Browsing by Author "Goenka, S"

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    A cross sectional study of the microeconomic impact of cardiovascular disease hospitalization in four Low and Middle –Income Countrie
    (PLoS One, 2011) Huffman, MD; Rao, KD; Pichon-Riviere, A; Zhao, D; Harikrishnan, S; Ramaiya, K; Ajay, VS; Goenka, S; Calcagno, JI; Caporale, JE; Niu, S; Li Y; Liu, J; Thankappan, KR; Daivadanam, M; Esch, JV; Murphy, A; Moran, AE; Gaziano, TA; Suhrcke, M; Reddy, KS; Leeder, S; Prabhakaran, D
    OBJECTIVE: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and middle-income countries (LMIC). BACKGROUND: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. METHODS AND FINDINGS: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. CONCLUSIONS: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.
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    A Cross-Sectional Study of the Microeconomic Impact of Cardiovascular Disease Hospitalization in Four Low- and Middle-Income Countries
    (PLOS ONE, 2011) Huffman, MD; Rao, KD; Pichon-Riviere, A; Zhao, D; Harikrishnan, S; Ramaiya, K; Ajay, VS; Goenka, S; Calcagno, JI; Caporale, JE; Niu, SL; Li, Y; Liu, J; Thankappan, KR; Daivadanam, M; van Esch, J; Murphy, A; Moran, AE; Gaziano, TA; Suhrcke, M; Reddy, KS; Leeder, S; Prabhakaran, D
    Objective: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low-and middle-income countries (LMIC). Background: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. Methods and Findings: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. Conclusions: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.
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    DISTRIBUTION OF 10-YEAR AND LIFETIME PREDICTED RISK FOR CARDIOVASCULAR DISEASE IN THE INDIAN SENTINEL SURVEILLANCE STUDY POPULATION
    (JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2011) Jeemon, P; Prabhakaran, D; Huffman, M; Goenka, S; Ramakrishnan, L; Thankappan, KR; Mohan, V; Joshi, PP; Lloyd-Jones, DM; Reddy, KS
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    Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results)
    (BMJ OPEN, 2011) Jeemon, P; Prabhakaran, D; Huffman, MD; Ramakrishnan, L; Goenka, S; Thankappan, KR; Mohan, V; Joshi, PP; Mohan, BVM; Ahmed, F; Ramanathan, M; Ahuja, R; Chaturvedi, V; Lloyd-Jones, DM; Reddy, KS
    Introduction: Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date. Methods: The authors estimated short-term and lifetime predicted CVD risk among 10 054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (>= 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups. Results: The mean age (SD) of the study population (men=63%) was 40.8 +/- 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively. Conclusion: Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.
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    Distribution of 10-year lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (Cross –sectional survey results).
    (BMJ Open, 2011) Jeemon, P; Prabhakaran, D; Huffman, MD; Ramakrishnan, L; Goenka, S; Thankappan, KR; Mohan, V; Joshi, PP; Mohan, BVM; Ahmed, F; Ramanathan, M; Ajuja, R; Chaturvedi, V; Lloyd-Jones, D; Reddy, KS
    Introduction:Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date.METHODS:The authors estimated short-term and lifetime predicted CVD risk among 10,054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (? 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups.RESULTS: The mean age (SD) of the study population (men=63%) was 40.8 ± 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively.CONCLUSION: Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.
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    Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015
    (LANCET HIV) Wang, HD; Wolock, TM; Carter, A; Nguyen, G; Kyu, HH; Gakidou, E; Hay, SI; Mills, EJ; Trickey, A; Msemburi, W; Coates, MM; Mooney, MD; Fraser, MS; Sligar, A; Salomon, J; Larson, HJ; Friedman, J; Abajobir, AA; Abate, KH; Abbas, KM; Abd El Razek, MM; Abd-Allah, F; Abdulle, AM; Abera, SF; Abubakar, I; Abu-Raddad, LJ; Abu-Rmeileh, NME; Abyu, GY; Adebiyi, AO; Adedeji, IA; Adelekan, AL; Adofo, K; Adou, AK; Ajala, ON; Akinyemiju, TF; Akseer, N; Al Lami, FH; Al-Aly, Z; Alam, K; Alam, NKM; Alasfoor, D; Aldhahri, SFS; Aldridge, RW; Alegretti, MA; Aleman, AV; Alemu, ZA; Alfonso-Cristancho, R; Ali, R; Alkerwi, A; Alla, F; Al-Raddadi, RMS; Alsharif, U; Alvarez, E; Alvis-Guzman, N; Amare, AT; Amberbir, A; Amegah, AK; Ammar, W; Amrock, SM; Antonio, CAT; Anwari, P; Auml; rnlov, J; Al Artaman,; Asayesh, H; Asghar, RJ; Assadi, R; Atique, S; Atkins, LS; Avokpaho, EFGA; Awasthi, A; Quintanilla, BPA; Bacha, U; Badawi, A; Barac, A; Barnighausen, T; Basu, A; Bayou, TA; Bayou, YT; Bazargan-Hejazi, S; Beardsley, J; Bedi, N; Bennett, DA; Bensenor, IM; Betsu, BD; Beyene, AS; Bhatia, E; Bhutta, ZA; Biadgilign, S; Bikbov, B; Birlik, SM; Bisanzio, D; Brainin, M; Brazinova, A; Breitborde, NJK; Brown, A; Burch, M; Butt, ZA; Campuzano, JC; Cardenas, R; Carrero, JJ; Castaneda-Orjuela, CA; Rivas, JC; Catala-Lopez, F; Chang, HY; Chang, JC; Chavan, L; Chen, WQ; Chiang, PPC; Chibalabala, M; Chisumpa, VH; Choi, JYJ; Christopher, DJ; Ciobanu, LG; Cooper, C; Dahiru, T; Damtew, SA; Dandona, L; Dandona, R; das Neves, J; de Jager, P; De Leo, D; Degenhardt, L; Dellavalle, RP; Deribe, K; Deribew, A; Jarlais, DCD; Dharmaratne, SD; Ding, EL; Doshi, PP; Driscoll, TR; Dubey, M; Elshrek, YM; Elyazar, I; Endries, AY; Ermakov, SP; Eshrati, B; Esteghamati, A; Faghmous, IDA; Sofia e Sa Farinha, C; Faro, A; Farvid, MS; Farzadfar, F; Fereshtehnejad, SM; Fernandes, JC; Fischer, F; Fitchett, JRA; Foigt, N; Fullman, N; Furst, T; Gankpe, FG; Gebre, T; Gebremedhin, AT; Gebru, AA; Geleijnse, JM; Gessner, BD; Gething, PW; Ghiwot, TT; Giroud, M; Gishu, MD; Glaser, E; Goenka, S; Goodridge, A; Gopalani, SV; Goto, A; Gugnani, HC; Guimaraes, MDC; Gupta, R; Gupta, R; Gupta, V; Haagsma, J; Hafezi-Nejad, N; Hagan, H; Hailu, GB; Hamadeh, RR; Hamidi, S; Hammami, M; Hankey, GJ; Hao, YT; Harb, HL; Harikrishnan, S; Haro, JM; Harun, KM; Havmoeller, R; Hedayati, MT; Heredia-Pi, IB; Hoek, HW; Horino, M; Horita, N; Hosgood, HD; Hoy, DG; Hsairi, M; Hu, GQ; Huang, H; Huang, JJ; Iburg, KM; Idrisov, BT; Innos, K; Iyer, VJ; Jacobsen, KH; Jahanmehr, N; Jakovljevic, MB; Javanbakht, M; Jayatilleke, AU; Jeemon, P; Jha, V; Jiang, GH; Jiang, Y; Jibat, T; Jonas, JB; Kabir, Z; Kamal, R; Kan, HD; Karch, A; Karema, CK; Karletsos, D; Kasaeian, A; Kaul, A; Kawakami, N; Kayibanda, JF; Keiyoro, PN; Kemp, AH; Kengne, AP; Kesavachandran, CN; Khader, YS; Khalil, I; Khan, AR; Khan, EA; Khang, YH; Khubchandani, J; Kim, YJ; Kinfu, Y; Kivipelto, M; Kokubo, Y; Kosen, S; Koul, PA; Koyanagi, A; Defo, BK; Bicer, BK; Kulkarni, VS; Kumar, GA; Lal, DK; Lam, H; Lam, JO; Langan, SM; Lansingh, VC; Larsson, A; Leigh, J; Leung, R; Li, YM; Lim, SS; Lipshultz, SE; Liu, SW; Lloyd, BK; Logroscino, G; Lotufo, PA; Lunevicius, R; Abd El Razek, HM; Mahdavi, M; Majdan, M; Majeed, A; Makhlouf, C; Malekzadeh, R; Mapoma, CC; Marcenes, W; Martinez-Raga, J; Marzan, MB; Masiye, F; Mason-Jones, AJ; Mayosi, BM; Mckee, M; Meaney, PA; Mehndiratta, MM; Mekonnen, AB; Melaku, YA; Memiah, P; Memish, ZA; Mendoza, W; Meretoja, A; Meretoja, TJ; Mhimbira, FA; Miller, TR; Mikesell, J; Mirarefin, M; Mohammad, KA; Mohammed, S; Mokdad, AH; Monasta, L; Moradi-Lakeh, M; Mori, R; Mueller, UO; Murimira, B; Murthy, GVS; Naheed, A; Naldi, L; Nangia, V; Nash, D; Nawaz, H; Nejjari, C; Ngalesoni, FN; Ngirabega, JDD; Le Nguyen, Q; Nisar, MI; Norheim, OF; Norman, RE; Nyakarahuka, L; Ogbo, FA; Oh, IH; Ojelabi, FA; Olusanya, BO; Olusanya, JO; Opio, JN; Oren, E; Ota, E; Padukudru, MA; Park, HY; Park, JH; Patil, ST; Patten, SB; Paul, VK; Pearson, K; Peprah, EK; Pereira, CC; Perico, N; Pesudovs, K; Petzold, M; Phillips, MR; Pillay, JD; Plass, D; Polinder, S; Pourmalek, F; Prokop, DM; Qorbani, M; Rafay, A; Rahimi, K; Rahimi-Movaghar, V; Rahman, M; Rahman, MHU; Rahman, SU; Rai, RK; Rajsic, S; Ram, U; Rana, SM; Rao, PV; Remuzzi, G; Rojas-Rueda, D; Ronfani, L; Roshandel, G; Roy, A; Ruhago, GM; Saeedi, MY; Sagar, R; Saleh, MM; Sanabria, JR; Santos, IS; Sarmiento-Suarez, R; Sartorius, B; Sawhney, M; Schutte, AE; Schwebel, DC; Seedat, S; Sepanlou, SG; Servan-Mori, EE; Shaikh, MA; Sharma, R; She, J; Sheikhbahaei, S; Shen, JB; Shibuya, K; Shin, HH; Sigfusdottir, ID; Silpakit, N; Silva, DAS; Silveira, DGA; Simard, EP; Sindi, S; Singh, JA; Singh, OP; Singh, PK; Skirbekk, V; Sliwa, K; Soneji, S; Sorensen, RJD; Soriano, JB; Soti, DO; Sreeramareddy, CT; Stathopoulou, V; Steel, N; Sunguya, BF; Swaminathan, S; Sykes, BL; Tabares-Seisdedos, R; Talongwa, RT; Tavakkoli, M; Taye, B; Tedla, BA; Tekle, T; Shifa, GT; Temesgen, AM; Terkawi, AS; Tesfay, FH; Tessema, GA; Thapa, K; Thomson, AJ; Thorne-Lyman, AL; Tobe-Gai, R; Topor-Madry, R; Towbin, JA; Tran, BX; Dimbuene, ZT; Tsilimparis, N; Tura, AK; Ukwaja, KN; Uneke, CJ; Uthman, OA; Venketasubramanian, N; Vladimirov, SK; Vlassov, VV; Vollset, SE; Wang, LH; Weiderpass, E; Weintraub, RG; Werdecker, A; Westerman, R; Wijeratne, T; Wilkinson, JD; Wiysonge, CS; Wolfe, CDA; Won, SH; Wong, JQ; Xu, GL; Yadav, AK; Yakob, B; Yalew, AZ; Yano, YC; Yaseri, M; Yebyo, HG; Yip, P; Yonemoto, N; Yoon, SJ; Younis, MZ; Yu, CH; Yu, SC; Zaidi, Z; Zaki, ME; Zeeb, H; Zhang, H; Zhao, Y; Zodpey, S; Zoeckler, L; Zuhlke, LJ; Lopez, AD; Murray, CJL
    Background Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings Global HIV incidence reached its peak in 1997, at 3.3 million new infections (95% uncertainty interval [UI] 3.1-3.4 million). Annual incidence has stayed relatively constant at about 2.6 million per year (range 2.5-2.8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38.8 million (95% UI 37.6-40.4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1.8 million deaths (95% UI 1.7-1.9 million) in 2005, to 1.2 million deaths (1.1-1.3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
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    Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
    (LANCET) Forouzanfar, MH; Afshin, A; Alexander, LT; Anderson, HR; Bhutta, ZA; Biryukov, S; Brauer, M; Burnett, R; Cercy, K; Charlson, FJ; Cohen, AJ; Dandona, L; Estep, K; Ferrari, AJ; Frostad, JJ; Fullman, N; Gething, PW; Godwin, WW; Griswold, M; Kinfu, Y; Kyu, HH; Larson, HJ; Liang, X; Lim, SS; Liu, PY; Lopez, AD; Lozano, R; Marczak, L; Mensah, GA; Mokdad, AH; Moradi-Lakeh, M; Naghavi, M; Neal, B; Reitsma, MB; Roth, GA; Salomon, JA; Sur, PJ; Vos, T; Wagner, JA; Wang, H; Zhao, Y; Zhou, M; Aasvang, GM; Abajobir, AA; Abate, KH; Abbafati, C; Abbas, KM; Abd-Allah, F; Abdulle, AM; Abera, SF; Abraham, B; Abu-Raddad, LJ; Abyu, GY; Adebiyi, AO; Adedeji, IA; Ademi, Z; Adou, AK; Adsuar, JC; Agardh, EE; Agarwal, A; Agrawal, A; Kiadaliri, AA; Ajala, ON; Akinyemiju, TF; Al-Aly, Z; Alam, K; Alam, NKM; Aldhahri, SF; Aldridge, RW; Alemu, ZA; Ali, R; Alkerwi, A; Alla, F; Allebeck, P; Alsharif, U; Altirkawi, KA; Martin, EA; Alvis-Guzman, N; Amare, AT; Amberbir, A; Amegah, AK; Amini, H; Ammar, W; Amrock, SM; Andersen, HH; Anderson, BO; Antonio, CAT; Anwar, P; Arnlov, J; Al Artaman; Asayesh, H; Asghar, RJ; Assadi, R; Atique, S; Avokpaho, EFGA; Awasthi, A; Quintanilla, BPA; Azzopardi, P; Bacha, U; Badawi, A; Bahit, MC; Balakrishnan, K; Barac, A; Barber, RM; Barker-Collo, SL; Barnighausen, T; Barquera, S; Barregard, L; Barrero, LH; Basu, S; Bans, C; Bazargan-Hejazi, S; Beardsley, J; Bedi, N; Beghi, E; Bell, ML; Bello, AK; Bennett, DA; Bensenor, IM; Berhane, A; Bernabe, E; Betsu, BD; Beyene, AS; Bhala, N; Bhansali, A; Bhatt, S; Biadgilign, S; Bikbov, B; Bisanzio, D; Bjertness, E; Blore, JD; Borschmann, R; Boufous, S; Bourne, RRA; Brainin, M; Brazinova, A; Breitborde, NJK; Brenner, H; Broday, DM; Brugha, TS; Brunekreef, B; Butt, ZA; Cahill, LE; Calabria, B; Campos-Nonato, IR; Cardenas, R; Carpenter, D; Casey, DC; Castaneda-Oquela, CA; Rivas, JC; Castro, RE; Catala-Lopez, F; Chang, JC; Chiang, PPC; Chibalabala, M; Chimed-Ochir, O; Chisumpa, VH; Chitheer, AA; Choi, JYJ; Christensen, H; Christopher, DJ; Ciobanu, LG; Coates, MM; Colquhoun, SM; Cooper, LT; Cooperrider, K; Cornaby, L; Cortinovis, M; Crump, JA; Cuevas-Nasu, L; Damasceno, A; Dandona, R; Darby, SC; Dargan, PI; das Neves, J; Davis, AC; Davletov, K; de Castro, EF; De la Cruz-Gongora, V; De Leo, D; Degenhardt, L; Del Gobbo, LC; del Pozo-Cruz, B; Dellavalle, RP; Deribew, A; Des Jarlais, DC; Dharmaratne, SD; Dhillon, PK; Diaz-Tome, C; Dicker, D; Ding, EL; Dorsey, ER; Doyle, KE; Driscoll, TR; Duan, L; Dubey, M; Duncan, BB; Elyazar, I; Endries, AY; Ermakov, SP; Erskine, HE; Eshrati, B; Esteghamati, A; Fahimi, S; Faraon, EJA; Farid, TA; Farinha, CSES; Faro, A; Farvid, MS; Farzadfar, F; Feigin, VL; Fereshtehnejad, SM; Fernandes, JG; Fischer, F; Fitchett, JRA; Fleming, T; Foigt, N; Foreman, K; Fowkes, FGR; Franklin, RC; Furst, T; Futran, ND; Gakidou, E; Garcia-Basteiro, AL; Gebrehiwot, TT; Gebremedhin, AT; Geleijnse, JM; Gessner, BD; Giref, AZ; Giroud, M; Gishu, MD; Goenka, S; Gomez-Cabrera, MC; Gomez-Dantes, H; Gona, P; Goodridge, A; Gopalani, SV; Gotay, CC; Goto, A; Gouda, HN; Gugnani, HC; Guillemin, F; Guo, YM; Gupta, R; Gupta, R; Gutierrez, RA; Haagsma, JA; Hafezi-Nejad, N; Haile, D; Hailu, GB; Halasa, YA; Hamadeh, RR; Hamidi, S; Handal, AJ; Hankey, GJ; Hao, YT; Harb, HL; Harikrishnan, S; Haro, JM; Hassanvand, MS; Hassen, TA; Havmoeller, R; Heredia-Pi, IB; Hernandez-Llanes, NF; Heydarpour, P; Hoek, HW; Hoffman, HJ; Horino, M; Horita, N; Hosgood, HD; Hoy, DG; Hsairi, M; Htet, AS; Hu, G; Huang, JJ; Husseini, A; Hutchings, SJ; Huybrechts, I; Iburg, KM; Idrisov, BT; Ileanu, BV; Inoue, M; Jacobs, TA; Jacobsen, KH; Jahanmehr, N; Jakovljevic, MB; Jansen, HAFM; Jassal, SK; Javanbakht, M; Jayatilleke, AU; Jee, SH; Jeemon, P; Jha, V; Jiang, Y; Jibat, T; Jin, Y; Johnson, CO; Jonas, JB; Kabir, Z; Kalkonde, Y; Kamal, R; Kan, H; Karch, A; Karema, CK; Karimkhani, C; Kasaeian, A; Kaul, A; Kawakami, N; Kazi, DS; Keiyoro, PN; Kemp, AH; Kengne, AP; Keren, A; Kesavachandran, CN; Khader, YS; Khan, AR; Khan, EA; Khan, G; Khang, YH; Khatibzadeh, S; Khera, S; Khoja, TAM; Khubchandani, J; Kieling, C; Kim, CI; Kim, D; Kimokoti, RW; Kissoon, N; Kivipelto, M; Knibbs, LD; Kokubo, Y; Kopec, JA; Koul, PA; Koyanagi, A; Kravchenko, M; Kromhout, H; Krueger, H; Ku, T; Defo, BK; Kuchenbecker, RS; Bicer, BK; Kuipers, EJ; Kumar, GA; Kwan, GF; Lal, DK; Lalloo, R; Lallukka, T; Lan, Q; Larsson, A; Latif, AA; Lawrynowicz, AEB; Leasher, JL; Leigh, J; Leung, J; Levi, M; Li, XH; Li, YC; Liang, J; Liu, SW; Lloyd, BK; Logroscino, G; Lotufo, PA; Lunevicius, R; Maclntyre, M; Mahdavi, M; Majdan, M; Majeed, A; Malekzadeh, R; Malta, DC; Manamo, WAA; Mapoma, CC; Marcenes, W; Martin, RV; Martinez-Raga, J; Masiye, F; Matsushita, K; Matzopoulos, R; Mayosi, BM; McGrath, JJ; McKee, M; Meaney, PA; Medina, C; Mehari, A; Mena-Rodriguez, F; Mekonnen, AB; Melaku, YA; Memish, ZA; Mendoza, W; Mensink, GBM; Meretoja, A; Meretoja, TJ; Mesfin, YM; Mhimbira, FA; Miller, TR; Mills, EJ; Mirarefin, M; Misganaw, A; Mock, CN; Mohammadi, A; Mohammed, S; Mola, GLD; Monasta, L; Hernandez, JCM; 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    Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd.
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    Impact of a worksite intervention program on cardiovascular risk factors: A demonstration project in an industrial population
    (Journal of American College of Cardiology, 2009) Prabhakaran, D; Jeemon, P; Goenka, S; Lakshmy, R; Thankappan, KR; Ahmed, F; Joshi, P; Mohan, BVM; Meera, R; Das, MS; Ahuja, RC; Saran, RK; Chaturvedi, V; Reddy, KS
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    Impact of comprehensive cardiovascular risk reduction program on risk factor clustering associated with elevated blood pressure in an Indian industrial population.
    (Indian Journal of Medical Research, 2012) Jeemon, P; Prabhakaran, D; Goenka, S; Ramakrishnan, L; Padmanabhan, S; Huffman, M; Joshi, P; Sivasankaran, S; Mohan, BVM; Ahmed, F; Ramanathan, M; Ahuja, R; Sinha, N; Thankappan, KR; Reddy, KS
    Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions.
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    Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population
    (INDIAN JOURNAL OF MEDICAL RESEARCH, 2012) Jeemon, P; Prabhakaran, D; Goenka, S; Ramakrishnan, L; Padmanabhan, S; Huffman, M; Joshi, P; Sivasankaran, S; Mohan, BVM; Ahmed, F; Ramanathan, M; Ahuja, R; Sinha, N; Thankappan, KR; Reddy, KS
    Background & objectives: Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions. Methods: Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group. Results: Mean age of participants was 40.9 +/- 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and > 3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while continued to be high in the control arm without interventions (both within group and between group P < 0.001). The proportion of 'low risk phenotype' increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P < 0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 113.3 to 17.8 per cent in the control arm (P < 0.001). Interpretation & conclusions: Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden.