Browsing by Author "Caroline Stein"

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Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019
(Elsevier Ltd, 2022) Ewerton Cousin; Bruce B. Duncan; Caroline Stein; Kanyin Liane Ong; Theo Vos; Cristiana Abbafati; Mohsen Abbasi-Kangevari; Michael Abdelmasseh; Amir Abdoli; Rami Abd-Rabu; Hassan Abolhassani; Eman Abu-Gharbieh; Manfred Mario Kokou Accrombessi; Qorinah Estiningtyas Sakilah Adnani; Muhammad Sohail Afzal; Gina Agarwal; Krishna K. Agrawaal; Marcela Agudelo-Botero; Bright Opoku Ahinkorah; Sajjad Ahmad; Tauseef Ahmad; Keivan Ahmadi; Sepideh Ahmadi; Ali Ahmadi; Ali Ahmed; Yusra Ahmed Salih; Wuraola Akande-Sholabi; Tayyaba Akram; Hanadi Al Hamad; Ziyad Al-Aly; Jacqueline Elizabeth Alcalde-Rabanal; Vahid Alipour; Syed Mohamed Aljunid; Rajaa M. Al-Raddadi; Nelson Alvis-Guzman; Saeed Amini; Robert Ancuceanu; Tudorel Andrei; Catalina Liliana Andrei; Ranjit Mohan Anjana; Adnan Ansar; Ippazio Cosimo Antonazzo; Benny Antony; Anayochukwu Edward Anyasodor; Jalal Arabloo; Damian Arizmendi; Benedetta Armocida; Anton A. Artamonov; Judie Arulappan; Zahra Aryan; Samaneh Asgari; Tahira Ashraf; Thomas Astell-Burt; Prince Atorkey; Maha Moh'd Wahbi Atout; Martin Amogre Ayanore; Ashish D. Badiye; Atif Amin Baig; Mohan Bairwa; Jennifer L. Baker; Ovidiu Constantin Baltatu; Palash Chandra Banik; Anthony Barnett; Mark Thomaz Ugliara Barone; Francesco Barone-Adesi; Amadou Barrow; Neeraj Bedi; Rebuma Belete; Uzma Iqbal Belgaumi; Arielle Wilder Bell; Derrick A. Bennett; Isabela M. Bensenor; David Beran; Akshaya Srikanth Bhagavathula; Sonu Bhaskar; Krittika Bhattacharyya; Vijayalakshmi S. Bhojaraja; Ali Bijani; Boris Bikbov; Setognal Birara; Virginia Bodolica; Aime Bonny; Hermann Brenner; Nikolay Ivanovich Briko; Zahid A. Butt; Florentino Luciano Caetano dos Santos; Luis Alberto Cámera; Ismael R. Campos-Nonato; Yin Cao; Chao Cao; Ester Cerin; Promit Ananyo Chakraborty; Joht Singh Chandan; Vijay Kumar Chattu; Simiao Chen; Jee-Young Jasmine Choi; Sonali Gajanan Choudhari; Enayet Karim Chowdhury; Dinh-Toi Chu; Barbara Corso; Omid Dadras; Xiaochen Dai; Albertino Antonio Moura Damasceno; Lalit Dandona; Rakhi Dandona; Claudio Alberto Dávila-Cervantes; Jan-Walter De Neve; Edgar Denova-Gutiérrez; Deepak Dhamnetiya; Daniel Diaz; Sanam Ebtehaj; Hisham Atan Edinur; Sahar Eftekharzadeh; Iman El Sayed; Islam Y. Elgendy; Muhammed Elhadi; Mohamed A. Elmonem; Mohammed Faisaluddin; Umar Farooque; Xiaoqi Feng; Eduarda Fernandes; Florian Fischer; David Flood; Marisa Freitas; Peter Andras Gaal; Mohamed M. Gad; Piyada Gaewkhiew; Lemma Getacher; Mansour Ghafourifard; Reza Ghanei Gheshlagh; Ahmad Ghashghaee; Nermin Ghith; Ghozali Ghozali; Paramjit Singh Gill; Ibrahim Abdelmageed Ginawi; Ekaterina Vladimirovna Glushkova; Mahaveer Golechha; Sameer Vali Gopalani; Rafael Alves Guimarães; Rajat Das Gupta; Rajeev Gupta; Vivek Kumar Gupta; Veer Bala Gupta; Sapna Gupta; Tesfa Dejenie Habtewold; Nima Hafezi-Nejad; Rabih Halwani; Asif Hanif; Graeme J. Hankey; Shafiul Haque; Ahmed I. Hasaballah; Syed Shahzad Hasan; Abdiwahab Hashi; Soheil Hassanipour; Simon I. Hay; Khezar Hayat; Mohammad Heidari; Mohammad Bellal Hossain Hossain; Sahadat Hossain; Mostafa Hosseini; Soodabeh Hoveidamanesh; Junjie Huang; Ayesha Humayun; Rabia Hussain; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Kevin S. Ikuta; Leeberk Raja Inbaraj; Usman Iqbal; Md Shariful Islam; Sheikh Mohammed Shariful Islam; Rakibul M. Islam; Nahlah Elkudssiah Ismail; Gaetano Isola; Ramaiah Itumalla; Masao Iwagami; Ihoghosa Osamuyi Iyamu; Mohammad Ali Jahani; Mihajlo Jakovljevic; Ranil Jayawardena; Ravi Prakash Jha; Oommen John; Jost B. Jonas; Tamas Joo; Ali Kabir; Rohollah Kalhor; Ashwin Kamath; Tanuj Kanchan; Himal Kandel; Neeti Kapoor; Gbenga A. Kayode; Sewnet Adem Kebede; Pedram Keshavarz; Mohammad Keykhaei; Yousef Saleh Khader; Himanshu Khajuria; Moien A. B. Khan; Md Nuruzzaman Khan; Maseer Khan; Amir M. Khater; Tawfik Ahmed Muthafer Khoja; Jagdish Khubchandani; Min Seo Kim; Yun Jin Kim; Ruth W. Kimokoti; Sezer Kisa; Adnan Kisa; Mika Kivimäki; Vladimir Andreevich Korshunov; Oleksii Korzh; Ai Koyanagi; Kewal Krishan; Barthelemy Kuate Defo; G. Anil Kumar; Nithin Kumar; Dian Kusuma; Carlo La Vecchia; Ben Lacey; Anders O. Larsson; Savita Lasrado; Wei-Chen Lee; Chiachi Bonnie Lee; Paul H. Lee; Shaun Wen Huey Lee; Ming-Chieh Li; Stephen S. Lim; Lee-Ling Lim; Giancarlo Lucchetti; Azeem Majeed; Ahmad Azam Malik; Borhan Mansouri; Lorenzo Giovanni Mantovani; Santi Martini; Prashant Mathur; Colm McAlinden; Nafiul Mehedi; Teferi Mekonnen; Ritesh G. Menezes; Amanual Getnet Mersha; Junmei Miao Jonasson; Tomasz Miazgowski; Irmina Maria Michalek; Andreea Mirica; Erkin M. Mirrakhimov; Agha Zeeshan Mirza; Prasanna Mithra; Abdollah Mohammadian-Hafshejani; Reza Mohammadpourhodki; Arif Mohammed; Ali H. Mokdad; Mariam Molokhia; Lorenzo Monasta; Mohammad Ali Moni; Farhad Moradpour; Rahmatollah Moradzadeh; Ebrahim Mostafavi; Ulrich Otto Mueller; Christopher J. L. Murray; Ahmad Mustafa; Gabriele Nagel; Vinay Nangia; Atta Abbas Naqvi; Biswa Prakash Nayak; Javad Nazari; Rawlance Ndejjo; Ruxandra Irina Negoi; Sandhya Neupane Kandel; Cuong Tat Nguyen; Huong Lan Thi Nguyen; Jean Jacques Noubiap; Christoph Nowak; Bogdan Oancea; Oluwakemi Ololade Odukoya; Ayodipupo Sikiru Oguntade; Temitope T. Ojo; Andrew T. Olagunju; Obinna E. Onwujekwe; Alberto Ortiz; Mayowa O. Owolabi; Raffaele Palladino; Songhomitra Panda-Jonas; Seithikurippu R. Pandi-Perumal; Shahina Pardhan; Tarang Parekh; Mojtaba Parvizi; Veincent Christian Filipino Pepito; Arokiasamy Perianayagam; Ionela-Roxana Petcu; Manju Pilania; Vivek Podder; Roman V. Polibin; Maarten J. Postma; Akila Prashant; Navid Rabiee; Mohammad Rabiee; Vafa Rahimi-Movaghar; Muhammad Aziz Rahman; Md. Mosfequr Rahman; Mosiur Rahman; Setyaningrum Rahmawaty; Nazanin Rajai; Pradhum Ram; Juwel Rana; Kamal Ranabhat; Priyanga Ranasinghe; Chythra R. Rao; Satish Rao; Salman Rawaf; David Laith Rawaf; Lal Rawal; Andre M. N. Renzaho; Nima Rezaei; Aziz Rezapour; Seyed Mohammad Riahi; Daniela Ribeiro; Jefferson Antonio Buendia Rodriguez; Leonardo Roever; Peter Rohloff; Godfrey M. Rwegerera; Paul MacDaragh Ryan; Maha Mohamed Saber-Ayad; Siamak Sabour; Basema Saddik; Sahar Saeedi Moghaddam; Amirhossein Sahebkar; Harihar Sahoo; K.M. Saif-Ur-Rahman; Hamideh Salimzadeh; Mehrnoosh Samaei; Juan Sanabria; Milena M. Santric-Milicevic; Brijesh Sathian; Thirunavukkarasu Sathish; Markus P. Schlaich; Abdul-Aziz Seidu; Mario Šekerija; Nachimuthu Senthil Kumar; Allen Seylani; Masood Ali Shaikh; Hina Shamshad; Md Shajedur Rahman Shawon; Sara Sheikhbahaei; Jeevan K. Shetty; Rahman Shiri; K.M. Shivakumar; Kerem Shuval; Jasvinder A. Singh; Ambrish Singh; Valentin Yurievich Skryabin; Anna Aleksandrovna Skryabina; Ahmad Sofi-Mahmudi; Amin Soheili; Jing Sun; Viktória Szerencsés; Miklós Szócska; Rafael Tabarés-Seisdedos; Hooman Tadbiri; Eyayou Girma Tadesse; Md. Tariqujjaman; Kavumpurathu Raman Thankappan; Rekha Thapar; Nihal Thomas; Binod Timalsina; Ruoyan Tobe-Gai; Marcello Tonelli; Marcos Roberto Tovani-Palone; Bach Xuan Tran; Jaya Prasad Tripathy; Lorainne Tudor Car; Biruk Shalmeno Tusa; Riaz Uddin; Era Upadhyay; Sahel Valadan Tahbaz; Pascual R. Valdez; Tommi Juhani Vasankari; Madhur Verma; Victor E. Villalobos-Daniel; Sergey Konstantinovitch Vladimirov; Bay Vo; Giang Thu Vu; Rade Vukovic; Yasir Waheed; Richard G. Wamai; Andrea Werdecker; Nuwan Darshana Wickramasinghe; Andrea Sylvia Winkler; Befikadu Legesse Wubishet; Xiaoyue Xu; Suowen Xu; Seyed Hossein Yahyazadeh Jabbari; Hiroshi Yatsuya; Sanni Yaya; Taklo Simeneh Yazie Yazie; Siyan Yi; Naohiro Yonemoto; Ismaeel Yunusa; Siddhesh Zadey; Sojib Bin Zaman; Maryam Zamanian; Nelson Zamora; Mikhail Sergeevich Zastrozhin; Anasthasia Zastrozhina; Zhi-Jiang Zhang; Chenwen Zhong; Mohammad Zmaili; Alimuddin Zumla; Mohsen Naghavi; Maria Inês Schmidt
Background: Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings: In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation: Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier B.V., 2020) Cristiana Abbafati; Kaja M. Abbas; Mohsen Abbasi-Kangevari; Foad Abd-Allah; Ahmed Abdelalim; Mohammad Abdollahi; Ibrahim Abdollahpour; Kedir Hussein Abegaz; Hassan Abolhassani; Victor Aboyans; Lucas Guimarães Abreu; Michael R.M. Abrigo; Ahmed Abualhasan; Laith Jamal Abu-Raddad; Abdelrahman I. Abushouk; Maryam Adabi; Victor Adekanmbi; Abiodun Moshood Adeoye; Olatunji O. Adetokunboh; Davoud Adham; Shailesh M. Advani; Ashkan Afshin; Gina Agarwal; Seyed Mohammad Kazem Aghamir; Anurag Agrawal; Tauseef Ahmad; Keivan Ahmadi; Mehdi Ahmadi; Hamid Ahmadieh; Muktar Beshir Ahmed; Temesgen Yihunie Akalu; Rufus Olusola Akinyemi; Tomi Akinyemiju; Blessing Akombi; Chisom Joyqueenet Akunna; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Samiah Alam; Tahiya Alam; Fahad Mashhour Alanezi; Turki M. Alanzi; Biresaw Wassihun Alemu; Khalid F. Alhabib; Muhammad Ali; Saqib Ali; Gianfranco Alicandro; Cyrus Alinia; Vahid Alipour; Hesam Alizade; Syed Mohamed Aljunid; François Alla; Peter Allebeck; Amir Almasi-Hashiani; Hesham M. Al-Mekhlafi; Jordi Alonso; Khalid A. Altirkawi; Mostafa Amini-Rarani; Fatemeh Amiri; Dickson A. Amugsi; Robert Ancuceanu; Deanna Anderlini; Jason A. Anderson; Catalina Liliana Andrei; Tudorel Andrei; Colin Angus; Mina Anjomshoa; Fereshteh Ansari; Alireza Ansari-Moghaddam; Ippazio Cosimo Antonazzo; Carl Abelardo T. Antonio; Catherine M. Antony; Ernoiz Antriyandarti; Davood Anvari; Razique Anwer; Seth Christopher Yaw Appiah; Jalal Arabloo; Morteza Arab-Zozani; Aleksandr Y. Aravkin; Filippo Ariani; Bahram Armoon; Johan Ärnlöv; Afsaneh Arzani; Mehran Asadi-Aliabadi; Ali A. Asadi-Pooya; Charlie Ashbaugh; Michael Assmus; Zahra Atafar; Desta Debalkie Atnafu; Maha Moh'd Wahbi Atout; Floriane Ausloos; Marcel Ausloos; Beatriz Paulina Ayala Quintanilla; Getinet Ayano; Martin Amogre Ayanore; Samad Azari; Ghasem Azarian; Zelalem Nigussie Azene; Alaa Badawi; Ashish D. Badiye; Mohammad Amin Bahrami; Mohammad Hossein Bakhshaei; Ahad Bakhtiari; Shankar M. Bakkannavar; Alberto Baldasseroni; Kylie Ball; Shoshana H. Ballew; Daniela Balzi; Maciej Banach; Srikanta K. Banerjee; Agegnehu Bante Bante; Adhanom Gebreegziabher Baraki; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Lope H. Barrero; Celine M. Barthelemy; Lingkan Barua; Sanjay Basu; Bernhard T. Baune; Mohsen Bayati; Jacob S. Becker; Neeraj Bedi; Ettore Beghi; Yannick Béjot; Michelle L. Bell; Fiona B. Bennitt; Isabela M. Bensenor; Kidanemaryam Berhe; Adam E. Berman; Akshaya Srikanth Bhagavathula; Reshmi Bhageerathy; Neeraj Bhala; Dinesh Bhandari; Krittika Bhattacharyya; Zulfiqar A. Bhutta; Ali Bijani; Boris Bikbov; Muhammad Shahdaat Bin Sayeed; Antonio Biondi; Binyam Minuye Birihane; Catherine Bisignano; Raaj Kishore Biswas; Helen Bitew; Somayeh Bohlouli; Mehdi Bohluli; Alexandra S. Boon-Dooley; Guilherme Borges; Antonio Maria Borzì; Shiva Borzouei; Cristina Bosetti; Soufiane Boufous; Dejana Braithwaite; Michael Brauer; Nicholas J.K. Breitborde; Susanne Breitner; Hermann Brenner; Paul Svitil Briant; Andrey Nikolaevich Briko; Nikolay Ivanovich Briko; Gabrielle B. Britton; Dana Bryazka; Blair R. Bumgarner; Katrin Burkart; Richard Thomas Burnett; Sharath Burugina Nagaraja; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Leah E. Cahill; Luis Alberto Cámera; Ismael R. Campos-Nonato; Rosario Cárdenas; Giulia Carreras; Juan J. Carrero; Felix Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A. Castañeda-Orjuela; Giulio Castelpietra; Franz Castro; Kate Causey; Christopher R. Cederroth; Kelly M. Cercy; Ester Cerin; Joht Singh Chandan; Kai-Lan Chang; Fiona J. Charlson; Vijay Kumar Chattu; Sarika Chaturvedi; Nicolas Cherbuin; Odgerel Chimed-Ochir; Daniel Youngwhan Cho; Jee-Young Jasmine Choi; Hanne Christensen; Dinh-Toi Chu; Michael T. Chung; Sheng-Chia Chung; Flavia M. Cicuttini; Liliana G. Ciobanu; Massimo Cirillo; Thomas Khaled Dwayne Classen; Aaron J. Cohen; Kelly Compton; Owen R. Cooper; Vera Marisa Costa; Ewerton Cousin; Richard G. Cowden; Di H. Cross; Jessica A. Cruz; Saad M.A. Dahlawi; Albertino Antonio Moura Damasceno; Giovanni Damiani; Lalit Dandona; Rakhi Dandona; William James Dangel; Anna-Karin Danielsson; Paul I. Dargan; Aso Mohammad Darwesh; Ahmad Daryani; Jai K. Das; Rajat Das Gupta; José das Neves; Claudio Alberto Dávila-Cervantes; Dragos Virgil Davitoiu; Diego De Leo; Louisa Degenhardt; Marissa DeLang; Robert Paul Dellavalle; Feleke Mekonnen Demeke; Gebre Teklemariam Demoz; Desalegn Getnet Demsie; Edgar Denova-Gutiérrez; Nikolaos Dervenis; Govinda Prasad Dhungana; Mostafa Dianatinasab; Diana Dias da Silva; Daniel Diaz; Zahra Sadat Dibaji Forooshani; Shirin Djalalinia; Hoa Thi Do; Klara Dokova; Fariba Dorostkar; Leila Doshmangir; Tim Robert Driscoll; Bruce B. Duncan; Andre Rodrigues Duraes; Arielle Wilder Eagan; David Edvardsson; Nevine El Nahas; Iman El Sayed; Maha El Tantawi; Iffat Elbarazi; Islam Y. Elgendy; Shaimaa I. El-Jaafary; Iqbal R.F. Elyazar; Sophia Emmons-Bell; Holly E. Erskine; Sharareh Eskandarieh; Saman Esmaeilnejad; Alireza Esteghamati; Kara Estep; Arash Etemadi; Atkilt Esaiyas Etisso; Jessica Fanzo; Mohammad Farahmand; Mohammad Fareed; Roghiyeh Faridnia; Andrea Farioli; Andre Faro; Mithila Faruque; Farshad Farzadfar; Nazir Fattahi; Mehdi Fazlzadeh; Valery L. Feigin; Rachel Feldman; Seyed-Mohammad Fereshtehnejad; Eduarda Fernandes; Giannina Ferrara; Alize J. Ferrari; Manuela L. Ferreira; Irina Filip; Florian Fischer; James L. Fisher; Luisa Sorio Flor; Nataliya A. Foigt; Morenike Oluwatoyin Folayan; Artem Alekseevich Fomenkov; Lisa M. Force; Masoud Foroutan; Richard Charles Franklin; Marisa Freitas; Weijia Fu; Takeshi Fukumoto; João M. Furtado; Mohamed M. Gad; Emmanuela Gakidou; Silvano Gallus; Alberto L. Garcia-Basteiro; William M. Gardner; Biniyam Sahiledengle Geberemariyam; Assefa Ayalew Ayalew Ayalew Gebreslassie; Abraham Geremew; Anna Gershberg Hayoon; Peter W. Gething; Maryam Ghadimi; Keyghobad Ghadiri; Fatemeh Ghaffarifar; Mansour Ghafourifard; Farhad Ghamari; Ahmad Ghashghaee; Hesam Ghiasvand; Nermin Ghith; Asadollah Gholamian; Rakesh Ghosh; Paramjit Singh Gill; Themba G. Ginindza; Giorgia Giussani; Elena V. Gnedovskaya; Salime Goharinezhad; Sameer Vali Gopalani; Giuseppe Gorini; Houman Goudarzi; Alessandra C. Goulart; Felix Greaves; Michal Grivna; Giuseppe Grosso; Mohammed Ibrahim Mohialdeen Gubari; Harish Chander Gugnani; Rafael Alves Guimarães; Rashid Abdi Guled; Gaorui Guo; Yuming Guo; Rajeev Gupta; Tarun Gupta; Beatrix Haddock; Nima Hafezi-Nejad; Abdul Hafiz; Arvin Haj-Mirzaian; Arya Haj-Mirzaian; Brian J. Hall; Iman Halvaei; Randah R. Hamadeh; Samer Hamidi; Melanie S. Hammer; Graeme J. Hankey; Hamidreza Haririan; Josep Maria Haro; Ahmed I. Hasaballah; Md Mehedi Hasan; Edris Hasanpoor; Abdiwahab Hashi; Soheil Hassanipour; Hadi Hassankhani; Rasmus J. Havmoeller; Simon I. Hay; Khezar Hayat; Golnaz Heidari; Reza Heidari-Soureshjani; Hannah J. Henrikson; Molly E. Herbert; Claudiu Herteliu; Fatemeh Heydarpour; Thomas R. Hird; Hans W. Hoek; Ramesh Holla; Praveen Hoogar; H. Dean Hosgood; Naznin Hossain; Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mowafa Househ; Mohamed Hsairi; Vivian Chia-Rong Hsieh; Guoqing Hu; Kejia Hu; Tanvir M. Huda; Ayesha Humayun; Chantal K. Huynh; Bing-Fang Hwang; Vincent C. Iannucci; Segun Emmanuel Ibitoye; Nayu Ikeda; Kevin S. Ikuta; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Leeberk Raja Inbaraj; Helen Ippolito; Usman Iqbal; Seyed Sina Naghibi Irvani; Caleb Mackay Salpeter Irvine; M. Mofizul Islam; Sheikh Mohammed Shariful Islam; Hiroyasu Iso; Rebecca Q. Ivers; Chidozie C.D. Iwu; Chinwe Juliana Iwu; Ihoghosa Osamuyi Iyamu; Jalil Jaafari; Kathryn H. Jacobsen; Hussain Jafari; Morteza Jafarinia; Mohammad Ali Jahani; Mihajlo Jakovljevic; Farzad Jalilian; Spencer L. James; Hosna Janjani; Tahereh Javaheri; Javad Javidnia; Panniyammakal Jeemon; Ensiyeh Jenabi; Ravi Prakash Jha; Vivekanand Jha; John S. Ji; Lars Johansson; Oommen John; Yetunde O. John-Akinola; Catherine Owens Johnson; Jost B. Jonas; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; Ali Kabir; Zubair Kabir; Hamed Kalani; Rizwan Kalani; Leila R. Kalankesh; Rohollah Kalhor; Tanuj Kanchan; Neeti Kapoor; Behzad Karami Matin; André Karch; Mohd Anisul Karim; Getachew Mullu Kassa; Srinivasa Vittal Katikireddi; Gbenga A. Kayode; Ali Kazemi Karyani; Peter Njenga Keiyoro; Cathleen Keller; Laura Kemmer; Parkes J. Kendrick; Nauman Khalid; Mohammad Khammarnia; Ejaz Ahmad Khan; Maseer Khan; Khaled Khatab; Mona M. Khater; Mahalaqua Nazli Khatib; Maryam Khayamzadeh; Salman Khazaei; Christian Kieling; Yun Jin Kim; Ruth W. Kimokoti; Adnan Kisa; Sezer Kisa; Mika Kivimäki; Luke D. Knibbs; Ann Kristin Skrindo Knudsen; Jonathan M. Kocarnik; Sonali Kochhar; Jacek A. Kopec; Vladimir Andreevich Korshunov; Parvaiz A. Koul; Ai Koyanagi; Moritz U.G. Kraemer; Kewal Krishan; Kris J. Krohn; Hans Kromhout; Barthelemy Kuate Defo; G. Anil Kumar; Vivek Kumar; Om P. Kurmi; Dian Kusuma; Carlo La Vecchia; Ben Lacey; Dharmesh Kumar Lal; Ratilal Lalloo; Tea Lallukka; Faris Hasan Lami; Iván Landires; Justin J. Lang; Sinéad M. Langan; Anders O. Larsson; Savita Lasrado; Paolo Lauriola; Jeffrey V. Lazarus; Paul H. Lee; Shaun Wen Huey Lee; Kate E. Legrand; James Leigh; Matilde Leonardi; Haley Lescinsky; Janni Leung; Miriam Levi; Shanshan Li; Lee-Ling Lim; Shai Linn; Shiwei Liu; Simin Liu; Yang Liu; Justin Lo; Alan D. Lopez; Jaifred Christian F. Lopez; Platon D. Lopukhov; Stefan Lorkowski; Paulo A. Lotufo; Alton Lu; Alessandra Lugo; Emilie R. Maddison; Phetole Walter Mahasha; Mokhtar Mahdavi Mahdavi; Morteza Mahmoudi; Azeem Majeed; Afshin Maleki; Shokofeh Maleki; Reza Malekzadeh; Deborah Carvalho Malta; Abdullah A. Mamun; Ana Laura Manda; Helena Manguerra; Fariborz Mansour-Ghanaei; Borhan Mansouri; Mohammad Ali Mansournia; Ana M. Mantilla Herrera; Joemer C. Maravilla; Ashley Marks; Randall V. Martin; Santi Martini; Francisco Rogerlândio Martins-Melo; Anthony Masaka; Seyedeh Zahra Masoumi; Manu Raj Mathur; Kunihiro Matsushita; Pallab K. Maulik; Colm McAlinden; John J. McGrath; Martin McKee; Man Mohan Mehndiratta; Fereshteh Mehri; Kala M. Mehta; Ziad A. Memish; Walter Mendoza; Ritesh G. Menezes; Endalkachew Worku Mengesha; Alibek Mereke; Seid Tiku Mereta; Atte Meretoja; Tuomo J. Meretoja; Tomislav Mestrovic; Bartosz Miazgowski; Tomasz Miazgowski; Irmina Maria Michalek; Ted R. Miller; Edward J. Mills; G.K. Mini; Mohammad Miri; Andreea Mirica; Erkin M. Mirrakhimov; Hamed Mirzaei; Maryam Mirzaei; Roya Mirzaei; Mehdi Mirzaei-Alavijeh; Awoke Temesgen Misganaw; Prasanna Mithra; Babak Moazen; Dara K. Mohammad; Yousef Mohammad; Naser Mohammad Gholi Mezerji; Abdollah Mohammadian-Hafshejani; Noushin Mohammadifard; Reza Mohammadpourhodki; Ammas Siraj Mohammed; Hussen Mohammed; Jemal Abdu Mohammed; Shafiu Mohammed; Ali H. Mokdad; Mariam Molokhia; Lorenzo Monasta; Meghan D. Mooney; Ghobad Moradi; Masoud Moradi; Maziar Moradi-Lakeh; Rahmatollah Moradzadeh; Paula Moraga; Lidia Morawska; Joana Morgado-Da-Costa; Shane Douglas Morrison; Abbas Mosapour; Jonathan F. Mosser; Simin Mouodi; Seyyed Meysam Mousavi; Amin Mousavi Khaneghah; Ulrich Otto Mueller; Satinath Mukhopadhyay; Erin C. Mullany; Kamarul Imran Musa; Saravanan Muthupandian; Ashraf F. Nabhan; Mehdi Naderi; Ahamarshan Jayaraman Nagarajan; Gabriele Nagel; Mohsen Naghavi; Behshad Naghshtabrizi; Mukhammad David Naimzada; Farid Najafi; Vinay Nangia; Jobert Richie Nansseu; Morteza Naserbakht; Vinod C. Nayak; Ionut Negoi; Josephine W. Ngunjiri; Cuong Tat Nguyen; Huong Lan Thi Nguyen; Ming Nguyen; Yeshambel T. 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Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
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Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding: Bill & Melinda Gates Foundation. © 2020 Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license