
    Shinohara, Yukito
    Shiri, Rahman
    Shishani, Kawkab
    Shiue, Ivy
    Sigfusdottir, Inga D
    Silberberg, Donald H
    Simard, Edgar P
    Sindi, Shireen
    Singh, Abhishek
    Singh, Gitanjali M
    Singh, Jasvinder A
    Skirbekk, Vegard
    Sliwa, Karen
    Soljak, Michael
    Soneji, Samir
    Søreide, Kjetil
    Soshnikov, Sergey
    Sposato, Luciano A
    Sreeramareddy, Chandrashekhar T
    Stapelberg, Nicolas J C
    Stathopoulou, Vasiliki
    Steckling, Nadine
    Stein, Dan J
    Stein, Murray B
    Stephens, Natalie
    Stöckl, Heidi
    Straif, Kurt
    Stroumpoulis, Konstantinos
    Sturua, Lela
    Sunguya, Bruno F
    Swaminathan, Soumya
    Swaroop, Mamta
    Sykes, Bryan L
    Tabb, Karen M
    Takahashi, Ken
    Talongwa, Roberto T
    Tandon, Nikhil
    Tanne, David
    Tanner, Marcel
    Tavakkoli, Mohammad
    Te Ao, Braden J
    Teixeira, Carolina M
    Téllez Rojo, Martha M
    Terkawi, Abdullah S
    Texcalac-Sangrador, José Luis
    Thackway, Sarah V
    Thomson, Blake
    Thorne-Lyman, Andrew L
    Thrift, Amanda G
    Thurston, George D
    Tillmann, Taavi
    Tobollik, Myriam
    Tonelli, Marcello
    Topouzis, Fotis
    Towbin, Jeffrey A
    Toyoshima, Hideaki
    Traebert, Jefferson
    Tran, Bach X
    Trasande, Leonardo
    Trillini, Matias
    Trujillo, Ulises
    Dimbuene, Zacharie Tsala
    Tsilimbaris, Miltiadis
    Tuzcu, Emin Murat
    Uchendu, Uche S
    Ukwaja, Kingsley N
    Uzun, Selen B
    van de Vijver, Steven
    Van Dingenen, Rita
    van Gool, Coen H
    van Os, Jim
    Varakin, Yuri Y
    Vasankari, Tommi J
    Vasconcelos, Ana Maria N
    Vavilala, Monica S
    Veerman, Lennert J
    Velasquez-Melendez, Gustavo
    Venketasubramanian, N
    Vijayakumar, Lakshmi
    Villalpando, Salvador
    Violante, Francesco S
    Vlassov, Vasiliy Victorovich
    Vollset, Stein Emil
    Wagner, Gregory R
    Waller, Stephen G
    Wallin, Mitchell T
    Wan, Xia
    Wang, Haidong
    Wang, JianLi
    Wang, Linhong
    Wang, Wenzhi
    Wang, Yanping
    Warouw, Tati S
    Watts, Charlotte H
    Weichenthal, Scott
    Weiderpass, Elisabete
    Weintraub, Robert G
    Werdecker, Andrea
    Wessells, K Ryan
    Westerman, Ronny
    Whiteford, Harvey A
    Wilkinson, James D
    Williams, Hywel C
    Williams, Thomas N
    Woldeyohannes, Solomon M
    Wolfe, Charles D A
    Wong, John Q
    Woolf, Anthony D
    Wright, Jonathan L
    Wurtz, Brittany
    Xu, Gelin
    Yan, Lijing L
    Yang, Gonghuan
    Yano, Yuichiro
    Ye, Pengpeng
    Yenesew, Muluken
    Yentür, Gökalp K
    Yip, Paul
    Yonemoto, Naohiro
    Yoon, Seok-Jun
    Younis, Mustafa Z
    Younoussi, Zourkaleini
    Yu, Chuanhua
    Zaki, Maysaa E
    Zhao, Yong
    Zheng, Yingfeng
    Zhou, Maigeng
    Zhu, Jun
    Zhu, Shankuan
    Zou, Xiaonong
    Zunt, Joseph R
    Lopez, Alan D
    Vos, Theo
    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.

  • 2. Global Burden of Disease Study 2013 Collaborators,
    et al.
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    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.

  • 3.
    Kivimaki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    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.
    Fransson, Eleonor I.
    Karolinska Inst, Inst Environm Med, Sweden.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, 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.
    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.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, 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.
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, Sweden.
    Vahtera, Jussi
    Finnish Inst Occupat Hlth, Helsinki, 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.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, England.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, England.
    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.

  • 4.
    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.

  • 5.
    Newton, J. N.
    et al.
    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.
    Critchley, J. A.
    Dargan, P. I.
    Guys & St Thomas NHS Fdn Trust, London, England.
    Dherani, M. K.
    Univ Liverpool, Liverpool L69 3BX, Merseyside, England.
    Elliott, P.
    Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, MRC PHE Ctr Environm & Hlth, London, England.
    Ezzati, M.
    Univ London Imperial Coll Sci Technol & Med, Sch Publ Hlth, MRC PHE Ctr Populat Hlth, London, England.
    Fenton, K. A.
    London Sch Econ, London WC2A 2AE, England.
    Fraser, M. S.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Fürst, T.
    Univ London Imperial Coll Sci Technol & Med, Dept Infect Dis Epidemiol, London, England.
    Greaves, F.
    London Sch Econ, London WC2A 2AE, England.
    Green, M. A.
    Univ Sheffield, Sch Hlth & Related Res ScHARR, Sheffield, S Yorkshire, England.
    Gunnell, D. J.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.
    Hannigan, B. M.
    London Sch Econ, London WC2A 2AE, England.
    Hay, R. J.
    Int Fdn Dermatol, London, England.
    Hay, S. I.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Hemingway, H.
    Farr Inst Hlth Informat Res, London, England.
    Larson, H. J.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Looker, K. J.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England.
    Lunevicius, R.
    Univ Liverpool, Aintree Univ Hosp NHS Fdn Trust, Liverpool L69 3BX, Merseyside, England.
    Lyons, R. A.
    Swansea Univ, Coll Med, Farr Inst, Swansea, W Glam, Wales.
    Marcenes, W.
    Queen Mary Univ London, London, England.
    Mason-Jones, A. J.
    Univ York, Dept Hlth Sci, York YO10 5DD, N Yorkshire, England.
    Matthews, F. E.
    Newcastle Univ, Inst Hlth & Soc, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England.
    Moller, H.
    Kings Coll London, Canc Epidemiol & Populat Hlth, London, England.
    Murdoch, M. E.
    West Hertfordshire Hosp NHS Trust, Watford, Herts, England.
    Newton, C. R.
    Univ Oxford, Oxford, England.
    Pearce, N.
    Univ Oxford, London Sch Hyg & Trop Med, Oxford, England.
    Piel, F. B.
    Pope, D.
    Univ Liverpool, Liverpool L69 3BX, Merseyside, England.
    Rahimi, K.
    Univ Oxford, George Inst Global Hlth, Oxford, England.
    Rodriguez, Alina
    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.
    Scarborough, P.
    Univ Oxford, British Heart Fdn Ctr Populat Approaches NCD Prev, Oxford, England.
    Schumacher, A. E.
    Inst Hlth Metr & Evaluat, Seattle, WA USA.
    Shiue, I.
    Univ Edinburgh, Edinburgh, Midlothian, Scotland.
    Smeeth, L.
    Univ Oxford, London Sch Hyg & Trop Med, Oxford, England.
    Tedstone, A.
    London Sch Econ, London WC2A 2AE, England.
    Valabhji, J.
    Univ London Imperial Coll Sci Technol & Med, London, England.
    Williams, H. C.
    Univ Nottingham, Nottingham NG7 2RD, England.
    Wolfe, C. D. A.
    Kings Coll London, London WC2R 2LS, England.
    Woolf, A. D.
    Royal Cornwall Hosp, Treliske, Cornwall, England.
    Davis, A. C. J.
    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.

  • 6.
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    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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