Browsing by Author "Prabhakaran, D"

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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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    A PROgramme of Lifestyle Intervention in Families for Cardiovascular risk reduction (PROLIFIC Study): design and rationale of a family based randomized controlled trial in individuals with family history of premature coronary heart disease
    (BMC PUBLIC HEALTH, 2017) Jeemon, P; Harikrishnan, S; Sanjay, G; Sivasubramonian, S; Lekha, TR; Padmanabhan, S; Tandon, N; Prabhakaran, D
    Background: Recognizing patterns of coronary heart disease (CHD) risk in families helps to identify and target individuals who may have the most to gain from preventive interventions. The overall goal of the study is to test the effectiveness and sustainability of an integrated care model for managing cardiovascular risk in high risk families. The proposed care model targets the structural and environmental conditions that predispose high risk families to development of CHD through the following interventions: 1) screening for cardiovascular risk factors, 2) providing lifestyle interventions 3) providing a framework for linkage to appropriate primary health care facility, and 4) active follow-up of intervention adherence. Methods: Initially, a formative qualitative research component will gather information on understanding of diseases, barriers to care, specific components of the intervention package and feedback on the intervention. Then a cluster randomized controlled trial involving 740 families comprising 1480 participants will be conducted to determine whether the package of interventions (integrated care model) is effective in reducing or preventing the progression of CHD risk factors and risk factor clustering in families. The sustainability and scalability of this intervention will be assessed through economic (cost-effectiveness analyses) and qualitative evaluation (process outcomes) to estimate value and acceptability. Scalability is informed by cost-effectiveness and acceptability of the integrated cardiovascular risk reduction approach. Discussion: Knowledge generated from this trial has the potential to significantly affect new programmatic policy and clinical guidelines that will lead to improvements in cardiovascular health in India.
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    A simple, cost-effective quality assurance model for measurement of lipids in a large epidemiological study
    (NATIONAL MEDICAL JOURNAL OF INDIA, 2008) Lakshmy, R; Gupta, R; Kartha, CC; Malathi, T; Nigam, PK; Akarte, NR; Sampson, U; Borkotoky, S; Doiphode, DN; Arora, U; Prabhakaran, D; Reddy, KS
    Background. Laboratory measurements are an integral part of epidemiological studies in cardiovascular disease. Standardization and quality assurance is of utmost importance in the context of multicentre studies. Methods. We evaluated a simple and cost-effective method of quality assurance for measurement of total cholesterol, high density lipoprotein (HI)L) cholesterol and triglycerides in a study involving 10 centres. Three methods for quality assessment were used for the study that involved measurement of cholesterol, triglycerides and HDL cholesterol and included internal quality control, external quality control and 10% repeat analysis in addition to a uniform standardized protocol developed for the 10 centres. External quality control material was prepared and circulated by the coordinating laboratory. Results. External quality control material was distributed 20 times during the study. The mean variance index suggested a substantial improvement In the performance of participating laboratories over a period of time for cholesterol and triglycerides. This was also evident in the improvement in per cent technical error as a measure of bias and a higher correlation between replicates of samples analysed In the coordinating laboratory and the participating centres for cholesterol, triglycerides and HDL cholesterol. Conclusion. A cost-effective quality assurance model for laboratory measurement using local capacities was developed and implemented in a multicentre epidemiology study. Such a programme would be useful for developing countries where cost-cutting is important.
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    Association between Gender, Process of Care Measures, and Outcomes in ACS in India: Results from the Detection and Management of Coronary Heart Disease (DEMAT) Registry
    (PLOS ONE, 2013) Pagidipati, NJ; Huffman, MD; Jeemon, P; Gupta, R; Negi, P; Jaison, TM; Sharma, S; Sinha, N; Mohanan, P; Muralidhara, BG; Bijulal, S; Sivasankaran, S; Puri, VK; Jose, J; Reddy, KS; Prabhakaran, D
    Background: Studies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS), though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India. Methods and Results: The Detection and Management of Coronary Heart Disease (DEMAT) Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men) from ten tertiary care centers throughout India between 2007-2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest) rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001). Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p = 0.03), but these differences were attenuated after adjustment (OR = 0.86 (0.62, 1.19)). Neither the outcome of 30-day mortality (OR = 1.40 (0.62, 3.16)) nor MACE (OR = 1.00 (0.67, 1.48)) differed significantly between men and women after adjustment. Conclusions: ACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.
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    Association of high sensitive C-reactive protein (hsCRP) with established cardiovascular risk factors in the Indian population
    (Nutrition & Metabolism, 2011) Jeemon, P; Prabhakaran, D; Ramakrishnan, L; Gupta, R; Ahmed, F; Thankappan, KR; Kartha, CC; Chaturvedi, V; Reddy, KS
    INTRODUCTION: Inflammation, the key regulator of C-reactive protein (CRP) synthesis, plays a pivotal role in atherothrombotic cardiovascular disease.METHODS: High sensitivity CRP (hsCRP) analysis was carried out in randomly selected 600 individuals from the sentinel surveillance study in Indian industrial population (SSIP). The hsCRP was measured quantitatively by turbid metric test using kits from SPINREACT, Spain. We analyzed the association between hsCRP and traditional CVD risk factors in this sub-sample.RESULTS: Complete risk factor data and CRP levels were available from 581/600 individuals. One half (51.2%) of the study subjects were males. Mean age of the study group was 39.2 ± 11.2 years. The Pearson correlation coefficients were in the range of 0.12 for SBP (p = 0.004) to 0.55 for BMI (p < 0.001). The linear regression coefficients ranged from 0.01 for SBP, PG and TC (p < 0.001) to 0.55 for logeTAG (p < 0.001) after adjustment for age, sex and education. The mean of logehsCRP significantly increased (P < 0.001) from individuals with ?1 risk factors (-0.50) to individuals with three or more risk factors (0.60). In the multivariate model, the odds ratios for elevated CRP (CRP ? 2.6 mg/dl) were significantly elevated only in females in comparison to males (1.63, 95% CI; 1.02-2.58), overweight individuals in comparison to normal weight individuals (3.90, 95% CI; 2.34-6.44, p < 0.001), and abdominal obese individuals (1.62, 95% CI; 1.02-2.60, p = 0.04) in comparison to non-obese individuals.CONCLUSION: Clinical measurements of adiposity (body mass index and abdominal obesity) correlate well and can be surrogate for systemic inflammatory state of individuals.
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    Comparison of Risk Models to Predict In-Hospital Mortality for Patients With Acute Coronary Syndrome in India: The CSI-Kerala Risk Score
    (CIRCULATION, 2011) Huffman, MD; Mathew, R; Harikrishnan, S; Krishan, MN; Zachriah, G; Joseph, J; Prabhakaran, D; Faizal, A; Jayagopal, PB; Varghese, PK; Nambiar, A; Mohanan, PP
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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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    Double burden of underweight and overweight among children (10-19 years of age) of employees working in Indian industrial units
    (The National Medical Journal of India, 2009) Jeemon, P; Prabhakaran, D; Mohan, V; Thankappan, KR; Joshi, PP; Ahmed, F; Chaturvedi, V; Reddy, KS
    BACKGROUND: Along with the existing problem of underweight, overweight in children is increasing in the developing world. However, there is little information on its magnitude and pattern in the Indian context. We aimed to study the pattern and correlates of overweight in Indian children and adolescents.METHODS: A total of 3750 children in the age group of 10-19 years, who were family members of randomly selected employees from 10 different industrial sites in India, were surveyed using an interviewer-administered questionnaire. RESULTS: The prevalence of underweight was highest in peri-urban areas (30.2% and 53.2% according to Indian and international criteria, respectively). In urban and highly urban areas, the prevalence of underweight was 14.1% and 9.8%, respectively, according to the Indian criteria, and 27.1% and 19.2%, respectively, according to international criteria. The proportion of overweight children was highest in the highly urban category (19.1% and 13.4% according to Indian and international criteria, respectively). The level of urbanization (OR 3.1 and 4.7 for overweight in urban and highly urban areas, respectively, compared with peri-urban areas, p < 0.001), physical activity (OR 0.4, p < 0.001, in children with physical activity score > or = 75th percentile compared with a score < or = 75th percentile) and frequency of meals outside the home (OR 12, p < 0.001, if > 25% weekly meals taken outside the home compared with < 25% of weekly meals outside home) were significant predictors of overweight. CONCLUSION: There is a double burden of underweight and overweight among Indian children and adolescents.
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    Educational status and cardiovascular risk profile in Indians
    (Proceedings of the National Academy of Sciences, USA, 2007) Reddy, KS; Prabhakaran, D; Jeemon, P; Thankappan, KR; Joshi, P; Chaturvedi, V; Ramakrishnan, L; Ahmed, F
    The inverse graded relationship of education and risk factors of coronary heart disease (CHD) has been reported from Western populations. To examine whether risk factors of CHD are predicted by level of education and influenced by the level of urbanization in Indian industrial populations, a cross-sectional survey (n = 19,973; response rate, 87.6%) was carried out among employees and their family members in 10 medium-to-large industries in highly urban, urban, and periurban regions of India. Information on behavioral, clinical, and biochemical risk factors of CHD was obtained through standardized instruments, and educational status was assessed in terms of the highest educational level attained. Data from 19,969 individuals were used for analysis. Tobacco use and hypertension were significantly more prevalent in the low- (56.6% and 33.8%, respectively) compared with the high-education group (12.5% and 22.7%, respectively; P < 0.001). However, dyslipidemia prevalence was significantly higher in the high-education group (27.1% as compared with 16.9% in the lowest-education group; P < 0.01). When stratified by the level of urbanization, industrial populations located in highly urbanized centers were observed to have an inverse graded relationship (i.e., higher-education groups had lower prevalence) for tobacco use, hypertension, diabetes, and overweight, whereas in less-urbanized locations, we found such a relationship only for tobacco use and hypertension. This study indicates the growing vulnerability of lower socioeconomic groups to CHD. Preventive strategies to reduce major CHD risk factors should focus on effectively addressing these social disparities.
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    Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015
    (LANCET) Vos, T; Allen, C; Arora, M; Barber, RM; Bhutta, ZA; Brown, A; Carter, A; Casey, DC; Charlson, FJ; Chen, AZ; Coggeshall, M; Cornaby, L; Dandona, L; Dicker, DJ; Dilegge, T; Erskine, HE; Ferrari, AJ; Fitzmaurice, C; Fleming, T; Forouzanfar, MH; Fullman, N; Gething, PW; Goldberg, EM; Graetz, N; Haagsma, JA; Johnson, CO; Kassebaum, NJ; Kawashima, T; Kemmer, L; Khalil, IA; Kinfu, Y; Kyu, HH; Leung, JN; Liang, XF; Lim, SS; Lopez, AD; Lozano, R; Marczak, L; Mensah, GA; Mokdad, AH; Naghavi, M; Nguyen, G; Nsoesie, E; Olsen, H; Pigott, DM; Pinho, C; Rankin, Z; Reinig, N; Salomon, JA; Sandar, L; Smith, A; Stanaway, J; Steiner, C; Teeple, S; Thomas, BA; Troeger, C; Wagner, JA; Wang, HD; Wanga, V; Whiteford, HA; Zoeckler, L; Abajobir, AA; Abate, KH; Abbafati, C; Abbas, KM; Abd-Allah, F; Abraham, B; Abubakar, I; Abu-Raddad, LJ; Abu-Rmeileh, NME; Ackerman, IN; Adebiyi, AO; Ademi, Z; Adou, AK; Afanvi, KA; Agardh, EE; Agarwal, A; Kiadaliri, AA; Ahmadieh, H; Ajala, ON; Akinyemi, RO; Akseer, N; Al-Aly, Z; Alam, K; Alam, NKM; Aldhahri, SF; Alegretti, MA; Alemu, ZA; Alexander, LT; Alhabib, S; Ali, R; Alkerwi, A; Alla, F; Allebeck, P; Al-Raddadi, R; Alsharif, U; Altirkawi, KA; Alvis-Guzman, N; Amare, AT; Amberbir, A; Amini, H; Ammar, W; Amrock, SM; Andersen, HH; Anderson, GM; Anderson, B; Antonio, CAT; Aregay, AF; Arnlov, J; Al Artaman; Asayesh, H; Assadi, R; Atique, S; Avokpaho, EFGA; Awasthi, A; Quintanilla, BPA; Azzopardi, P; Bacha, U; Badawi, A; Balakrishnan, K; Banerjee, A; Barac, A; Barker-Collo, SL; Barnighausen, T; Barregard, L; Barrero, LH; Basu, A; Bazargan-Hejazi, S; Bell, B; Bell, ML; Bennett, DA; Bensenor, IM; Benzian, H; Berhane, A; Bernabe, E; Betsu, BD; Beyene, AS; Bhala, N; Bhatt, S; Biadgilign, S; Bienhofff, K; Bikbov, B; Biryukov, S; Bisanzio, D; Bjertness, E; Blore, J; Borschmann, R; Boufous, S; Brainin, M; Brazinova, A; Breitborde, NJK; Brown, J; Buchbinder, R; Buckle, GC; Butt, ZA; Calabria, B; Campos-Nonato, IR; Campuzano, JC; Carabin, H; Cardenas, R; Carpenter, DO; Carrero, JJ; Castaneda-Orjuela, CA; Rivas, JC; Catala-Lopez, F; Chang, JC; Chiang, PPC; Chibueze, CE; Chisumpa, VH; Choi, JYJ; Chowdhury, R; Christensen, H; Christopher, DJ; Ciobanu, LG; Cirillo, M; Coates, MM; Colquhoun, SM; Cooper, C; Cortinovis, M; Crump, JA; Damtew, SA; Dandona, R; Daoud, F; Dargan, PI; das Neves, J; Davey, G; Davis, AC; De Leo, D; Degenhardt, L; Del Gobbo, LC; Dellavalle, RP; Deribe, K; Deribew, A; Derrett, S; Des Jarlais, DC; Dharmaratne, SD; Dhillon, PK; Diaz-Torne, C; Ding, EL; Driscoll, TR; Duan, LL; Dubey, M; Duncan, BB; Ebrahimi, H; Ellenbogen, RG; Elyazar, I; Endres, M; Endries, AY; Ermakov, SP; Eshrati, B; Estep, K; Farid, TA; Farinha, CSES; Faro, A; Farvid, MS; Farzadfar, F; Feigin, VL; Felson, DT; Fereshtehnejad, SM; Fernandes, JG; Fernandes, JC; Fischer, F; Fitchett, JRA; Foreman, K; Fowkes, GR; Fox, J; Franklin, RC; Friedman, J; Frostad, J; Furst, T; Futran, ND; Gabbe, B; Ganguly, P; Gankpe, FG; Gebre, T; Gebrehiwot, TT; Gebremedhin, AT; Geleijnse, JM; Gessner, BD; Gibney, KB; Ginawi, IAM; Giref, AZ; Giroud, M; Gishu, MD; Glaser, E; Godwin, WW; Gomez-Dantes, H; Gona, P; Goodridge, A; Gopalani, SV; Gotay, CC; Goto, A; Gouda, HN; Grainger, R; Greaves, F; Guillemin, F; Guo, YM; Gupta, R; Gupta, R; Gupta, V; Gutierrez, RA; Haile, D; Hailu, AD; Hailu, GB; Halasa, YA; Hamadeh, RR; Hamidi, S; Hammami, M; Hancock, J; Handal, AJ; Hankey, GJ; Hao, YT; Harb, HL; Harikrishnan, S; Haro, JM; Havmoeller, R; Hay, RJ; Heredia-Pi, IB; Heydarpour, P; Hoek, HW; Horino, M; Horita, N; Hosgood, HD; Hoy, DG; Htet, AS; Huang, H; Huang, JJ; Huynh, C; Iannarone, M; Iburg, KM; Innos, K; Inoue, M; Iyer, VJ; Jacobsen, KH; Jahanmehr, N; Jakovljevic, MB; Javanbakht, M; Jayatilleke, AU; Jee, SH; Jeemon, P; Jensen, PN; Jiang, Y; Jibat, T; Jimenez-Corona, A; Jin, Y; Jonas, JB; Kabir, Z; Kalkonde, Y; Kamal, R; Kan, HD; Karch, A; Karema, CK; Karimkhani, C; Kasaeian, A; Kaul, A; Kawakami, N; Karimkhani, C; Kasaeian, A; Kaul, A; Kawakami, N; Keiyoro, PN; Kemp, AH; Keren, A; Kesavachandran, CN; Khader, YS; Khaiff, AR; Khaiff, EA; Khang, YH; Khera, S; Khoja, TAM; Khubchandani, J; Kieling, C; Kim, P; Kim, CI; Kim, D; Kim, YJ; Kissoon, N; Knibbs, LD; Knudsen, AK; Kokubo, Y; Kolte, D; Kopec, JA; Kosen, S; Kotsakis, GA; Koul, PA; Koyanagi, A; Kravchenko, M; Defo, BK; Bicer, BK; Kudom, AA; Kuipers, EJ; Kumar, GA; Kutz, M; Kwan, GF; Lal, A; Lalloo, R; Lallukka, T; Lam, H; Lam, JO; Langan, SM; Larsson, A; Lavados, PM; Leasher, JL; Leigh, J; Leung, R; Levi, M; Li, YC; Li, YM; Liang, J; Liu, SW; Liu, Y; Lloyd, BK; Lo, WD; Logroscino, G; Looker, KJ; Lotufo, PA; Lunevicius, R; Lyons, RA; Mackay, MT; Abd El Razek, MM; Mahdavi, M; Majdan, M; Majeed, A; Malekzadeh, R; Marcenes, W; Margolis, DJ; Martinez-Raga, J; Masiye, F; Massano, J; McGarvey, ST; McGrath, JJ; McKee, M; McMahon, BJ; Meaney, PA; Mehari, A; Meija-Rodriguez, F; Mekonnen, AB; Melaku, YA; Memiah, P; Memish, ZA; Mendoza, W; Meretoja, A; Meretoja, TJ; Mhimbira, FA; Miller, TR; Mills, EJ; Mirarefin, M; Mitchell, PB; Mock, CN; Mohammadi, A; Mohammed, S; Monasta, L; Hernandez, JCM; Montico, M; Mooney, MD; Moradi-Lakeh, M; Morawska, L; Mueller, UO; Mullany, E; Mumford, JE; Murdoch, ME; Nachega, JB; Nagel, G; Naheed, A; Naldi, L; Nangia, V; Newton, JN; Ng, M; Ngalesoni, FN; Le Nguyen, Q; Nisar, MI; Pete, PMN; Nona, JM; Norheim, OF; Norman, RE; Norrving, B; Nunes, BP; Ogbo, FA; Oh, IH; Ohkubo, T; Olivares, PR; Olusanya, BO; Olusanya, JO; Ortiz, A; Osman, M; Ota, E; Mahesh, PA; Park, EK; Parsaeian, M; Passos, VMD; Caicedo, AJP; Patten, SB; Patton, GC; Pereira, DM; Perez-Padilla, R; Perico, N; Pesudovs, K; Petzold, M; Phillips, MR; Piel, FB; Pillay, JD; Pishgar, F; Plass, D; Platts-Mills, JA; Polinder, S; Pond, CD; Popova, S; Poulton, RG; Pourmalek, F; Prabhakaran, D; Prasad, NM; Qorbani, M; Rabiee, RHS; Radfar, A; Rafay, A; Rahimi, K; Rahimi-Movaghar, V; Rahman, M; Rahman, MHU; Rahman, SU; Rai, RK; Rajsic, S; Ram, U; Rao, P; Refaat, AH; Reitsma, MB; Remuzzi, G; Resnikofff, S; Reynolds, A; Ribeiro, AL; Blancas, MJR; Rolm, HS; Rojas-Rueda, D; Ronfani, L; Roshandel, G; Roth, GA; Rothenbacher, D; Roy, A; Sagar, R; Sahathevan, R; Sanabria, JR; Sanchez-Nino, MD; Santos, IS; Santos, JV; Sarmiento-Suarez, R; Sartorius, B; Satpathy, M; Savic, M; Sawhney, M; Schaub, MP; Schmidt, MI; Schneider, IJC; Schottker, B; Schwebel, DC; Scott, JG; Seedat, S; Sepanlou, SG; Servan-Mori, EE; Shackelford, KA; Shaheen, A; Shaikh, MA; Sharma, R; Sharma, U; Shen, JB; Shepard, DS; Sheth, KN; Shibuya, K; Shin, MJ; Shiri, R; Shiue, I; Shrime, MG; Sigfusdottir, ID; Silva, DAS; Silveira, DGA; Singh, A; Singh, JA; Singh, OP; Singh, PK; Sivonda, A; Skirbekk, V; Skogen, JC; Sligar, A; Silwa, K; Soljak, M; Soreide, K; Soriano, JB; Sposato, LA; Sreeramareddy, CT; Stathopoulou, V; Steel, N; Stein, DJ; Steiner, TJ; Steinke, S; Stovner, L; Stroumpoulis, K; Sunguya, BF; Sur, P; Swaminathan, S; Sykes, BL; Szoeke, CEI; Tabares-Seisdedos, R; Takala, JS; Landon, N; Tanne, D; Tavakkoli, M; Taye, B; Taylor, HR; Te Ao, BJ; Tedla, BA; Terkawi, AS; Thomson, AJ; Thorne-Lyman, AL; Thrift, AG; Thurston, GD; Tobe-Gai, R; Tonelli, M; Topor-Madry, R; Topouzis, F; Tran, BX; Dimbuene, ZT; Tsilimbaris, M; Tura, AK; Tuzcu, EM; Tyrovolas, S; Ukwaja, KN; Undurraga, EA; Uneke, CJ; Uthman, OA; van Gool, CH; Varakin, YY; Vasankari, T; Venketasubramanian, N; Verma, RK; Violante, FS; Vladimirov, SK; Vlassov, VV; Vollset, SE; Wagner, GR; Waller, SG; Wang, LH; Watkins, DA; Weichenthal, S; Weiderpass, E; Weintraub, RG; Werdecker, A; Westerman, R; White, RA; Williams, HC; Wiysonge, CS; Wolfe, CDA; Won, S; Woodbrook, R; Wubshet, M; Xavier, D; Xu, GL; Yadav, AK; Yan, LJL; Yano, YCR; Yaseri, M; Ye, PP; Yebyo, HG; Yip, P; Yonemoto, N; Yoon, SJ; Younis, MZ; Yu, C; Zaidi, Z; Zaki, MES; Zeeb, H; Zhou, MG; Zodpey, S; Zuhlke, LJ; Murray, CJL
    Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9.3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17.2 billion, 95% uncertainty interval [UI] 15.4-19.2 billion) and diarrhoeal diseases (2.39 billion, 2.30-2.50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2.36 billion (2.35-2.37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Copyright (C) The Author(s). Published by Elsevier Ltd.
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    Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015
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    Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. 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 alcohol on coronary heart disease in Indian men
    (Atherosclerosis, 2010) Roy, A; Prabhakaran, D; Jeemon, P; Thankappan, KR; Mohan, V; Ramakrishnan, L; Joshi, P; Ahmed, F; Mohan, BV; Saran, RK; Sinha, N; Reddy, KS
    BACKGROUND: Moderate alcohol consumption is known to be protective against coronary heart disease (CHD). However, the INTERHEART study, a case-control study of acute myocardial infarction (MI) patients, revealed that alcohol consumption in South Asians was not protective against CHD. We therefore planned to study cardiovascular risk factor and CHD prevalence among male alcohol users as compared to age matched lifetime abstainers. METHODS: The subjects for this study were recruited from a cross-sectional survey carried out among employees and their family members aged 20-69 years in 10 medium-to-large industries from diverse sites in India, using a stratified random sampling technique. Information on education, behavioral, clinical and biochemical risk factors of CHD and alcohol use was obtained through standardized instruments. CHD diagnosis was based on Rose Questionnaire or a prior physician diagnosed CHD. RESULTS: A total of 4465 subjects were present or past alcohol users. The mean age of alcohol users and lifetime abstainers was 42.8+/-11.0 years and 42.8+/-11.1 years, respectively (p=0.90). Systolic blood pressure and diastolic blood pressure were significantly higher in alcohol users (128.7+/-17.6 mmHg/80.1+/-11.3 mmHg) as compared to lifetime abstainers (126.9+/-15.9 mmHg/79.5+/-10.3 mmHg, p<0.01). Fasting blood sugar in alcohol users (98.7+/-30.5 mg%) was also significantly higher than lifetime abstainers (96.6+/-26.0 mg%, p<0.01). Total cholesterol was lower in alcohol users (179.1+/-41.1 mg%) as compared to lifetime abstainers (182.7+/-38.2 mg%, p<0.01). HDL cholesterol was higher in alcohol users (42.9+/-10.8 mg%) as compared to lifetime abstainers (41.3+/-10.0 mg%, p<0.01). Body mass index (BMI) was lower in alcohol users as compared to lifetime abstainers (22.7+/-4.1 kg/m2 vs. 24.0+/-3.3 kg/m2, p<0.001). Tobacco use was significantly higher in alcohol users (63.1% vs. 20.7%). The odds ratio (OR) of having CHD after adjusting for tobacco use, BMI and education was 1.4 (95%CI 1.0-1.9) in alcohol users as compared to controls. The OR was 1.2 (95%CI 0.8-1.6) in occasional alcohol users, 1.6 (95%CI 1.0-2.2) in regular alcohol users and 2.1 (95% CI 1.1-3.0) in past alcohol users as compared to controls.CONCLUSION:We did not observe an inverse (protective) association between alcohol intake and the prevalence of CHD. In contrast, our study indicated an association in the reverse direction, suggesting possible harm of alcohol for coronary risk in Indian men. This relationship needs to be further examined in large, prospective study.
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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.
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    Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations
    (BULLETIN OF THE WORLD HEALTH ORGANIZATION, 2006) Reddy, KS; Prabhakaran, D; Chaturvedi, V; Jeemon, P; Thankappan, KR; Ramakrishnan, L; Mohan, BVM; Pandav, CS; Ahmed, FU; Joshi, PP; Meera, R; Amin, RB; Ahuja, RC; Das, MS; Jaison, TM
    Objective To establish a surveillance network for cardiovascular diseases (CVD) risk factors in industrial settings and estimate the risk factor burden using standardized tools. Methods We conducted a baseline cross-sectional survey (as part of a CVD surveillance programme) of industrial populations from 10 companies across India, situated in close proximity to medical colleges that served as study centres. The study subjects were employees (selected by age and sex stratified random sampling) and their family members. Information on behavioural, clinical and biochemical determinants was obtained through standardized methods (questionnaires, clinical measurements and biochemical analysis). Data collation and analyses were done at the national coordinating centre. Findings We report the prevalence of CVD risk factors among individuals aged 20-69 years (n = 19 973 for the questionnaire survey, n = 10 442 for biochemical investigations); mean age was 40 years. The overall prevalence of most risk factors was high, with 50.9% of men and 51.9% of women being overweight, central obesity was observed among 30.9% of men and 32.8% of women, and 40.2% of men and 14.9% of women reported current tobacco use. Self-reported prevalence of diabetes (5.3%) and hypertension (10.9%) was lower than when measured clinically and biochemically (10.1% and 27.7%, respectively). There was marked heterogeneity in the prevalence of risk factors among the study centres. Conclusion There is a high burden of CVD risk factors among industrial populations across India. The surveillance system can be used as a model for replication in India as well as other developing countries.