Beruflich Dokumente
Kultur Dokumente
Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the worlds population to Lancet 2016; 388: 1545602
live in full health, a trend largely attributable to an epidemiological transition in many countries from causes aecting See Editorial page 1447
children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, See Comment pages 1448
Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with and 1450
disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. *Collaborators listed at the end
of the Article
Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated Correspondence to:
Prof Theo Vos, Institute for
and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, Health Metrics and Evaluation,
updates to literature reviews for 85 causes, and the identication and inclusion of additional studies published up to Seattle, WA 98121, USA
November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. tvos@uw.edu
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 rst 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 93 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 (172 billion, 95% uncertainty interval [UI] 154192 billion) and diarrhoeal
diseases (239 billion, 230250 billion). Eight causes of chronic disease and injury each aected more than 10% of the
worlds population in 2015: permanent caries, tension-type headache, iron-deciency anaemia, age-related and other
hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that
aected the greatest number of people in 2015 was anaemia, with 236 billion (235237 billion) individuals aected.
The second and third leading impairments by number of individuals aected 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 2030% of total disability,
largely attributable to nutritional deciencies, 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-deciency 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 worlds population is increasing the number of people living with sequelae of diseases
and injuries. Shifts in the epidemiological prole 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 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
1 Data sources 2 Data adjustment 3b Alternative disease modelling strategies (details figure 1B)
Figure 1: Analytical ow chart for the estimation of cause-specic YLDs by location, age, sex, and year for GBD 2015
Ovals represent data inputs, square boxes represent analytical steps, cylinders represent databases, and parallelograms represent intermediate and nal results. The ow chart is colour-coded by major
estimation component: raw data sources, in pink; data adjustments, in yellow; DisMod-MR 2.1 estimation, in purple; alternative modelling strategies, in light green; injury modelling strategy, in dark
green; estimation of impairments and underlying causes, in brown; post-DisMod-MR and comorbidity correction, in blue; disability weights, in orange; and cause of death and demographic inputs, in
grey. GBD=Global Burden of Disease. TB=tuberculosis. SF-12=Short Form 12 questions. MEPS=Medical Expenditure Panel Surveys. CSMR=cause-specic mortality rate. SMR=standardised mortality
ratio. YLDs=years lived with disability. YLLs=years of life lost. IHME=Institute for Health Metrics and Evaluation.
List of causes and sequelae The cause and sequelae list was expanded based upon
The GBD cause and sequelae list is organised feedback after the release of GBD 2013 and input from
hierarchically (methods appendix 62553). At Level 1 GBD 2015 collaborators. Nine causes for which
there are three cause groups: communicable, maternal, non-fatal outcomes are estimated were added: Ebola
neonatal, and nutritional diseases (Group 1 diseases); virus disease, motor-neuron disease, environmental
non-communicable diseases; and injuries. These Level 1 heat and cold exposure, four subtypes of leukaemia,
aggregates are subdivided at Level 2 of the hierarchy into and two subtypes of non-melanoma skin cancer
21 cause groupings. The disaggregation into Levels 3 (methods appendix pp 62553). The incorporation of
and 4 contains the nest level of detail for causes these changes expanded the cause list from the
captured in GBD 2015. Sequelae of diseases and injuries 301 causes with non-fatal estimates examined in
are organised at Levels 5 and 6 of the hierarchy. The GBD 2013, to 310 causes with non-fatal estimates and
nest detail for all sequelae estimated in GBD is at from 2337 to 2619 unique sequelae at Level 6 of the
Level 6 and is aggregated into summary sequelae hierarchy. At the newly created Level 5 of the hierarchy
categories (Level 5) for causes with large numbers of there were 154 summary sequela categories. The
sequelae. Sequelae in GBD are mutually exclusive and methods appendix (pp 65461) provides a list of
collectively exhaustive, and thus our YLD estimates at International Classication of Diseases version 9
each level of the hierarchy sum to the total of the level (ICD-9) and version 10 (ICD-10) codes used in the
above. Prevalence aggregations are estimated at the level extraction of hospital and claims data, mapped to GBD
of individuals who might have more than one sequela or 2015 non-fatal causes, impairments, and nature of
disease and therefore are not additive. injury categories.
synthesis of often sparse and heterogeneous epidemio- same as the general cancer health states. For motor-
logical data. For GBD 2015, the computational engine of neuron disease we accessed the Pooled Resource Open-
DisMod-MR 2.1 remained unchanged, but we substantially Access ALS Clinical Trials (PROACT) database containing
rewrote the code that organises the ow of data and detailed information on symptoms and impairments for
settings at each level of the analytical cascade. The more than 8500 patients who took part in the trials.23
sequence of estimation occurs at ve levels: global, super-
region, region, country, and where applicable, subnational Disability weights
locations (appendix pp 61124). At each level of the cascade, We used the same disability weights as in GBD 2013 (see
the DisMod-MR 2.1 computational engine enforces methods appendix pp 66994 for a complete listing of
consistency between all disease parameters. For GBD 2015, the lay descriptions and values for the 235 health states
we generated ts for the years 1990, 1995, 2000, 2005, 2010, used in GBD 2015).
and 2015. We log-linearly interpolated estimates for the
intervening years in each 5-year period. Greater detail on Comorbidity
DisMod-MR 2.1 is available at Global Health Data In step 7, we estimated the co-occurrence of dierent For DisMod-MR 2.1 engine and
Exchange and the methods appendix (pp 711). diseases by simulating 40 000 individuals in each the code see http://ghdx.
healthdata.org/global-burden-
In previous iterations of GBD, custom models were geographyagesexyear combination as exposed to the disease-study-2015
created for a short list of causes for which the compartment independent probability of having any of the sequelae
model underpinning DisMod (susceptible, diseased, and included in GBD 2015 based on disease prevalence. We
dead) was insucient to capture the complexity of the tested the contribution of dependent and independent
disease or for which incidence and prevalence needed to comorbidity in the US Medical Expenditure Panel Surveys
be derived from other data. Step 3b of gure 1 describes (MEPS) data, and found that independent comorbidity
the development of custom models with greater detail was the dominant factor even though there are well
shown in the methods appendix gure 1B (p 604, and known examples of dependent comorbidity. Age was
for associated write-ups pp 26601) for HIV/AIDS, the main predictor of comorbidity such that age-specic
tuberculosis, malaria, cancer, neonatal disorders, microsimulations accommodated most of the required
infectious diseases for which we derived incidence from comorbidity correction. Taking dependent comorbidity
seroprevalence data, and infectious diseases for which we into account changed the overall YLDs estimated in the
derived incidence from cause of death rates and pooled MEPS data by only 25% (and ranging from 06% to
estimates of the case fatality proportion. 34% depending on age) in comparison to assuming
In GBD 2013, we estimated the countryagesexyear independent comorbidity (methods appendix pp 1820).24
prevalence of nine impairments (step 4 of gure 1).
Impairments in GBD are disorders or specic domains of YLD computation
functional health loss that are spread across many GBD We report 95% uncertainty intervals (95% UI) for each
causes as sequelae and for which there are better data to quantity in this analysis using 1000 samples from the
estimate the occurrence of the overall impairment than for posterior distribution of prevalence and 1000 samples of
each sequela based on the underlying cause. Overall the disability weight to generate 1000 samples of the YLD
impairment prevalence was estimated with DisMod-MR 2.1 distribution. The 95% UI is reported as the 25th and 975th
except for anaemia, for which spatiotemporal Gaussian values of the distribution. We report signicant changes
Process regression methods were applied. We constrained in disease estimates between countries or over time if the
cause-specic estimates of impairments, such as in the change was noted in more than 950 of the 1000 samples
19 causes of blindness, to sum to the total prevalence computed for each result. For GBD 2015, we computed
estimated for that impairment. Anaemia, epilepsy, hearing age-standardised prevalence YLD rates from the updated
loss, heart failure, and intellectual disability were estimated world population age standard developed for GBD 2013.25
at dierent levels of severity. Less common diseases and their sequelae were included
in 35 residual categories (methods appendix pp 69597).
Severity distributions For 22 of these residual categories, estimates were made
In step 5, sequelae were further dened in terms from epidemiological data for incidence or prevalence.
of severity for 194 causes at Level 4 of the hierarchy For 13 residual categories, we estimated YLDs by
(gure 1A). We generally followed the same approach for multiplying the residual YLL estimates by the ratio of
estimating the distribution of severity as in GBD 2013. YLDs to YLLs from the estimates for explicitly modelled
For Ebola virus disease, we created a health state for the Level 3 causes in the same disease category.
infectious disease episode with duration derived from
average hospital admission times, and a health state for Socio-demographic Index
ongoing postinfection malaise and joint problems based In GBD 2013, a sociodemographic status variable
on four follow-up studies1922 from which we derived an was computed based on a principal components
average duration. The health states for the subtypes of analysis of income per capita, educational attainment,
leukaemia and non-melanoma skin cancer were the average age of the population, and the total fertility
[126140 billion]), vision loss (940 million Appendicitis 10 159 11 619 144
(9549 to 10 840) (10 918 to 12 407) (135 to 152)*
[905974 million]), developmental intellectual disability
Pancreatitis 7160 8 902 243
(153 million [114191 million]), infertility (113 million (6 6607 694) (8 2129 643) (219 to 266)*
[934136 million]), heart failure (400 million Maternal haemorrhage 8438 8740 36
[386414 million]), and epilepsy (392 million (661410 620) (677411 061) (03 to 76)
[343437 million]; table 3; see results appendix Other sexually transmitted 7569 7656 12
(pp 74048) for the prevalence estimates of the underlying diseases (65118741) (65838853) (01 to 24)
causes of these impairments). Iron deciency was the Ischaemic heart disease 6308 7287 155
cause of anaemia in more than half of all cases. Over (59186716) (67987808) (143 to 168)*
90% of hearing loss was classied as age-related or other Maternal obstructed labour 6830 6521 45
and uterine rupture (52028933) (49778588) (91 to 03)*
hearing loss. The largest number of people with vision
Hepatitis C 4609 5394 170
loss had uncorrected refraction error. Idiopathic (4316 to 4918) (5032 to 5778) (157 to 184)*
developmental intellectual disability, idiopathic female Ischaemic stroke 4651 5385 158
infertility, and idiopathic epilepsy were the most common (4397 to 4912) (5017 to 5726) (134 to 184)*
causes of their impairments. Ischaemic heart disease Measles 15 610 4652 702
was the most common cause of heart failure. (669931 357) (20729206) (736 to 660)*
Paratyphoid fever 5580 4587 178
Global causes of disability (44986896) (37385601) (226 to 127)*
Global trends in YLDs 2005 to 2015 Haemorrhagic stroke 3144 3583 140
(29733307) (33363822) (114 to 162)*
GBD 2015 included the assessment of 2619 sequelae at
Paralytic ileus and intestinal 2664 3167 189
Level 6 of the GBD cause hierarchy, including 1316 sequelae obstruction (24942855) (29463406) (169 to 207)*
from injuries that contributed to the global burden of Encephalitis 1489 1603 77
disability. Causes at Level 4 of the hierarchy that resulted in (13801608) (14721750) (59 to 95)*
30 million or more YLDs in 2015 included lower back pain, Acute glomerulonephritis 1528 1534 04
major depressive disorder, age-related and other hearing (13951672) (13941685) (26 to 31)
loss, and neck pain. Figure 2 compares the leading causes Data in parentheses are 95% UIs. *Percentage changes that are statistically signicant.
of global YLDs in 2005 and 2015, using the cause
breakdowns at Level 3 of the GBD cause hierarchy. Among Table 1: Global incidence of short duration (less than 3 months) sequelae in 2005 and 2015 for all ages
and both sexes combined, with percentage change between 2005 and 2015 for level 4 causes with
the ten leading causes of YLDs, iron-deciency anaemia
incidence greater than 1 million cases per year
and depressive disorders switched ranks to positions three
and four respectively, diabetes rose from the eighth to the
sixth position, migraine dropped from position six to Age-standardised YLD rates attributable to hepatitis A, B,
seven, and other musculoskeletal disorders dropped from and C increased, and decreased for hepatitis E. The number
rank seven to eight (gure 2). of individuals with chronic hepatitis C infection increased
Estimates of prevalence and YLDs at the global level for from 121 million (108133 million) in 2005 to 142 million
2005 and 2015 for each cause are presented in table 3 (see (127157 million) in 2015.
results appendix pp 71740 for full detail at the sequelae
level). Prevalence and age-standardised YLDs for Changes in age-standardised YLDs and YLLs over time
21 Group 1 diseases decreased signicantly and by more In 2005, non-communicable diseases (NCDs) accounted
than 10%, including measles, African trypanosomiasis, for 23 of the leading 25 causes of age-standardised YLDs
diphtheria, lymphatic lariasis, and rabies. worldwide and 23 of the 25 leading causes in 2015
Age-standardised YLD rates for all maternal causes and (gure 2). Although diabetes rose only two ranks in the
sequelae combined decreased between 2005 and 2015, list of leading cause of YLDs, from position eight to six
whereas overall age-standardised YLDs for neonatal between 2005 and 2015, the increase in age-standardised
disorders increased by 311% (032679%) since 2005 to rate was 54% (3275%). Musculoskeletal disorders
144 YLDs per 100 000 (109185 YLDs per 100 000) in 2015, occupied three of the leading 25 causes of disability in
and age-standardised YLD rates decreased and absolute both 2005 and 2015; lower back and neck pain were the
numbers of cases increased for nutritional deciencies. single largest cause with little change in their rates.
YLLs and YLDs, but with a faster decrease in YLLs than in Schistosomiasis 329 773 252 340 235
(297 093367 878) (211 032321 081) (325 to 44)*
YLDs. The rate of change in YLDs for the main drivers of
G6PD deciency 231 109 247 074 69
non-fatal health loss, musculoskeletal disorders, and (205 067259 769) (209 307286 713) (14 to 119)*
mental and substance use disorders was small. Dermatitis 215 260 245 291 140
(199 590230 536) (227 283262 752) (132 to 148)*
Global distribution of disability weights across individuals Osteoarthritis 178 665 237 369 329
Figure 5 shows the global distribution of individuals from (173 558184 053) (230 336244 648) (319 to 338)*
our comorbidity microsimulation by six categories of Major depressive disorder 183 434 216 047 178
disability, age, and sex for the highest and lowest SDI (163 947206 420) (192 863243 319) (166 to 190)*
quintile. The six categories of disability are no disability, Scabies 191 482 204 152 66
(166 101223 739) (177 534237 466) (40 to 95)*
very mild disability (disability weight less than or equal to
Viral skin diseases 161 167 174 843 85
001), mild disability (from 001 to 005 inclusive), (152 218170 651) (165 156185 072) (80 to 90)*
moderate (from 005 to 01 inclusive), severe (from 01 to Chronic obstructive 149 115 174 483 170
03 inclusive), and profound (greater than 03). In 2015, pulmonary disease (137 380160 739) (160 205188 952) (151 to 190)*
most of the worlds population experienced mild or Genital prolapse 137 383 161 679 177
greater disability. Having no disability at all was most (121 623154 875) (142 335182 566) (152 to 200)*
common in children. After age 25 years, the proportion of Gastritis and duodenitis 135 993 157 060 155
the population having no disability became progressively (134 420137 351) (154 055160 141) (129 to 179)*
smaller, and by age 55 years in low SDI countries and age Peripheral vascular disease 115 109 154 651 344
(101 439131 405) (136 318176 211) (334 to 352)*
75 years in high SDI countries, nearly everyone had some
Uterine broids 126 797 151 115 192
form of disability. Very mild to moderate disability (ie, (120 900133 050) (144 147158 477) (188 to 195)*
individuals with a disability weight of 01 or less) was Hepatitis C 120 457 142 123 180
common in childhood and young adults, but was replaced (108 080133 129) (126 978157 045) (167 to 192)*
by more severe disability with increasing age. The Other mental and 107 895 128 178 188
patterns were similar for both sexes, apart from a much substance use disorders (107 213108 449) (127 512128 877) (179 to 197)*
larger amount of disability in women older than 80 years Iodine deciency 103 701 110 920 70
in the top SDI quintiles, reecting the much higher (93 441116 438) (100 337125 253) (47 to 94)*
average age of women in this age category. For policy Ischaemic heart disease 87 511 110 193 259
(80 13396 170) (100 332121 427) (246 to 272)*
considerations around the age of retirement in ageing
Benign prostatic 80 684 104 625 297
populations, it is noteworthy that from age 60 years hyperplasia (70 33890 853) (90 730118 244) (275 to 320)*
onwards more than half of the population had severe or Dysthymia 86 812 104 106 199
worse disability. The extent to which this loss of health (74 97499 103) (90 398118 969) (184 to 215)*
limits or precludes the ability to work depends on the Chronic kidney disease due 79 184 100 824 273
nature of the impairments and the type of employment in to diabetes (68 48190 737) (86 923115 652) (249 to 299)*
older workers with that level of disability. Chronic kidney disease due 74 917 94 553 262
to other causes (64 01286 576) (81 142109 371) (242 to 283)*
Expected changes in disease prole with higher Idiopathic developmental 82 996 92 074 109
intellectual disability (47 588117 109) (52 280130 411) (95 to 119)*
Socio-demographic Index
Other cardiovascular and 72 772 90 348 242
Figure 6 depicts changes in patterns of disability by level of circulatory diseases (68 09077 763) (84 71196 659) (227 to 255)*
SDI for age-standardised and all-age YLD rates per 100 000. Otitis media 83 022 86 393 41
Age-standardised YLD rates gradually decreased with (73 65793 266) (76 37497 104) (27% to 55)*
increasing SDI in both sexes (gure 6A). The cause Psoriasis 67 753 79 700 176
composition of YLDs somewhat varied across levels of (65 10770 298) (76 69182 804) (170 to 183)*
SDI; these dierences were largely derived from absolute Other 73 045 74 385 18
haemoglobinopathies and (72 60073 470) (73 89874 862) (09 to 27%)
levels of disability due to communicable causes and
haemolytic anaemias
nutritional deciencies, and to a lesser extent, maternal
and neonatal disorders. Age-standardised YLD rates due to Data in parentheses are 95% UIs. *Percentage changes that are statistically signicant.
NCDs and injuries were similar at all SDI levels.
Table 2: Global prevalence of longer duration (more than 3 months) sequelae in 2005 and 2015 for all
Across levels of SDI, mental and substance use ages and both sexes combined, with percentage change between 2005 and 2015 for Level 4 causes with
disorders, musculoskeletal disorders, and other NCDs prevalence greater than 1%
were consistently among the leading causes of
age-standardised YLD rates. Anaemia led to generally African countries; depression in ve eastern sub-Saharan
higher rates of age-standardised YLDs in women than in Africa countries; other neglected tropical diseases in
men across levels of SDI, but the largest imbalance Angola, Democratic Republic of the Congo, and Gabon;
occurred at SDI levels between 010 and 050. Disability sense organ disorders in Comoros and Myanmar;
from injuries exacted a larger burden for men than for diabetes in Fiji and Marshall Islands; war in Lebanon and
women, particularly at lower levels of SDI. Syria; and onchocerciasis in Liberia.
Without adjustments for population age structure
(gure 6B), the eect of ageing populations and causes Regional, country, territory, and selected subnational results
of disability that disproportionately aect older Lower back and neck pain was the leading cause of
individuals become prominent. At all levels of SDI, disability in all high-income countries in 2015. However,
total YLDs per 100 000 did not notably dier by sex; ratios of observed to expected YLDs from lower back and
instead, the cause composition of disability showed neck pain ranged from 060 for Singapore to more than
greater dierences. Below an SDI score of 025, 159 in Norway. Most high-income countries experienced
communicable causes accounted for 3045% of total higher than expected levels of disability due to depressive
disability, primarily due to nutritional deciencies, disorders. The USA and Australia were the only two high-
malaria, and neglected tropical diseases. YLDs income countries where drug use disorders were a top ten
per 100 000 due to musculoskeletal disorders, cause of disability, and observed levels of YLDs were much
particularly lower back and neck pain and other mus- higher than expected. South Koreas ratio of observed-to-
culoskeletal disorders, increased substantially from low expected levels of YLDs due to diabetes exceeded 130,
to high SDI, with a more pronounced increase whereas Japans diabetes-related disability was lower than
beginning at an SDI score of 06. This rise was expected on the basis of SDI. In the UK, observed disability
particularly evident in women. due to asthma was well above expected levels.
In 2015, lower back and neck pain was the leading
Trends in age-standardised YLDs per capita cause of YLDs for all but two countries in Latin America
Globally, age-standardised YLDs per capita (an indicator and the Caribbean; Haiti and Venezuela were the
of overall disability experienced per person in a given exceptions, with iron-deciency anaemia as the leading
place) moderately decreased for both sexes between 1990 causes of disability for both countries. Disability due to
and 2015 (results appendix pp 71416). Age-standardised diabetes surpassed expected levels by at least a factor of
YLDs per capita were consistently higher for women two for six countries and territories: Antigua, Barbados,
than for men at the global level. For both sexes, YLDs Dominica, Puerto Rico, Trinidad and Tobago, and the
per capita were generally higher for lower levels of SDI. Virgin Islands. Peru, however, had a ratio of less than 06
YLDs per capita were noticeably larger for low SDI and for observed and expected YLDs for diabetes.
low-middle SDI groups than for other SDI levels (ie, In 2015, lower back and neck pain was the leading
high SDI, high-middle SDI, and middle SDI), which cause of YLDs for 24 out of 28 countries and territories of
were more similar to each other. southeast Asia, east Asia, and Oceania. Other leading
causes of disability were sensory disorders in Myanmar,
Leading causes of YLDs and deviations from expected levels diabetes in Fiji and the Marshall Islands, and
based on Socio-demographic Index iron-deciency anaemia in Papua New Guinea. Although
Clear, though varied, patterns emerged across and within lower back and neck pain was the primary cause of
GBD regions in comparison of observed levels of YLDs disability, many countries had far lower levels of this
due to leading causes of disability with levels expected on than expected given their SDI, including Thailand (073),
the basis of SDI. Figure 7 displays ratios of observed and Indonesia (076), and Malaysia (075). Observed YLDs
expected YLDs for the leading ten causes at level 3 of the due to depressive disorders were often lower than
GBD hierarchy in 2015, colour coded by the magnitude expected, with 22 countries recording ratios below 080.
of dierences between observed and expected YLDs. Conversely, numerous geographies recorded YLD ratios
Globally, lower back and neck pain was the leading exceeding 200 for diabetes (eg, 229 in Taiwan).
cause of disability in 2015. Two mental disorders, major Beyond lower back and neck pain, which was the leading
depressive and anxiety disorders, were the third and cause of YLDs for three of ve countries in south Asia in
ninth leading causes of global disability, and diabetes was 2015 (with India and Pakistan being the exception), a
the sixth leading driver of disability. Iron-deciency mixture of causes accounted for the regions main causes
anaemia was the only Group 1 cause among the leading of disability; this heterogeneity probably reects the
ten causes for global YLDs (ranked fourth). Sensory diversity of countries in the region and their places along
disorders ranked second and skin diseases ranked fth. the development spectrum. Iron-deciency anaemia was
Lower back and neck pain was the leading global cause of the rst leading cause and lower back and neck pain was
disability in 2015 in most countries. The leading cause of the second leading cause of YLDs in both India and
disability in 2015 was iron-deciency anaemia in Pakistan, whereas sensory disorders, other musculoskeletal
27 countries; HIV/AIDS in all six southern sub-Saharan disorders, and iron-deciency anaemia ranked second for
Data in parentheses are 95% UIs. *Percentage changes that are statistically signicant.
Table 3: Global prevalence and YLDs for 2015, percentage change of counts, and percentage change of age-standardised rates between 2005 and 2015 for all causes, Level 5 sequelae, and
nine impairments
disability in Nepal, Bangladesh, and Bhutan, respectively. region. Observed YLDs due to diabetes consistently
YLDs due to anxiety were lower than expected in all exceeded expected levels, with two countries posting
countries in the region except for Bangladesh. ratios higher than 300 (ie, Qatar [312], and the United
In the GBD super-region of central Europe, eastern Arab Emirates [352]). Iran and Morocco recorded much
Europe, and central Asia, lower back and neck pain was the higher disability due to drug use disorders than expected
leading cause of disability in every geographical region in based on SDI.
2015; Although all countries in eastern and central Europe In comparison with the rest of the world, ranks of cause-
recorded higher than expected YLD ratios for most of their specic disability, and their ratios of observed to expected
top ten causes, central Asia mostly had lower than expected values, were vastly dierent in sub-Saharan Africa. Of the
or as expected YLD ratios. Sense organ diseases were the 46 countries within the super-regions, nine had lower back
second leading causes of disability and depressive disorders and neck pain as the leading cause of YLDs in 2015. In
were the third leading causes in this super-region. southern Sub-Saharan Africa, HIV/AIDS was the leading
Sizeable discrepancies occurred for observed and cause of disability for all countries. Iron-deciency anaemia
expected YLDs based on SDI throughout north Africa ranked as the leading cause of YLDs for 11 countries in
and the Middle East, probably reecting the uneven western sub-Saharan Africa. For the remaining countries,
achievements in development found in this region. lower back and neck pain were primarily the leading cause
Lower back and neck pain was the primary driver of of YLDs; Liberia, the exception, had onchocerciasis as its
YLDs in the region. Exceptions to this were Lebanon and leading cause of disability. Malaria and various neglected
Syria, for which war caused the most disability in 2015, tropical diseases caused more YLDs than expected in most
and Afghanistan for which iron-deciency was the west African countries. For eastern sub-Saharan Africa,
leading cause. Depression, sense organ diseases, diabetes sense organ diseases, iron deciency, depressive disorders,
ranked second, third, and fourth, respectively, for the and lower back and neck pain were leading causes of YLDs
in 2015. In central sub-Saharan Africa, skin diseases were much faster for YLLs; this pattern is to be expected if access
consistently among the leading three-to-four causes of to eective treatment is decreasing the number of deaths
disability in this region. HIV/AIDS resulted in far more but not reducing prevalence or incidence. The last category
YLDs than expected based on SDI, with Equatorial Guinea, includes disorders where decreases are equal, if not slightly
and Central African Republic recording ratios of observed higher, for YLDs including ischaemic heart disease, falls,
versus expected YLDs higher than 200. cervical cancer, and other injuries. Examination of
dierential trends by region or country might provide
Discussion insights into the role of access to treatment in reducing
We used 60 900 data sources to estimate the incidence YLLs and, conversely, the role of increasing or decreasing
and prevalence of 2619 sequelae of 310 causes for risks and social determinants in driving changes in disease
591 geographical regions for the years 1990, 1995, 2000, incidence and prevalence. More detailed exploration of
2005, 2010, and 2015. After accounting for variation over these dierential trends is warranted in future work.
time and across regions in case denitions, disease assays,
survey instruments, and coding practice, and using Disability and retirement age
standardised modelling approaches to deal with missing As life expectancy has steadily increased in most countries,
data, conicting data, and a range of sampling and non- there have been calls in some high SDI countries to extend
sampling errors, we characterised the global and national retirement ages to reect these changes in survival.2830
patterns in non-fatal health outcomes. We found that global A crucial factor in these debates is whether individuals are
age-standardised YLDs per capita decreased slightly in the living for longer and have higher average levels of
last 25 years from 0114 (00850147) in 1990 to 0110 functional health at each age or not. In this study, we
(00820141) per capita in 2015, a total decrease of 369% found that age-standardised YLDs per capita decreased,
(312425%) over a generation (appendix pp 71416). The but rather slowly, over the period 2005 to 2015. Comparison
ageing of the worlds population and the general increase of trends in age-standardised YLDs and YLLs by cause
in YLDs per capita with age resulted in an increase in shows that the main causes of YLDs are not decreasing
global YLDs per capita. Within this overall pattern, 133 out and in some settings might be increasing. Other than a
of 310 causes had statistically signicant decreases in YLDs somewhat slower rate of improvement for YLDs at oldest
per capita between 2005 and 2015 compared with 82 causes age (80 years), age discontinuities are not observable in
with statistically signicant increases in YLDs per capita these patterns. Ultimately, the debate on retirement age
over the same time period. The most important will hinge on the skill sets required for dierent types
contributors to global YLDs were musculoskeletal disorders of work, whether work contributes to diminished
(185% [164209%] of all YLDs in 2015), mental and or improved functional health status, and societal
substance use disorders (184% [156212%]), and the expectations for retirement. Our ndings suggest that the
category of other NCDs (179% [150217%]), dominated burden from mental and substance use disorders, and
by hearing loss, vision loss, and skin diseases. musculoskeletal disorders, which are frequent causes of
early retirement31,32 in terms of age-specic prevalence, has
Typology of diseases based on YLDs and YLLs not declined much over time; the continued prevalence of
The comparison of trends in age-standardised YLDs and these and other disorders associated with increasing age
YLLs provides insight into the drivers of dierences in might limit the capacities of an older workforce.
rates of increases and decreases for diseases and injuries.
Diseases and injuries can be parsed into four groups. The Epidemiological transition
rst of these are a small set of disorders including causes The analysis of YLD rates by Level 2 causes as a function of
such as drug use disorders and skin cancer for which age- SDI shows a very dierent picture than that reported for
standardised rates of both YLDs and YLLs increased at a YLLs. At the lower end of the SDI spectrum, incremental
rate of more than 04% per year from 2005 to 2015. increases in SDI are associated with reductions in both
A second category of diseases includes those in which age-standardised YLDs and all-age YLD rates spurred by
YLDs are increasing but YLLs are decreasing, including decreases in disability from neglected tropical diseases and
disorders such as thyroid cancer, cirrhosis, and neonatal anaemia as well as decreases in tuberculosis, diarrhoea,
encephalopathy. One explanation for this pattern is that pneumonia, meningitis, and other infectious diseases.
risk factors, broadly dened, are causing an increase in At SDI levels above 08 (see methods appendix pp 698711
incidence, whereas access to eective treatment has for SDI values for each country), age-standardised rates of
improved enough to continue reducing mortality. For a health loss increase slightly, attributable to higher rates of
third category of disorders, YLDs are essentially constant, mental and substance use disorders, musculoskeletal
but YLLs are decreasing. This grouping is quite large and disorders, and neurological disorders. In this phase of the
includes many of the major causes of disability such as epidemiological transition, this increase in rates, although
musculoskeletal disorders, various neurological disorders, small, combined with population ageing, results in
and a number of cancers. For many infectious causes, increases in YLDs per 100 000. The rising average YLD per
decreased are occurring for both YLLs and YLDs but are capita rates have implications for health systems; a larger
Leading causes 1990 Leading causes 2005 % change % change % change age- Leading causes 2015 % change % change % change age-
number all-age standardised number all-age standardised
of YLDs YLD rate YLD rate of YLDs YLD rate YLD rate
19902005 19902005 19902005 200515 200515 200515
1 Lower back and neck pain 1 Lower back and neck pain 345 94 18 1 Lower back and neck pain 186 49 21
2 Iron-deciency anaemia 2 Sense organ diseases 394 134 21 2 Sense organ diseases 252 108 06
3 Sense organ diseases 3 Iron-deciency anaemia 148 66 06 3 Depressive disorders 182 45 10
4 Depressive disorders 4 Depressive disorders 329 80 06 4 Iron-deciency anaemia 38 149 116
5 Skin diseases 5 Skin diseases 219 08 05 5 Skin diseases 117 12 04
6 Migraine 6 Migraine 297 55 03 6 Diabetes 325 172 54
7 Other musculoskeletal disorders 7 Other musculoskeletal disorders 518 234 135 7 Migraine 153 20 08
8 Anxiety disorders 8 Diabetes 692 376 207 8 Other musculoskeletal disorders 205 66 13
9 Diabetes 9 Anxiety disorders 261 26 15 9 Anxiety disorders 148 15 10
10 Asthma 10 Asthma 26 165 155 10 Oral disorders 224 82 02
11 Oral disorders 11 Oral disorders 339 89 16 11 Asthma 94 33 23
12 Falls 12 Schizophrenia 361 107 07 12 Schizophrenia 195 57 03
13 Schizophrenia 13 Falls 134 78 139 13 Osteoarthritis 348 192 39
14 COPD 14 COPD 222 06 98 14 COPD 162 28 59
15 Autistic spectrum 15 Osteoarthritis 530 244 63 15 Falls 113 15 86
16 Haemoglobinopathies 16 Gynaecological diseases 291 50 34 16 Autistic spectrum 123 07 06
17 Gynaecological diseases 17 Autistic spectrum 232 02 05 17 Gynaecological diseases 107 21 33
18 Intestinal nematode 18 Other mental and substance 325 78 02 18 Drug use disorders 236 94 82
19 Osteoarthritis 19 Drug use disorders 421 156 116 19 Other mental and substance 187 50 03
20 Other mental and substance 20 Haemoglobinopathies 108 99 53 20 Medication overuse headache 189 52 06
21 Bipolar disorder 21 Bipolar disorder 294 52 01 21 Bipolar disorder 149 16 05
22 Epilepsy 22 Medication overuse headache 326 79 15 22 Congenital anomalies 285 137 147
23 Medication overuse headache 23 Epilepsy 109 98 79 23 Haemoglobinopathies 43 77 49
24 Other unintentional 24 Congenital anomalies 489 211 224 24 Chronic kidney disease 238 95 01
25 Drug use disorders 25 Chronic kidney disease 353 101 24 25 Ischaemic heart disease 302 152 03
26 Diarrhoeal diseases 26 Conduct disorder 158 58 07 26 Alzheimers disease 388 228 11
27 Conduct disorder 27 Other unintentional 07 181 236 27 Cerebrovascular disease 207 68 42
28 Chronic kidney disease 28 Alcohol use disorders 282 42 25 28 Alcohol use disorders 111 17 45
29 Congenital anomalies 29 Ischaemic heart disease 407 144 27 29 Epilepsy 64 172 163
30 Alcohol use disorders 30 Diarrhoeal diseases 22 205 99 30 Other cardiovascular 239 96 05
33 Cerebrovascular disease 31 Cerebrovascular disease 33 Conduct disorder Communicable, maternal,
34 Ischaemic heart disease 33 Alzheimers disease 34 Other unintentional neonatal, and nutritional
36 Other cardiovascular 34 Other cardiovascular 35 Diarrhoeal diseases Non-communicable
40 Alzheimers disease 39 Intestinal nematode 46 Intestinal nematode Injuries
Figure 2: Leading 30 Level 3 causes of global YLDs for both sexes combined, 1990, 2005, and 2015, with percentage change in number of YLDs, and all-age and age-standardised rates
Causes are connected by lines between time periods. For the time period of 1990 to 2005 and for 2005 to 2015, three measures of change are shown: percent change in the number of YLDs, percent
change in the all-age YLD rate, and percent change in the age-standardised YLD rate. YLD=years lived with disability. COPD=chronic obstructive pulmonary disease.
fraction of the population is likely to need care for many Mental and substance use disorders
disorders. Some of these disorders are currently costly to Consistent with the ndings of earlier GBD studies,
manage.33 The increase in health-care costs per individual GBD 2015 conrms the large contribution of mental and
in the population that occurs once an SDI of 08 is exceeded substance use disorders to global disability. For the rst
is a predictable component of the epidemiological time, in GBD 2015 we found a positive association
transition; these costs should be anticipated during the between conict and depression and anxiety, albeit with
health planning processes of countries in that stage of the wide uncertainty. This uncertainty is due to sparse and
transition. low-quality data for these disorders in post-conict
countries. Going forward, we plan to make separate
Disease-specic issues estimates for post-traumatic stress disorder in GBD,
Musculoskeletal disorders which might add considerably more data from conict
Musculoskeletal disorders continue to be a leading cause settings and show a stronger association. GBD results
of disability worldwide and more so when taking into have provided an evidence base to support global action
account that additional musculoskeletal burden from such as a stated commitment by the World Bank and
long-term sequelae of fractures and dislocations is WHO to make mental health a global development
classied under injuries in GBD. A key component of priority39 and the consideration of mental health and
healthy ageing is to maintain mobility, and a key public substance use disorders in shaping the Sustainable
health intervention recommended for improving health Development Goals.40 Cost-eective interventions are
outcomes for all chronic diseases is physical activity. able to reduce the burden imposed by mental and
Painful musculoskeletal disorders increase with age and substance use disorders, including in low-income and
are a great threat to mobility, compromising health more middle-income countries.41
broadly.3436 Even if cures for musculoskeletal disorders Increases in deaths attributable to drug use in the
are not yet available, the clinical goal of preventing USA have resulted in considerable policy and media
disability is attainable.37,38 attention. In our assessment, the ten countries with the
1 2 3 4 5 6 7 8 9 10
Early neonatal Iron NN sepsis PEM Haemog Other inf Diarrhoea NN preterm Congenital Endocrine NN enceph
Late neonatal Iron PEM Diarrhoea Congenital Haemog NN preterm Other nutr NN enceph Other inf Epilepsy
Post neonatal Iron Diarrhoea PEM Haemog Skin Other NTD Congenital Other inf NN preterm Endocrine
14 years Iron Skin PEM Diarrhoea Sense Asthma Haemog Other NTD Congenital Otitis
59 years Iron Skin Asthma Sense Haemog Other NTD Conduct Malaria ASD Anxiety
1014 years Iron Skin Conduct Anxiety Asthma Migraine Sense Depression Back & neck Haemog
1519 years Skin Depression Iron Back & neck Migraine Anxiety Sense Conduct Other MSK Asthma
2024 years Depression Back & neck Skin Migraine Iron Other MSK Anxiety Sense Other mental Drugs
2529 years Back & neck Depression Migraine Skin Iron Other MSK Anxiety Sense Drugs Schiz
3034 years Back & neck Depression Migraine Skin Iron Sense Other MSK Anxiety Schiz Gynae
3539 years Back & neck Depression Migraine Sense Other MSK Skin Iron Anxiety Diabetes Schiz
4044 years Back & neck Depression Sense Migraine Other MSK Diabetes Skin Iron Anxiety Schiz
4549 years Back & neck Depression Sense Diabetes Other MSK Migraine Skin Iron Anxiety Schiz
5054 years Back & neck Sense Depression Diabetes Other MSK Migraine Skin Osteoarth Anxiety Schiz
5559 years Back & neck Sense Diabetes Depression Other MSK Migraine Osteoarth Skin Oral Anxiety
6064 years Back & neck Sense Diabetes Depression Other MSK Osteoarth Oral Skin Migraine COPD
6569 years Sense Back & neck Diabetes Depression Other MSK Osteoarth Oral COPD Skin IHD
7074 years Sense Back & neck Diabetes Depression Oral Other MSK Osteoarth COPD IHD Skin
7579 years Sense Back & neck Diabetes Alzheimer's Depression Oral Osteoarth Other MSK COPD IHD
80 years Sense Alzheimers Back & neck Diabetes Falls IHD Osteoarth Depression COPD Oral
Rate of change 200515
019 to 003 003 to 001 001 to 006 006 to 009 009 to 015
015 to 019 019 to 024 024 to 029 029 to 042 042 to 063
Figure 3: Leading ten Level 3 causes of global age-specic years lived with disability in 2015
Each cause is coloured by the percentage change in age-specic years lived with disability from 2005 to 2015. Alzheimers=Alzheimer disease and other dementias.
ASD=autism. Back & neck=low back and neck pain. Conduct=conduct disorders. Congenital=congenital anomalies. COPD=chronic obstructive pulmonary disease.
Drugs=drug use disorders. Endocrine=endocrine, metabolic, blood, and immune disorders. Gyne=gynaecological disorders. Haemog=haemoglobinopathies and haemolytic
anaemias. IHD=ischaemic heart disease. Iron=iron-deciency anaemia. NN enceph=neonatal encephalopathy due to birth asphyxia and trauma. NN preterm=neonatal
preterm birth complications. NN sepsis=neonatal sepsis and other neonatal infections. Other NTD=other neglected tropical diseases. Oral=oral disorders.
Osteoarth=osteoarthritis. Other inf=other infectious diseases. Other mental=other mental and substance use disorders. Other MSK=other musculoskeletal disorders.
Other nutr=other nutritional deciencies. PEM=protein-energy malnutrition. Schiz=schizophrenia. Sense=sense organ disease. Skin=skin and subcutaneous diseases.
highest prevalence of opioid dependence in decreasing for diabetes. We also included, wherever possible, studies
order in 2015 were Iran, United Arab Emirates, Russia, reporting on mean FPG but not diabetes prevalence, using
Morocco, the USA, Australia, Ukraine, Tunisia, Belarus, a regression between mean FPG and diabetes prevalence
Canada, and Iraq. Among these countries, we estimated from studies reporting on both. We have also made the
the highest excess mortality from opioid dependence in assessment of diabetes prevalence more consistent with
the eastern European countries at about twice the level cause of death data for diabetes. Our improved eorts at
of that in the USA, Canada, and the north African and measuring the prevalence of diabetes conrms the
Middle Eastern countries; the lowest rate among these increase in global age-standardised incidence, prevalence,
highly prevalent countries was in Australia. Within the and YLDs. Of note, the increase in YLDs at the global scale
USA, prescription opioids have been estimated to is greater than the increase in YLLs, which reects
account for 37% of drug overdose deaths in 2013.42,43 improved access to treatments that lower case fatality. The
The availability of overdose response treatments in rise of diabetes prevalence, related to the global increase in
the form of naloxone kits to laypersons has also body-mass index,46 given the costs of treating the disease47
accelerated.44 An alternative approach is opioid and the related increases in cardiovascular risks, poses one
substitution treatment to reduce the risk of overdose. of the more important challenges to health systems in the
The intensity at which countries use harm-reduction coming years. This is particularly the case in regions with
strategies such as needle exchange and opioid high prevalence of diabetes such as central America,
substitution programmes follows an inverse pattern,45 north Africa and the Middle East, and Oceania.
with the most intense programmes in Australia, but Ezzati and colleagues48 and the International Diabetes
very rare use of such strategies in eastern Europe, Federation (IDF)49 have estimated diabetes prevalence for
suggesting that embracing harm reduction is an many countries; the intra-class correlation coecient for
eective means of reducing drug deaths. the estimates from Ezzati and colleagues and the GBD
for 2015 is 074, and for the IDF estimates is 065. These
Diabetes large dierences appear to stem from the inclusion of
To obtain standard estimates for health loss due to diabetes cause of death data in the modelling for GBD and also
for GBD 2015 using both fasting plasma glucose (FPG) from the inclusion of self-reported diabetes prevalence in
means and standard deviations as well as diabetes the study by Ezzati and colleagues.48 In GBD, these
prevalence, we re-extracted all available data from 1990 to sources were excluded from our analyses because of
2015. Across studies, we found 20 dierent case denitions changing patterns in the prevalence of known and
5 Key
Dengue
Non-communicable diseases
Injuries HIV
Communicable, maternal, neonatal, and nutritional diseases
Thyroid C
Prostate C Kidney C
2 Lymphoma
Testis C Melanoma skin C
Congenital
Myeloma
NN enceph
Other neopla
1 NN hemol Uterus C Diabetes War
Other NN Drugs
HTN HD Parkinsons
YLDs (%)
Schiz ILD
Varicella Hep
0 STD Skin PVD
URI NN preterm
Stroke
Otitis Diarrhoea COPD Med treat
PEM Road injuries
Asthma Hodgkin NN sepsis
Hernia
1 TB LRI Gastritis Mech Epilepsy
Chagas RHD Mat HTN Violence
Animal
Stomach C F body Other trans
Mat sepsis Other digest Self-harm
AGN LF
Poison Fire Heat Other unint
and cold
Iodine Cervix C
2
Comp abort Trachoma
Cysticer Mat hem Obst labour
PUD
Intest inf
Drowning
Whooping Oncho
3 Other mat
Other resp
4
Nematode
Yellow fev
5
5 4 3 2 1 0 1 2 3 4 5
YLLs (%)
Figure 4: Global annualised rate of change in age-standardised years of life lost (YLLs) and years lived with disability (YLDs) for Level 3 causes between
1990 and 2015
TB=tuberculosis. HIV=HIV/AIDS. Diarrhoea=diarrhoeal diseases. Intest Inf=intestinal infectious diseases. LRI=lower respiratory infections. URI=upper respiratory
infections. Otitis=otitis media. Whooping=whooping cough. Varicella=varicella and herpes zoster. Chagas=chagas disease. Cysticer=cysticercosis. LF=lymphatic
lariasis. Oncho=onchocerciasis. Trachoma=trachoma. Dengue=dengue. Yellow Fev=yellow fever.Nematode=intestinal nematode infections. Mat hem=maternal
haemorrhage. Mat sepsis=maternal sepsis and other maternal infections. Mat HTN=maternal hypertensive disorders. Obst labour=maternal obstructed labour and
uterine rupture. Comp abort=maternal abortion, miscarriage, and ectopic pregnancy. Oth mat=other maternal disorders. NN preterm=neonatal preterm birth
complications. NN enceph=neonatal encephalopathy due to birth asphyxia and trauma. NN sepsis=neonatal sepsis and other neonatal infections.
NN haemol=haemolytic disease and other neonatal jaundice. Oth NN=other neonatal disorders. PEM=protein-energy malnutrition. Iodine=iodine deciency.
Oth nutr=other nutritional deciencies. STD=sexually transmitted diseases excluding HIV. Hep=hepatitis. Stomach C=stomach cancer. Melanoma=malignant skin
melanoma. Skin C=non-melanoma skin cancer. Cervix C=cervical cancer. Uterus C=uterine cancer. Prostate C=prostate cancer. Testis C=testicular cancer. Kidney
C=kidney cancer. Thyroid C=thyroid cancer. Hodgkin=Hodgkin lymphoma. Lymphoma=non-Hodgkin lymphoma. Myeloma=multiple myeloma. Oth neopla=Other
neoplasms. RHD=rheumatic heart disease. Stroke=cerebrovascular disease. HTN HD=hypertensive heart disease. PVD=peripheral vascular disease. COPD=chronic
obstructive pulmonary disease. Asthma=asthma. ILD=interstitial lung disease and pulmonary sarcoidosis. Oth resp=other chronic respiratory diseases. PUD=peptic
ulcer disease. Gastritis=gastritis and duodenitis. Hernia=inguinal, femoral, and abdominal hernia. Oth digest=other digestive diseases. Parkinson=Parkinsons disease.
Schiz=schizophrenia. Drugs=drug use disorders. AGN=acute glomerulonephritis. Congenital=congenital anomalies. Skin=skin and subcutaneous diseases.
Road inj=road injuries. Oth trans=other transport injuries. Drown=drowning. Fire=re, heat, and hot substances. Poison=poisonings. Mech=exposure to mechanical
forces. Med treat=adverse eects of medical treatment. Animal=animal contact. F body=foreign body. Heat & cold=environmental heat and cold exposure.
Oth unint=other unintentional injuries. Violence=interpersonal violence. War=collective violence and legal intervention.
Dementia A
Brayne and colleagues50,51 reported that age-specic Female Male
prevalence of Alzheimers was decreasing in the UK. Of 80
the four studies in the USA with similar measurements 7579
over time that were reviewed, one showed a decrease,
7074
whereas no change in prevalence was seen
in the remaining studies.52,53 Our assessment of 6569
age-standardised prevalence showed that Alzheimers 6064
and other dementias decreased slowly in the UK, by
5559
369% (253485%) from 2005 to 2015, but remained
constant in the rest of the world. The decrease might be 5054
due to reductions in vascular dementias rather than 4549
Age (years)
3034
Figure 5: Population pyramids with the number of individuals, by age and
sex, grouped by severity of their disability weight (DW) for all comorbid 2529
conditions combined into no disability, very mild disability (DW 0001),
mild disability (DW 001005), moderate disability (DW 00501), severe 2024
disability (DW 0103), and very severe disability (DW >03) for geographies 1519
of high (A) and low (B) quintiles of Socio-demographic Index in 2015
Disability weights are combined multiplicatively as 1(1DW1)(1 DW2)... 1014
(1DWn) for n comorbid sequelae. Socio-demographic Index (SDI) is calculated
for each geography as a function of lag-dependent income per capita, average 59
educational attainment in the population aged over 15 years, and the total 04
fertility rate. SDI units are interpretable; a zero represents the lowest level of
income per capita, educational attainment, and highest total fertility rate (TFR) 46 36 26 15 5 0 5 15 26 36 46
observed from 1980 to 2015 and a one represents the highest income per Population (millions)
capita, educational attainment, and lowest TFR observed in the same period. Disability No disability Mild Severe
Cutos on the SDI scale for the quintiles have been selected based on level Very mild Moderate Very severe
examination of the entire distribution of geographies between 1980 and 2015.
075
Malaria
Our assessment of malaria prevalence and incidence in
high burden sub-Saharan Africa was based on the Malaria
Socio-demographic Index
1 2 3 4 5 6 7 8 9 10
Back & neck Sense Depression Iron Skin Diabetes Migraine Other MSK Anxiety Oral
Global (10) (093) (101) (093) (098) (093) (129) (093) (086)
(096)
Back & neck Sense Depression Skin Diabetes Migraine Other MSK Anxiety Oral Iron
High income (094) (111) (092) (129) (104) (127) (132) (095) (092)
(111)
Back & neck Depression Diabetes Sense Other MSK Skin Anxiety Migraine Drugs Iron
High-income North America (131) (23) (089) (183) (094) (154) (097) (294) (09)
(108)
Back & neck Sense Depression Skin Other MSK Diabetes Migraine Iron Anxiety Oral
Canada (091) (098) (102) (162) (157) (113) (117) (123) (095)
(131)
Back & neck Depression Other MSK Skin Sense Migraine Anxiety Iron Diabetes Falls
Greenland (094) (218) (103) (068) (103) (128) (099) (072) (117)
(11)
Back & neck Depression Diabetes Sense Other MSK Skin Anxiety Migraine Drugs Iron
USA (134) (239) (089) (186) (093) (157) (095) (302) (087)
(105)
Back & neck Depression Sense Other MSK Skin Anxiety Migraine Diabetes Asthma Drugs
Australasia (13) (084) (193) (093) (172) (117) (127) (159) (291)
(112)
Back & neck Depression Other MSK Sense Skin Migraine Anxiety Diabetes Drugs Asthma
Australia (133) (20) (084) (093) (121) (172) (122) (305) (158)
(112)
Back & neck Depression Sense Anxiety Skin Diabetes Other MSK Migraine Asthma Oral
New Zealand (114) (085) (177) (092) (151) (153) (10) (163) (109)
(115)
Back & neck Sense Depression Skin Diabetes Migraine Oral Other MSK Iron Falls
High-income Asia Pacific (104) (086) (098) (096) (089) (096) (092) (112) (089)
(084)
Back & neck Depression Skin Sense Diabetes Iron Migraine Falls Anxiety Asthma
Brunei (09) (093) (105) (239) (106) (084) (135) (085) (113)
(082)
Back & neck Sense Depression Skin Oral Diabetes Migraine Other MSK Alzheimer's Iron
Japan (105) (087) (10) (097) (083) (091) (105) (106)
(082) (093)
Back & neck Sense Depression Skin Migraine Iron Oral Other MSK Anxiety Falls
Singapore (101) (095) (093) (075) (105) (095) (085) (092)
(06) (083)
Back & neck Sense Depression Diabetes Skin Migraine Iron Other MSK Oral Falls
South Korea (102) (083) (137) (092) (083) (128) (094) (106)
(09) (09)
Back & neck Sense Depression Migraine Skin Anxiety Diabetes Oral Other MSK Falls
Western Europe (094) (105) (117) (087) (128) (088) (099) (094) (104)
(127)
Back & neck Sense Depression Skin Migraine Oral Falls Anxiety Diabetes Iron
Andorra (091) (112) (088) (115) (113) (123) (124) (094) (082)
(141)
Back & neck Sense Depression Migraine Skin Oral Anxiety Diabetes Falls Other MSK
Austria (093) (107) (129) (088) (123) (122) (09) (119) (086)
(122)
Back & neck Sense Depression Skin Migraine Diabetes Oral Falls Anxiety Other MSK
Belgium (106) (101) (087) (114) (11) (117) (125) (117) (083)
(139)
Back & neck Sense Depression Migraine Skin Diabetes Anxiety Oral Asthma Other MSK
Cyprus (096) (107) (114) (088) (127) (122) (109) (124) (079)
(14)
Back & neck Sense Depression Skin Migraine Other MSK Diabetes Oral Anxiety Iron
Denmark (079) (11) (094) (109) (123) (112) (107) (125) (079)
(145)
Back & neck Sense Depression Skin Falls Migraine Diabetes Oral Asthma Iron
Finland (085) (123) (092) (158) (114) (106) (112) (135) (10)
(138)
Back & neck Sense Depression Skin Anxiety Migraine Falls Oral Other MSK Diabetes
France (092) (103) (086) (154) (104) (123) (10) (102) (069)
(115)
Back & neck Sense Depression Migraine Skin Anxiety Diabetes Oral Falls Other MSK
Germany (098) (108) (123) (086) (147) (102) (105) (102) (082)
(148)
Back & neck Sense Depression Migraine Skin Oral Anxiety Diabetes Falls Alzheimer's
Greece (095) (121) (111) (083) (113) (119) (071) (086) (101)
(128)
Back & neck Sense Depression Migraine Skin Anxiety Oral Iron Diabetes Falls
Iceland (093) (089) (115) (079) (123) (118) (083) (081) (096)
(138)
Back & neck Sense Depression Skin Migraine Anxiety Iron Other MSK Oral Asthma
Ireland (092) (107) (091) (114) (158) (10) (109) (117) (136)
(125)
Back & neck Sense Depression Skin Migraine Iron Diabetes Oral Other MSK War
Israel (094) (11) (086) (114) (111) (12) (115) (095) (697772)
(12)
Back & neck Sense Depression Migraine Diabetes Skin Anxiety Other MSK Alzheimer's Falls
Italy (109) (106) (139) (101) (086) (124) (10) (122) (094)
(131)
Back & neck Sense Depression Migraine Skin Diabetes Oral Anxiety Falls Asthma
Luxembourg (092) (111) (128) (087) (13) (121) (123) (115) (142)
(142)
Back & neck Sense Depression Diabetes Migraine Skin Oral Anxiety Falls Asthma
Malta (089) (102) (102) (113) (09) (115) (118) (113) (112)
(131)
Back & neck Sense Depression Migraine Skin Anxiety Diabetes Oral Other MSK Falls
Netherlands (09) (099) (121) (087) (159) (123) (132) (113) (094)
(15)
Back & neck Sense Depression Anxiety Skin Migraine Diabetes Oral Other MSK Falls
Norway (081) (103) (187) (085) (107) (122) (115) (087) (107)
(159)
Back & neck Sense Depression Migraine Skin Diabetes Oral Anxiety Other MSK Asthma
Portugal (083) (109) (113) (088) (078) (109) (113) (094) (118)
(134)
Back & neck Sense Depression Migraine Skin Diabetes Iron Falls Anxiety Oral
Spain (099) (109) (115) (086) (078) (125) (102) (101) (091)
(097)
Back & neck Sense Depression Diabetes Skin Migraine Anxiety Other MSK Oral Iron
Sweden (078) (105) (136) (09) (091) (122) (102) (09) (089)
(125)
1 2 3 4 5 6 7 8 9 10
Back & neck Sense Depression Skin Migraine Oral Falls Anxiety Diabetes Other MSK
Switzerland
(148) (09) (108) (088) (108) (122) (141) (125) (089) (074)
Back & neck Sense Depression Skin Migraine Asthma Other MSK Anxiety Oral Iron
UK
(117) (079) (096) (088) (11) (186) (118) (107) (091) (092)
Back & neck Sense Depression Skin Migraine Other MSK Asthma Anxiety Oral Iron
England
(117) (079) (095) (087) (104) (122) (179) (108) (091) (095)
Back & neck Sense Depression Skin Migraine Asthma Falls Oral Anxiety Diabetes
Northern Ireland
(111) (073) (097) (088) (103) (141) (121) (091) (089) (063)
Back & neck Migraine Sense Depression Asthma Skin Diabetes Other MSK Falls Anxiety
Scotland
(123) (175) (079) (097) (235) (089) (107) (102) (121) (112)
Back & neck Sense Depression Asthma Skin Migraine Diabetes Other MSK Falls Anxiety
Wales
(115) (079) (107) (259) (09) (103) (095) (108) (107) (109)
Back & neck Depression Sense Skin Anxiety Migraine Iron Diabetes Other MSK Asthma
Southern Latin America
(088) (107) (084) (093) (153) (093) (102) (083) (107) (103)
Back & neck Depression Sense Skin Anxiety Iron Migraine Diabetes Other MSK Asthma
Argentina
(087) (107) (084) (092) (152) (112) (091) (082) (109) (101)
Back & neck Depression Sense Skin Anxiety Migraine Diabetes Other MSK Oral Asthma
Chile
(088) (11) (086) (096) (157) (095) (09) (105) (098) (108)
Back & neck Sense Depression Skin Anxiety Iron Migraine Diabetes Asthma Other MSK
Uruguay
(089) (08) (103) (093) (149) (109) (094) (06) (111) (092)
Central Europe, eastern Europe, Back & neck Sense Depression Skin Iron Migraine Diabetes Oral Anxiety Osteoarth
and central Asia (12) (116) (11) (089) (145) (099) (10) (099) (081) (129)
Back & neck Sense Depression Iron Skin Migraine Diabetes Oral Drugs Osteoarth
Eastern Europe (121) (125) (093) (096) (326) (133)
(117) (181) (089) (101)
Back & neck Sense Depression Skin Migraine Diabetes Iron Falls Oral Drugs
Belarus (119) (122) (113) (089) (284)
(118) (115) (102) (102) (097)
Back & neck Sense Depression Skin Migraine Diabetes Iron Oral Osteoarth Alcohol
Estonia (116) (116) (093) (528)
(108) (125) (088) (103) (105) (138)
Back & neck Sense Depression Diabetes Skin Migraine Iron Oral Osteoarth Anxiety
Latvia (089)
(124) (122) (097) (132) (085) (103) (118) (135) (077)
Back & neck Sense Depression Skin Diabetes Migraine Iron Oral Osteoarth IHD
Lithuania
(123) (117) (116) (086) (108) (104) (118) (095) (132) (194)
Back & neck Sense Depression Skin Migraine Iron Diabetes Oral Anxiety Alcohol
Moldova
(12) (096) (10) (095) (102) (124) (067) (094) (07) (329)
Back & neck Sense Depression Iron Skin Migraine Diabetes Drugs Oral Alcohol
Russia
(12) (13) (114) (222) (088) (10) (095) (339) (098) (605)
Back & neck Sense Depression Skin Migraine Diabetes Oral Osteoarth Drugs IHD
Ukraine
(126) (117) (129) (089) (103) (086) (092) (124) (326) (176)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Central Europe
(129) (11) (106) (114) (09) (098) (101) (093) (129) (091)
Back & neck Sense Depression Skin Iron Migraine Anxiety Oral Diabetes Osteoarth
Albania
(137) (094) (098) (083) (125) (098) (088) (098) (051) (091)
Back & neck Sense Depression Diabetes Skin Migraine War Oral Iron Anxiety
Bosnia
(116) (098) (098) (101) (09) (098) (188724) (106) (101) (088)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Bulgaria
(128) (104) (106) (118) (09) (098) (101) (096) (121) (112)
Back & neck Sense Depression Skin Diabetes Migraine Oral Iron Osteoarth Anxiety
Croatia
(137) (097) (104) (09) (083) (097) (107) (11) (12) (092)
Back & neck Sense Depression Diabetes Skin Migraine Oral Iron Anxiety Osteoarth
Czech Republic
(138) (109) (113) (146) (088) (098) (104) (105) (096) (143)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Hungary
(138) (105) (107) (162) (096) (098) (094) (095) (135) (085)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Macedonia
(126) (099) (101) (114) (089) (098) (097) (089) (121) (058)
Back & neck Sense Depression Diabetes Skin Migraine Iron Oral Anxiety Osteoarth
Montenegro
(127) (104) (104) (115) (091) (098) (112) (098) (091) (126)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth IHD
Poland
(121) (127) (107) (125) (088) (097) (103) (095) (134) (209)
Back & neck Sense Depression Skin Migraine Diabetes Oral Iron Osteoarth Anxiety
Romania
(133) (103) (104) (09) (098) (075) (104) (118) (128) (089)
Back & neck Sense Depression Diabetes Skin Migraine Oral Anxiety Osteoarth Iron
Serbia
(131) (10) (102) (122) (092) (098) (098) (091) (123) (08)
Back & neck Sense Depression Skin Diabetes Migraine Iron Anxiety Oral Osteoarth
Slovakia
(134) (106) (108) (089) (125) (097) (109) (094) (085) (135)
Back & neck Sense Depression Skin Diabetes Migraine Oral Iron Osteoarth Anxiety
Slovenia
(135) (099) (109) (09) (107) (098) (116) (118) (135) (095)
Back & neck Sense Depression Iron Skin Migraine Diabetes Anxiety Oral Asthma
Central Asia
(101) (098) (097) (136) (087) (098) (098) (08) (106) (069)
Back & neck Sense Depression Diabetes Skin Migraine Iron Oral Anxiety Disaster
Armenia
(10) (103) (101) (14) (087) (097) (111) (106) (081) (13888)
Back & neck Sense Depression Iron Skin Diabetes Migraine Anxiety Oral Osteoarth
Azerbaijan
(098) (108) (102) (155) (088) (136) (096) (082) (103) (126)
Back & neck Sense Depression Diabetes Skin Migraine Iron Oral Anxiety Osteoarth
Georgia
(093) (105) (101) (119) (085) (098) (125) (102) (082) (121)
1 2 3 4 5 6 7 8 9 10
Back & neck Iron Sense Depression Skin Migraine Diabetes Oral Anxiety Osteoarth
Kazakhstan
(104) (24) (11) (103) (09) (096) (117) (114) (082) (131)
Back & neck Iron Depression Sense Skin Migraine Anxiety Diabetes Oral Asthma
Kyrgyzstan
(104) (13) (091) (085) (086) (10) (076) (052) (105) (069)
Back & neck Depression Sense Skin Iron Migraine Diabetes Anxiety Oral Falls
Mongolia
(098) (094) (094) (087) (097) (098) (079) (078) (102) (137)
Back & neck Iron Depression Sense Skin Migraine Anxiety Diabetes Oral Epilepsy
Tajikistan
(106) (103) (087) (08) (085) (10) (078) (066) (106) (154)
Back & neck Depression Sense Iron Skin Migraine Diabetes Anxiety Oral Asthma
Turkmenistan
(094) (10) (106) (131) (088) (096) (133) (082) (102) (065)
Back & neck Depression Sense Iron Skin Migraine Diabetes Anxiety Oral Asthma
Uzbekistan
(10) (094) (093) (108) (087) (098) (084) (078) (103) (079)
Back & neck Sense Depression Skin Anxiety Iron Diabetes Migraine Asthma Other MSK
Latin America and Caribbean
(087) (106) (108) (099) (152) (102) (112) (10) (118) (101)
Back & neck Sense Depression Diabetes Skin Iron Migraine Anxiety Other MSK Oral
Central Latin America
(086) (112) (094) (144) (095) (093) (09) (101) (089) (108)
Back & neck Sense Depression Skin Anxiety Migraine Diabetes Asthma Other MSK Oral
Colombia
(094) (114) (102) (102) (135) (089) (081) (123) (093) (107)
Back & neck Sense Depression Skin Iron Migraine Anxiety Diabetes Asthma Other MSK
Costa Rica
(089) (116) (101) (091) (101) (088) (108) (072) (118) (098)
Back & neck Sense Iron Depression Skin Diabetes Migraine Anxiety Asthma Oral
El Salvador
(094) (096) (159) (09) (094) (094) (091) (103) (124) (107)
Back & neck Iron Sense Skin Depression Diabetes Migraine Anxiety Asthma Oral
Guatemala
(096) (106) (094) (096) (085) (167) (09) (105) (102) (118)
Honduras Back & neck Sense Skin Depression Iron Asthma Migraine Anxiety Diabetes Oral
(098) (095) (106) (088) (079) (154) (091) (105) (089) (107)
Mexico Back & neck Sense Diabetes Depression Skin Migraine Anxiety Other MSK Oral Iron
(079) (117) (19) (091) (091) (091) (085) (094) (108) (05)
Nicaragua Back & neck Sense Depression Skin Iron Migraine Anxiety Diabetes Asthma Oral
(096) (095) (087) (096) (082) (091) (105) (085) (096) (108)
Panama Back & neck Sense Depression Skin Diabetes Iron Migraine Asthma Anxiety Oral
(091) (119) (099) (095) (135) (12) (088) (137) (109) (103)
Venezuela Iron Back & neck Sense Depression Skin Diabetes Migraine Anxiety Asthma Other MSK
(306) (09) (112) (096) (098) (117) (086) (106) (101) (09)
Andean Latin America Back & neck Sense Depression Iron Skin Anxiety Migraine Diabetes Asthma Oral
(093) (107) (109) (134) (102) (137) (10) (076) (11) (109)
Bolivia Back & neck Iron Sense Depression Skin Anxiety Migraine Diabetes Asthma Oral
(10) (152) (097) (103) (102) (133) (099) (073) (111) (112)
Ecuador Back & neck Sense Depression Iron Skin Diabetes Anxiety Migraine Oral Asthma
(091) (102) (108) (133) (099) (115) (137) (087) (109) (086)
Peru Back & neck Sense Depression Skin Iron Migraine Anxiety Asthma Oral Diabetes
(092) (114) (111) (103) (129) (107) (138) (122) (109) (057)
Caribbean Back & neck Sense Depression Iron Skin Diabetes Anxiety Migraine Asthma Other MSK
(089) (106) (111) (12) (109) (124) (149) (10) (162) (105)
Antigua Back & neck Depression Sense Diabetes Skin Iron Anxiety Migraine Other MSK Asthma
(082) (12) (121) (22) (105) (143) (149) (094) (137) (131)
Bahamas Back & neck Sense Depression Diabetes Skin Iron Anxiety Migraine Other MSK Asthma
(082) (119) (118) (194) (105) (154) (149) (094) (147) (138)
Barbados Back & neck Sense Diabetes Depression Skin Other MSK Iron Anxiety Migraine Asthma
(081) (107) (205) (115) (096) (157) (149) (146) (094) (126)
Belize Back & neck Depression Iron Skin Sense Anxiety Diabetes Migraine Asthma Other MSK
(084) (104) (119) (105) (092) (135) (114) (097) (158) (113)
Bermuda Back & neck Depression Sense Skin Iron Anxiety Diabetes Migraine Other MSK Asthma
(089) (125) (119) (102) (132) (153) (187) (096) (141) (146)
Cuba Back & neck Sense Depression Skin Diabetes Anxiety Iron Migraine Other MSK Asthma
(082) (111) (114) (108) (091) (146) (136) (095) (111) (131)
Dominica Back & neck Diabetes Sense Depression Skin Iron Anxiety Migraine Asthma Other MSK
(083) (212) (107) (112) (105) (129) (141) (095) (152) (125)
Dominican Republic Back & neck Sense Depression Skin Iron Anxiety Migraine Asthma Diabetes Other MSK
(082) (098) (107) (105) (119) (137) (097) (15) (071) (091)
Grenada Back & neck Depression Sense Iron Skin Diabetes Other MSK Anxiety Migraine Asthma
(08) (111) (106) (152) (105) (178) (173) (141) (094) (143)
Guyana Back & neck Iron Depression Sense Diabetes Skin Anxiety Migraine Asthma Other MSK
(084) (141) (102) (091) (136) (104) (133) (097) (158) (085)
Haiti Iron Back & neck Depression Disaster Skin Sense Asthma Anxiety Migraine Diabetes
(101) (096) (089) (122789) (102) (08) (197) (145) (10) (138)
Jamaica Back & neck Sense Depression Diabetes Skin Iron Anxiety Migraine Other MSK Asthma
(083) (10) (11) (143) (105) (125) (138) (095) (139) (148)
Puerto Rico Back & neck Sense Diabetes Depression Skin Anxiety Iron Other MSK Migraine Asthma
(088) (12) (237) (123) (102) (153) (138) (13) (095) (141)
Saint Lucia Back & neck Sense Depression Diabetes Skin Iron Anxiety Migraine Asthma Other MSK
(083) (105) (111) (148) (105) (126) (141) (095) (152) (125)
Saint Vincent and the Grenadines Back & neck Sense Depression Diabetes Skin Iron Anxiety Migraine Asthma Other MSK
(082) (105) (11) (184) (105) (123) (141) (095) (145) (121)
1 2 3 4 5 6 7 8 9 10
Back & neck Sense Depression Skin Iron Diabetes Anxiety Migraine Asthma Other MSK
Suriname (082) (098) (105) (125) (121) (138) (096) (153) (119)
(107)
Back & neck Diabetes Sense Depression Skin Iron Anxiety Other MSK Migraine Asthma
Trinidad and Tobago (081) (311) (111) (15) (149) (158)
(117) (118) (144) (094)
Back & neck Sense Diabetes Depression Skin Other MSK Iron Anxiety Migraine Asthma
Virgin Islands, USA (089) (138) (146)
(119) (214) (124) (102) (144) (154) (096)
Back & neck Depression Sense Anxiety Skin Migraine Iron Diabetes Other MSK Asthma
Tropical Latin America
(087) (123) (099) (214) (10) (112) (10) (086) (121) (141)
Back & neck Depression Sense Anxiety Skin Migraine Iron Diabetes Other MSK Asthma
Brazil
(086) (123) (099) (215) (10) (112) (10) (086) (122) (143)
Back & neck Depression Sense Skin Anxiety Iron Migraine Diabetes Other MSK Asthma
Paraguay
(097) (124) (097) (114) (181) (106) (106) (092) (09) (101)
Back & neck Sense Depression Skin Diabetes Other MSK Iron Migraine Schiz Anxiety
Southeast Asia, east Asia, and Oceania
(086) (094) (074) (10) (076) (122) (08) (065) (131) (072)
Back & neck Sense Depression Skin Diabetes Other MSK Iron Schiz Migraine Anxiety
East Asia
(089) (091) (073) (096) (064) (11) (079) (138) (057) (071)
Back & neck Sense Depression Skin Diabetes Other MSK Iron Schiz Migraine Anxiety
China
(088) (091) (074) (096) (062) (109) (079) (139) (057) (07)
Back & neck Sense Skin Iron Depression Other MSK Diabetes COPD Anxiety Migraine
North Korea
(105) (077) (093) (092) (061) (115) (059) (21) (083) (059)
Back & neck Sense Diabetes Other MSK Depression Skin Anxiety Iron Migraine Osteoarth
Taiwan (province of China)
(099) (108) (229) (159) (073) (089) (103) (105) (063) (144)
Back & neck Sense Skin Depression Diabetes Other MSK Iron Migraine Anxiety Asthma
Southeast Asia
(081) (101) (106) (076) (11) (153) (081) (083) (075) (102)
Back & neck Iron Sense Skin Depression Migraine Other MSK Asthma Anxiety Diabetes
Cambodia
(094) (094) (095) (105) (067) (082) (111) (114) (081) (082)
Back & neck Sense Skin Diabetes Depression Other MSK Iron Migraine Anxiety Asthma
Indonesia
(076) (099) (105) (117) (077) (167) (094) (083) (077) (093)
Back & neck Skin Iron Sense Depression Diabetes Other MSK Migraine Asthma Anxiety
Laos
(09) (105) (07) (084) (068) (136) (127) (082) (128) (08)
Back & neck Sense Skin Depression Diabetes Other MSK Nematode Anxiety Migraine Schiz
Malaysia
(075) (10) (105) (084) (151) (182) (440593) (12) (079) (118)
Back & neck Sense Iron Skin Depression Migraine Other MSK Anxiety Haemog Diabetes
Maldives
(082) (098) (135) (108) (075) (084) (117) (076) (361) (056)
Back & neck Diabetes Sense Depression Skin Other MSK Migraine Anxiety Asthma Oral
Mauritius
(082) (204) (115) (084) (107) (177) (082) (08) (103) (084)
Sense Back & neck Skin Depression Diabetes Iron Other MSK Migraine Asthma Anxiety
Myanmar
(113) (079) (104) (069) (123) (069) (138) (082) (108) (079)
Philippines Back & neck Sense Skin Diabetes Iron Depression Other MSK Migraine Asthma Anxiety
(095) (105) (107) (149) (092) (075) (169) (082) (129) (077)
Sri Lanka Back & neck Sense Diabetes Skin Depression Iron Migraine Asthma Anxiety Other MSK
(081) (114) (144) (106) (081) (104) (082) (114) (079) (086)
Seychelles Back & neck Sense Skin Depression Diabetes Migraine Other MSK Anxiety Asthma Schiz
(079) (118) (107) (084) (134) (082) (115) (081) (091) (115)
Thailand Back & neck Sense Depression Skin Other MSK Diabetes Migraine Iron Anxiety Asthma
(073) (104) (082) (106) (163) (083) (084) (082) (079) (108)
Timor-Leste Back & neck Sense Iron Skin Depression Migraine Asthma Other MSK Diabetes Anxiety
(087) (097) (066) (107) (07) (082) (115) (103) (105) (084)
Vietnam Back & neck Sense Skin Depression Migraine Other MSK Diabetes Schiz Other nutr Asthma
(085) (092) (107) (077) (085) (118) (06) (12) (7236) (086)
Oceania Back & neck Iron Skin Diabetes Sense Depression Asthma Other MSK Nematode Migraine
(101) (098) (136) (269) (096) (07) (176) (158) (375) (077)
American Samoa Back & neck Diabetes Skin Sense Iron Depression Other MSK Asthma Migraine Anxiety
(09) (278) (134) (103) (091) (077) (187) (131) (072) (083)
Micronesia Back & neck Skin Diabetes Sense Depression Other MSK Asthma Iron Migraine Anxiety
(091) (131) (168) (091) (072) (165) (145) (066) (073) (082)
Fiji Diabetes Back & neck Skin Sense Iron Depression Asthma Other MSK Nematode Migraine
(307) (084) (127) (103) (11) (075) (164) (145) (5808) (072)
Guam Back & neck Diabetes Sense Skin Other MSK Depression Iron Asthma Other NTD Migraine
(094) (317) (127) (124) (196) (089) (097) (147) (234 96429) (072)
Kiribati Back & neck Diabetes Nematode Skin Sense Iron Depression Asthma Migraine Other MSK
(093) (307) (702) (127) (081) (054) (065) (168) (072) (103)
Marshall Diabetes Back & neck Skin Iron Sense Nematode Depression Other MSK Asthma Migraine
(331) (088) (129) (123) (087) (721) (069) (17) (141) (072)
Northern Mariana Islands Back & neck Skin Diabetes Depression Sense Other MSK Iron Migraine Anxiety Asthma
(086) (125) (33) (082) (128) (161) (108) (071) (085) (116)
Papua New Guinea Iron Back & neck Skin Sense Diabetes Depression Asthma Nematode Other MSK LF
(097) (095) (129) (084) (235) (063) (17) (334) (143) (10035)
Samoa Back & neck Skin Sense Diabetes Iron Depression Other MSK Asthma Migraine Anxiety
(09) (133) (092) (15) (084) (074) (16) (116) (073) (082)
Solomon Islands Back & neck Skin Diabetes Sense Iron Depression Other MSK Asthma Migraine Anxiety
(095) (125) (269) (081) (053) (065) (156) (145) (073) (088)
Tonga Back & neck Skin Diabetes Sense Iron Depression Other MSK Asthma Migraine Osteoarth
(092) (134) (149) (083) (097) (073) (169) (168) (073) (201)
1 2 3 4 5 6 7 8 9 10
Back & neck Skin Diabetes Sense Depression Other MSK Asthma Migraine Nematode Anxiety
Vanuatu (091) (131) (179) (082) (067) (155) (145) (073) (291) (083)
Back & neck Depression Sense Diabetes Iron Skin Migraine Other MSK Anxiety Asthma
North Africa and Middle East (107) (093) (086) (162) (082) (084) (134) (106) (094)
(107)
Back & neck Depression Sense Diabetes Iron Skin Migraine Other MSK Anxiety Asthma
North Africa and Middle East (107) (093) (086) (162) (082) (084) (134) (106) (094)
(107)
Iron Back & neck War Skin Depression Sense Diabetes Other unint Migraine Anxiety
Afghanistan (08) (115) (16345) (084) (08) (528) (118) (123)
(073) (272)
Back & neck Diabetes Depression Sense Skin Migraine Other MSK Iron Anxiety Asthma
Algeria (104) (095) (104) (10)
(147) (082) (083) (108) (152) (07)
Back & neck Diabetes Depression Sense Other MSK Skin Migraine Iron Anxiety Drugs
Bahrain
(095) (29) (111) (102) (196) (09) (107) (143) (107) (178)
Back & neck Iron Diabetes Sense Depression Skin Migraine Other MSK Anxiety Asthma
Egypt
(108) (153) (15) (093) (077) (084) (107) (119) (10) (096)
Back & neck Depression Sense Diabetes Migraine Skin Other MSK Anxiety Drugs Other cardio
Iran
(103) (105) (094) (148) (098) (08) (144) (107) (341) (621)
Back & neck Diabetes Depression War Sense Skin Iron Migraine Anxiety Other MSK
Iraq
(108) (219) (093) (39543) (079) (075) (065) (106) (114) (092)
Back & neck Depression Diabetes Skin Iron Sense Migraine Other MSK Anxiety Asthma
Jordan
(10) (101) (199) (092) (097) (092) (105) (169) (107) (103)
Back & neck Depression Migraine Skin Diabetes Sense Iron Anxiety Other MSK Asthma
Kuwait
(088) (118) (106) (089) (246) (109) (118) (112) (132) (101)
War Back & neck Diabetes Depression Sense Skin Iron Migraine Anxiety Asthma
Lebanon
(10 68982) (083) (20) (102) (09) (093) (135) (103) (127) (114)
Back & neck Depression Diabetes Sense Skin Migraine War Iron Anxiety Other MSK
Libya
(104) (10) (13) (081) (087) (107) (46477) (072) (104) (119)
Back & neck Diabetes Sense Depression Skin Migraine Iron Other MSK Anxiety Drugs
Morocco
(114) (221) (079) (088) (092) (105) (056) (136) (109) (401)
Back & neck Depression Skin Sense Iron Migraine Anxiety Diabetes War Other MSK
Palestine
(106) (129) (083) (072) (059) (107) (107) (114) (19872) (108)
Back & neck Depression Diabetes Other Cardio Sense Migraine Skin Iron Other MSK Anxiety
Oman
(095) (107) (242) (192) (101) (11) (085) (115) (143) (105)
Back & neck Depression Diabetes Migraine Skin Sense Anxiety Other MSK Iron Heat & cold
Qatar
(094) (115) (312) (112) (094) (096) (105) (126) (114) (1726)
Back & neck Depression Migraine Skin Sense Diabetes Anxiety Other MSK Iron Asthma
Saudi Arabia
(099) (111) (127) (093) (101) (151) (108) (133) (052) (08)
Back & neck Iron Depression Skin Sense Migraine Diabetes Anxiety Asthma Other MSK
Sudan
(107) (081) (084) (084) (075) (108) (19) (115) (118) (116)
War Back & neck Depression Sense Skin Iron Migraine Diabetes Anxiety Asthma
Syria
(161215) (105) (094) (078) (08) (073) (107) (107) (106) (099)
Back & neck Diabetes Depression Sense Skin Other MSK Migraine Anxiety Iron Asthma
Tunisia
(102) (135) (10) (082) (089) (158) (102) (104) (066) (105)
Back & neck Sense Depression Diabetes Other MSK Skin Migraine Iron Anxiety Oral
Turkey
(113) (085) (092) (13) (167) (083) (101) (093) (092) (118)
Back & neck Depression Diabetes Other MSK Migraine Sense Skin Drugs Anxiety Iron
United Arab Emirates
(099) (118) (352) (192) (114) (115) (091) (216) (104) (121)
Back & neck War Depression Skin Sense Iron Migraine Diabetes Anxiety Other MSK
Yemen
(111) (24822) (084) (084) (077) (044) (111) (176) (117) (134)
Iron Back & neck Sense Depression Other MSK Skin Migraine Diabetes Anxiety COPD
South Asia
(137) (091) (111) (092) (196) (089) (119) (09) (08) (177)
Iron Back & neck Sense Depression Other MSK Skin Migraine Diabetes Anxiety COPD
South Asia
(137) (091) (111) (092) (196) (089) (119) (09) (08) (177)
Back & neck Other MSK Sense Depression Iron Skin Migraine Anxiety Diabetes Epilepsy
Bangladesh
(106) (27) (095) (082) (067) (094) (12) (111) (10) (297)
Back & neck Iron Sense Depression Skin Other MSK Migraine Diabetes Diarrhoea Anxiety
Bhutan
(105) (148) (098) (083) (095) (184) (119) (117) (333) (088)
Iron Back & neck Sense Depression Other MSK Migraine Skin Diabetes Anxiety COPD
India
(158) (089) (116) (094) (193) (12) (086) (083) (074) (201)
Back & neck Sense Skin Migraine Other MSK Iron Depression Disaster Anxiety Asthma
Nepal
(113) (089) (097) (133) (193) (048) (063) (66196) (094) (107)
Iron Back & neck Sense Depression Skin Migraine Other MSK Diabetes Anxiety Asthma
Pakistan
(102) (087) (093) (09) (10) (113) (156) (147) (092) (091)
Iron Back & neck Depression Sense Skin Other NTD Migraine HIV Asthma Malaria
Sub-Saharan Africa
(079) (098) (104) (102) (093) (124) (08) (474) (098) (225)
HIV Back & neck Depression Sense Skin Iron Diabetes Migraine Asthma Anxiety
Southern sub-Saharan Africa
(11159) (103) (105) (106) (095) (096) (154) (078) (129) (079)
HIV Back & neck Iron Depression Sense Skin Diabetes Asthma Migraine TB
Botswana
(14061) (098) (151) (109) (098) (095) (133) (149) (077) (1589)
HIV Back & neck Depression Sense Skin Iron Diabetes Asthma Migraine Anxiety
Lesotho
(7348) (108) (114) (091) (093) (064) (163) (168) (077) (078)
HIV Back & neck Iron Depression Sense Skin Diabetes Asthma Migraine Anxiety
Namibia
(7797) (099) (128) (109) (095) (096) (107) (142) (078) (076)
HIV Back & neck Sense Depression Diabetes Skin Iron Migraine Asthma Anxiety
South Africa
(16551) (104) (112) (104) (165) (095) (101) (078) (127) (081)
1 2 3 4 5 6 7 8 9 10
HIV Back & neck Depression Skin Sense Iron Diabetes Asthma Nematode Migraine
Swaziland
(17235) (094) (109) (095) (097) (092) (151) (195) (573) (077)
HIV Back & neck Iron Depression Skin Sense Asthma Migraine Diabetes Anxiety
Zimbabwe
(4619) (104) (082) (104) (094) (088) (118) (078) (112) (075)
Iron Back & neck Depression Sense Skin Malaria Migraine Schisto Anxiety Asthma
Western sub-Saharan Africa
(099) (111) (099) (098) (085) (339) (079) (1095) (082) (082)
Iron Back & neck Depression Sense Skin Malaria Migraine Anxiety Asthma Schisto
Benin
(076) (108) (094) (091) (091) (586) (085) (083) (081) (4381)
Iron Back & neck Depression Skin Sense Malaria Migraine Haemog Anxiety Diarrhoea
Burkina Faso
(073) (108) (091) (092) (087) (156) (09) (172) (09) (081)
Back & neck Depression Iron Skin Sense Oncho HIV Malaria Migraine Anxiety
Cameroon
(105) (099) (057) (092) (093) (654 33273) (944) (4565) (077) (078)
Back & neck Depression Iron Sense Skin Migraine Diabetes Other cardio Anxiety Asthma
Cape Verde
(101) (105) (108) (098) (093) (076) (083) (952) (073) (076)
Iron Back & neck Skin Depression Sense Migraine Diarrhoea Asthma Anxiety Heat & cold
Chad
(131) (118) (091) (092) (092) (086) (10) (085) (087) (425)
Iron Back & neck Skin Sense Depression Malaria Migraine HIV Asthma Anxiety
Cte dIvoire
(075) (106) (108) (097) (094) (1532) (08) (45) (091) (081)
Iron Back & neck Depression Skin Sense Malaria Migraine Anxiety Diarrhoea Asthma
The Gambia
(073) (108) (101) (091) (084) (343) (084) (085) (094) (074)
Back & neck Iron Depression Sense Skin Malaria Migraine Schisto Anxiety Diabetes
Ghana
(092) (087) (10) (099) (069) (15078) (076) (662712) (075) (066)
Back & neck Iron Skin Sense Depression Malaria Schisto Migraine Asthma Anxiety
Guinea
(11) (068) (106) (093) (092) (214) (1379) (087) (095) (086)
Iron Back & neck Depression Sense Skin Migraine Malaria HIV Schisto Asthma
Guinea-Bissau
(077) (111) (092) (092) (091) (085) (177) (278) (1556) (09)
Oncho Back & neck Iron Sense Skin Depression Schisto Malaria Migraine Anxiety
Liberia
(92 16185) (11) (073) (091) (091) (082) (1867) (185) (085) (085)
Iron Back & neck Sense Depression Skin Malaria Migraine Anxiety Heat & cold Diarrhoea
Mali
(111) (093) (094) (092) (083) (111) (09) (09) (329) (066)
Iron Back & neck Sense Depression Skin Migraine Asthma Anxiety Heat & cold Schisto
Mauritania
(124) (107) (106) (096) (091) (079) (094) (08) (599) (23773)
Iron Back & neck Sense Skin Depression Migraine Heat & cold Malaria Diarrhoea Anxiety
Niger
(078) (116) (094) (094) (092) (098) (39) (032) (077) (097)
Iron Back & neck Depression Sense Skin Schisto Malaria Migraine Anxiety Asthma
Nigeria
(118) (118) (105) (103) (078) (292668) (5871) (073) (08) (086)
Back & neck Iron Depression Sense Skin Other NTD Migraine Malaria Asthma Anxiety
So Tom and Prncipe
(104) (065) (099) (097) (092) (254) (078) (243) (088) (079)
Iron Back & neck Depression Sense Skin Migraine Anxiety Diarrhoea Asthma Diabetes
Senegal
(104) (098) (095) (093) (091) (083) (084) (096) (072) (101)
Back & neck Iron Depression Skin Sense Malaria Migraine Oncho Asthma Anxiety
Sierra Leone
(108) (059) (093) (091) (087) (516) (084) (46 36269) (086) (084)
Back & neck Iron Depression Skin Sense Malaria Migraine Asthma Anxiety Diarrhoea
Togo
(11) (071) (095) (097) (094) (885) (082) (093) (082) (104)
Depression Iron Sense Skin Back & neck Migraine Other NTD Anxiety HIV Asthma
Eastern sub-Saharan Africa
(111) (062) (099) (095) (078) (079) (088) (094) (382) (094)
Depression Back & neck Skin Sense Iron Migraine Asthma Diarrhoea Anxiety Malaria
Burundi
(105) (085) (092) (09) (026) (088) (10) (099) (10) (079)
Sense Depression Back & neck Iron Skin Malaria Migraine Asthma Anxiety Diabetes
Comoros
(109) (106) (086) (06) (091) (76) (08) (106) (092) (111)
Iron Depression Sense Back & neck Skin Other NTD Heat & cold Migraine Diabetes Anxiety
Djibouti
(088) (112) (102) (073) (091) (276) (943) (075) (116) (087)
Eritrea Iron Depression Sense Skin Back & neck War Schisto Migraine Asthma Anxiety
(089) (106) (10) (091) (07) (10299) (4257) (081) (097) (094)
Ethiopia Depression Sense Skin Back & neck Iron Schisto Anxiety Migraine Other NTD Asthma
(113) (10) (102) (08) (032) (2664) (10) (076) (066) (079)
Kenya Iron Other NTD Depression Sense Skin Back & neck HIV Migraine Anxiety Schisto
(105) (438) (113) (109) (101) (081) (968) (08) (087) (1762)
Madagascar Iron Sense Depression Back & neck Skin Asthma Schisto Migraine Anxiety Diarrhoea
(07) (114) (109) (083) (09) (128) (14577) (079) (092) (107)
Malawi Depression Iron Back & neck Sense Skin HIV Malaria Migraine Anxiety Asthma
(105) (053) (085) (093) (091) (757) (262) (083) (096) (09)
Mozambique Iron Depression Sense HIV Back & neck Skin Malaria Migraine Asthma Anxiety
(071) (104) (099) (743) (083) (089) (188) (084) (096) (097)
Rwanda Back & neck Sense Depression Iron War Skin Asthma Migraine Anxiety Other NTD
(08) (094) (088) (05) (19809) (077) (125) (079) (092) (082)
Somalia Iron Depression Sense Skin Back & neck Schisto Iodine Asthma Migraine Other NTD
(123) (103) (099) (093) (081) (165) (35) (103) (093) (084)
South Sudan Iron Depression Sense Oncho Back & neck Skin Schisto Heat & cold Asthma Migraine
(081) (105) (102) (45 41575) (081) (091) (1122) (589) (11) (084)
Tanzania Iron Depression Skin Sense Back & neck Migraine Asthma Anxiety HIV Malaria
(085) (108) (093) (086) (065) (072) (097) (09) (538) (1232)
Uganda Depression Skin Sense Iron Back & neck Malaria HIV Asthma Migraine Anxiety
(131) (091) (096) (045) (079) (975) (686) (101) (079) (089)
1 2 3 4 5 6 7 8 9 10
Depression HIV Skin Sense Iron Back & neck Migraine Schisto Asthma Anxiety
Zambia
(111) (2066) (091) (096) (052) (077) (088) (198448) (093) (088)
Other NTD Iron Back & neck Sense Skin Depression Oncho Asthma Malaria Migraine
Central sub-Saharan Africa
(436) (07) (11) (122) (111) (097) (31 76728) (144) (143) (087)
Other NTD Skin Sense Back & neck Depression Iron Asthma Schisto Malaria Migraine
Angola
(405) (113) (125) (10) (10) (038) (159) (56716) (1561) (08)
Iron Back & neck Sense Skin Depression Oncho Asthma Other NTD HIV Migraine
Central African Republic
(084) (112) (117) (11) (095) (37 52786) (146) (095) (34) (087)
Iron Sense Back & neck Skin Other NTD Depression Asthma Diabetes Schisto Migraine
Congo (Brazzaville)
(103) (127) (10) (116) (585) (104) (125) (12) (10 90969) (077)
Other NTD Iron Back & neck Sense Skin Oncho Depression Asthma Malaria Migraine
DR Congo
(456) (076) (115) (121) (11) (31 56222) (096) (14) (111) (09)
Back & neck Sense Skin Depression Diabetes Iron Asthma Malaria Migraine HIV
Equatorial Guinea
(095) (123) (114) (111) (122) (075) (172) (668341) (078) (2187)
Other NTD Iron Sense Back & neck Depression Skin Schisto Diabetes Asthma Migraine
Gabon
(2482) (158) (131) (094) (113) (11) (55 30855) (114) (162) (077)
Colour key
00081 081088 088094 094099 099105
105113 113126 126158 158
Figure 7: Leading ten causes of years lived with disability (YLDs) with the ratio of observed years lived with disability (YLDs) to years lived with disability (YLDs) expected on the basis of SDI
in 2015, by location
Shades of blue represent much lower observed YLDs than expected levels based on SDI, whereas red shows that observed YLDs exceed expected levels. Alzheimers=Alzheimers disease and
other dementias. Back & neck=low back and neck pain. COPD=chronic obstructive pulmonary disease. Drugs=drug use disorders. Haemog=haemoglobinopathies and haemolytic anaemias.
Heat & cold=environmental heat and cold exposure. IHD=ischaemic heart disease. Iron=iron-deciency anaemia. NTD=neglected tropical diseases. Oncho=onchocerciasis. Oral=oral disorders.
Osteoarth=osteoarthritis. Other cardio=other cardiovascular and circulatory diseases. Other MSK=other musculoskeletal disorders. Other nutr=other nutritional deciencies. Other unint=other
unintentional injuries. PEM=protein-energy malnutrition. Schitso=schistosomiasis. Schiz=schizophrenia. Sense=sense organ diseases. Skin=skin and subcutaneous diseases. TB=tuberculosis.
malaria prevalence and incidence become available for all than WHO (120%). Our list of countries with high burden
malaria-endemic countries outside of Africa. of tuberculosis is consistent with that of WHO, with a few
exceptions. Afghanistan and Cambodia are lower in our
Tuberculosis estimates, and surpassed by Ukraine and Angola.
We added new data from tuberculosis prevalence surveys
done in Indonesia, Ghana, and several subnational Cardiovascular diseases
locations in India. Our analysis of tuberculosis relied on Ageing and population growth have led to a growing
prevalence surveys, case notications and cause-specic number of people living with atherosclerotic vascular
mortality estimates. We used the expert judgment values disease worldwide, despite the decrease in incident
for the case-detection rates (CDRs) from WHO as an initial myocardial infarction and ischaemic stroke in high-
guide of how much notications need to be increased to income regions. Rising levels of obesity and diabetes in
reect incidence of all tuberculosis, but relied on many countries makes this an area of major concern for
DisMod-MR 2.1 to nd an estimate that is consistent with global health. Increased attention will need to be directed
available prevalence and cause-specic mortality rates. We toward this highly treatable set of disorders. Health
found that, particularly in older age groups, our estimated systems will need to improve the delivery of cost-eective
CDR often falls below the all-age CDR of WHO. In treatments such as blood pressure and cholesterol-
GBD 2013, we used a relative risk approach to predict the lowering drugs while eorts continue to focus on
proportion of HIV-infected individuals with tuberculosis. decreasing tobacco smoking, improving diet, and
In GBD 2015, we improved our modelling strategy by increasing physical activity. Investments in universal
making use of more abundantly available data on the primary care and public health campaigns need to be
proportions of HIV infected cases among all tuberculosis balanced against the need to improve access to emergency
cases from the WHO case notications to separate out care, including the strengthening of pre-hospital systems
combined HIV and tuberculosis from all forms of and expanded access to revascularisation treatments.
tuberculosis. In our modelling of tuberculosis, we have not
separately estimated the incidence and prevalence related Cancer
to multidrug-resistant tuberculosis. Given the policy The International Agency for Research on Cancer last
interest in multidrug-resistant tuberculosis, we plan to produced cancer estimates by country, age, sex, and
include estimates for multidrug-resistant tuberculosis in cancer site for 2012 for the GLOBOCAN project.60 The
future rounds of the GBD. Our global tuberculosis (all- total estimated cancer incidence from GLOBOCAN for
forms) incidence estimate (102 million [92115 million] 2012 was 141 million individuals. By comparison, GBD
cases in 2015) is slightly higher than that of WHO 2015 estimated 186 million (180194 million) new
(96 million cases in 2014), and we estimate a slightly cases of cancer in 2015, which includes cases of non-
larger fraction of combined HIV and tuberculosis (130%) melanoma skin cancer. GLOBOCAN used nine dierent
average disability weights; however, country analyses Self-reported functional health status
might use local disability weights. Until there is evidence We found only modest progress in high-SDI countries
of systematic variation across communities, this remains in reducing age-standardised YLDs per capita over the
a theoretical and not a practical consideration. Given the last 25 years. There are, however, reports in the literature
close correlation between the internet survey and the of substantial improvements based on self-rated
population-based surveys, we are considering the health.71,72 In the USA, these improvements seem to be
implementation of an open rolling internet survey to survey programme-specic and have not been reported
collect more data for disability weights including new or in all data systems.71 Nevertheless, more work is needed
revised health-state descriptions. to understand the dierent trends between our
assessment of YLDs per capita and self-rated health.
GATHER compliance Item response theory has been used in some elds to
Providing all documentation for data sources, establishing identify changing response patterns for single items
access to the datasets used in modelling, and posting the compared with the pool of all items.73 Item response
code has been a labour-intensive activity; GBD 2015 is theory cannot capture systematic changes that aect a
compliant with the new GATHER guidelines as a result.17 set of items, and anchoring vignettes have been
Posting code, we believe, will stimulate other researchers proposed as a strategy to deal with these challenges.72,74
to explore the methods used in GBD estimation of non- In the era of increased interest in measuring functional
fatal outcomes and hopefully lead to suggestions for health status, more exploration of the reasons for
improved estimation. With a steadily growing set of co- the divergence from a sequelae-based approach to
investigators and a widening community interested in measuring functional health status used in GBD versus
global health estimation, the enhanced transparency of an overall self-rating will be an important avenue of
GBD will improve the ecacy of the overall eort. future research.
incidence and prevalence, GBD provides a framework to Third, for some disorders the data available to estimate
assist countries in prioritising the collection of new data excess mortality by age and sex and to capture how excess
to inform better monitoring of functional health status. mortality changes with development status are very
By setting clear reference case denitions and data limited. There are probably many unpublished sources
collection methods (methods appendix pp 47), GBD can of information in some countries that could be usefully
also provide guidance on how to collect information most brought to bear on the challenge of estimating the
relevant to population health measurement. agesexyearlocation levels of excess mortality.
Fourth, the microsimulation step of this study assumes
Future directions for GBD that prevalence within an agesexlocationyear group of
With each cycle of the GBD we expect, given the present dierent sequelae is independent. Although this is clearly
interest in subnational assessments, to report increasingly known not to be the case for some pairs of disorders, the
granular results. These subnational ndings will be of independence assumption provides reasonable overall
important national policy interest, but the discipline of adjustments for comorbidity. Progress in incorporating
examining the evidence for each community and modelling dependent comorbidity has been dicult because
at the more granular level will, we believe, improve the information on the correlation structure of prevalence is
quality of the national estimation as well. Additions to the extremely limited and only available for a minor fraction
cause list will continue to be driven by policy interest, such of all possible pairs of conditions in the GBD study.
as the need to incorporate Zika virus, to split diabetes into Fifth, we estimated separate DisMod-MR 2.1 models for
separate estimates for type 1 and type 2, and by adding 1990, 1995, 2000, 2005, 2010, and 2015. Independent
diseases to our cause list that are main contributors to large estimation of each time period implies that the uncertainty
residual categories, such as other cardiovascular disease, intervals for each period are also independent. Furthermore,
other musculoskeletal disorders, and other neurological compositional bias in the data available in dierent time
disorders. We plan to continue to expand our networks of periods might lead to spurious time trends. A more
topic-specic and country collaborators to enhance the appealing strategy would be to simultaneously estimate the
quality of our estimates through their feedback and by trends in incidence, excess mortality, and remission by age
enhancing the amount of data we can bring to bear on and sex consistent with all the available data for a geography
GBD estimation. Our country collaborations to generate on prevalence, incidence, remission, excess mortality, and
subnational estimates have shown us that these eorts cause-specic mortality by age and sex. DisMod-MR 2.1
greatly enhance access to valuable data sources, particularly does not allow for time-varying trends in incidence, excess
administrative datasets on inpatient and outpatient mortality, and remission, but a prototype DisMod-MR AT
episodes and unpublished surveys. (age and time) has been developed and is being tested.
Allowing for all rates to change at dierent paces over age
Limitations and time increases the number of parameters that need to
The GBD 2015 study has some key limitations. First, be estimated by orders of magnitude.
although we have sought to capture and include in our Sixth, we have emphasised in the reporting of results
estimations many sources of uncertainty, we have not the changes from calendar year 2005 to calendar
captured all sources. We have not been able to routinely year 2015, although we have estimated results for 1990,
capture uncertainty due to dierent model specications 1995, 2000, 2005, 2010, and 2015 and interpolated for the
in our results. We do not have the ability to reect the years in between. For some disorders, reporting the
uncertainty of data sources that exist but of which we are change from 2005 to 2015 (such as for Ebola virus
not aware. Subnational collaborations in China and disease) does not capture the major epidemic in west
Mexico revealed many data sources not captured in Africa in 2014. Likewise, disasters and wars are often
previous iterations of the GBD study. Inclusion of these concentrated in a single year; comparisons of any two
data sources can lead to shifts in estimates that are years can provide misleading inferences about trends.
outside the previously estimated 95% UIs. Seventh, for a few disorders (eg, tetanus, neonatal sepsis,
Second, within DisMod-MR 2.1 we estimate the average rabies, and diphtheria) we estimate disease incidence from
association between dierent types of studies for reporting estimates of mortality and the inverse of the case-fatality
on a specic outcome such as the dierence between rate estimated from available studies. When the case-
12-month recall and point prevalence in a survey. These fatality rate is very low, these estimates of incidence are
estimated associations from within the DisMod-MR 2.1 highly sensitive to very small changes in the estimated
likelihood estimation are used to adjust the data to a case-fatality rate and have large uncertainty intervals.
reference case denition or study design. These estimated Finally, although extraordinary eorts have gone into
adjustment factors are themselves uncertain, which vetting the results by GBD researchers and the
increases the overall uncertainty in our estimation. More collaborator network, there are probably some ndings
standardisation in data collection would be highly desirable that have not been scrutinised carefully enough. Making
and would reduce our dependence on the relatively all results and underlying data available and having an
challenging estimation process involved in crosswalks. increasing number of visualisation tools are eective
strategies that we will keep expanding to meet our goal of Euripide Frinel G Arthur Avokpaho*, Ashish Awasthi*,
producing the highest quality global health data to our Beatriz Paulina Ayala Quintanilla*, Peter Azzopardi*, Umar Bacha*,
Alaa Badawi*, Kalpana Balakrishnan*, Amitava Banerjee*,
growing audience of policy makers, researchers, the Aleksandra Barac*, Suzanne L Barker-Collo*, Till Brnighausen*,
media, and the general population. Lars Barregard*, Lope H Barrero*, Arindam Basu*,
Shahrzad Bazargan-Hejazi*, Brent Bell*, Michelle L Bell*,
Conclusion Derrick A Bennett*, Isabela M Bensenor*, Habib Benzian*,
Adugnaw Berhane*, Eduardo Bernab*, Balem Demtsu Betsu*,
The GBD studies seek to quantify the prevalence and Addisu Shunu Beyene*, Neeraj Bhala*, Samir Bhatt*,
incidence of the major sequelae for a comprehensive list Sibhatu Biadgilign*, Kelly Bienho*, Boris Bikbov*, Stan Biryukov*,
of diseases and injuries; given the diversity of data Donal Bisanzio*, Espen Bjertness*, Jed Blore*, Rohan Borschmann*,
sources, the range of biases in these sources, and the Souane Boufous*, Michael Brainin*, Alexandra Brazinova*,
Nicholas J K Breitborde*, Jonathan Brown*, Rachelle Buchbinder*,
gaps in availability, this is a challenging task. Despite Georey Colin Buckle*, Zahid A Butt*, Bianca Calabria*,
the limitations, the standardised and comprehensive Ismael Ricardo Campos-Nonato*, Julio Cesar Campuzano*,
approach of the GBD studies study provides useful Hlne Carabin*, Rosario Crdenas*, David O Carpenter*,
insights. We believe users of the ndings, including the Juan Jesus Carrero*, Carlos A Castaeda-Orjuela*,
Jacqueline Castillo Rivas*, Ferrn Catal-Lpez*, Jung-Chen Chang*,
wealth of country-specic and cause-specic detail Peggy Pei-Chia Chiang*, Chioma Ezinne Chibueze*,
available in the appendix, can usefully examine the broad Vesper Hichilombwe Chisumpa*, Jee-Young Jasmine Choi*,
trends for their country or subnational geography, Rajiv Chowdhury*, Hanne Christensen*,
benchmark against geographies at a similar level of Devasahayam Jesudas Christopher*, Liliana G Ciobanu*,
Massimo Cirillo*, Matthew M Coates*, Samantha M Colquhoun*,
development, and understand the strength or weakness Cyrus Cooper*, Monica Cortinovis*, John A Crump*,
of these estimates. Regular quantication of health is Solomon Abrha Damtew*, Rakhi Dandona*, Farah Daoud*,
particularly important as the new health-related targets Paul I Dargan*, Jos das Neves*, Gail Davey*, Adrian C Davis*,
of the Sustainable Development Goals have broadened Diego De Leo*, Louisa Degenhardt*, Liana C Del Gobbo*,
Robert P Dellavalle*, Kebede Deribe*, Amare Deribew*, Sarah Derrett*,
the health agenda throughout the world. At the same Don C Des Jarlais*, Samath D Dharmaratne*, Preet K Dhillon*,
time, development and transformations in the risks to Cesar Diaz-Torn*, Eric L Ding*, Tim R Driscoll*, Leilei Duan*,
health experienced by dierent groups in the world are Manisha Dubey*, Bruce Bartholow Duncan*, Hedyeh Ebrahimi*,
Richard G Ellenbogen*, Iqbal Elyazar*, Matthias Endres*,
leading to some broad transformations in health.
Aman Yesuf Endries*, Sergey Petrovich Ermakov*, Babak Eshrati*,
Everyone needs to have access to the timeliest, valid, Kara Estep*, Talha A Farid*, Carla Soa e Sa Farinha*, Andr Faro*,
reliable, and local information possible to enrich debates Maryam S Farvid*, Farshad Farzadfar*, Valery L Feigin*,
on how to accelerate health progress in all communities. David T Felson*, Seyed-Mohammad Fereshtehnejad*,
Jeerson G Fernandes*, Joao C Fernandes*, Florian Fischer*,
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Joseph R A Fitchett*, Kyle Foreman*, F Gerry R Fowkes*,
Theo Vos, Christine Allen, Megha Arora, Ryan M Barber, Jordan Fox*, Richard C Franklin*, Joseph Friedman*,
Zulqar A Bhutta, Alexandria Brown, Austin Carter, Daniel C Casey, Joseph Frostad*, Thomas Frst*, Neal D Futran*, Belinda Gabbe*,
Fiona J Charlson, Alan Z Chen, Megan Coggeshall, Leslie Cornaby, Parthasarathi Ganguly*, Fortun Gbtoho Gankp*, Teshome Gebre*,
Lalit Dandona, Daniel J Dicker, Tina Dilegge, Holly E Erskine, Tsegaye Tewelde Gebrehiwot*, Amanuel Tesfay Gebremedhin*,
Alize J Ferrari, Christina Fitzmaurice, Tom Fleming, Johanna M Geleijnse*, Bradford D Gessner*, Katherine B Gibney*,
Mohammad H Forouzanfar, Nancy Fullman, Peter W Gething, Ibrahim Abdelmageem Mohamed Ginawi*, Ababi Zergaw Giref*,
Ellen M Goldberg, Nicholas Graetz, Juanita A Haagsma, Maurice Giroud*, Melkamu Dedefo Gishu*, Elizabeth Glaser*,
Catherine O Johnson, Nicholas J Kassebaum, Toana Kawashima, William W Godwin*, Hector Gomez-Dantes*, Philimon Gona*,
Laura Kemmer, Ibrahim A Khalil, Yohannes Kinfu, Hmwe H Kyu, Amador Goodridge*, Sameer Vali Gopalani*, Carolyn C Gotay*,
Janni Leung, Xiaofeng Liang, Stephen S Lim, Alan D Lopez, Atsushi Goto*, Hebe N Gouda*, Rebecca Grainger*, Felix Greaves*,
Rafael Lozano, Laurie Marczak, George A Mensah, Ali H Mokdad, Francis Guillemin*, Yuming Guo*, Rahul Gupta*, Rajeev Gupta*,
Mohsen Naghavi, Grant Nguyen, Elaine Nsoesie, Helen Olsen, Vipin Gupta*, Reyna A Gutirrez*, Demewoz Haile*,
David M Pigott, Christine Pinho, Zane Rankin, Nikolas Reinig, Alemayehu Desalegne Hailu*, Gessessew Bugssa Hailu*,
Joshua A Salomon, Logan Sandar, Alison Smith, Jerey Stanaway, Yara A Halasa*, Randah Ribhi Hamadeh*, Samer Hamidi*,
Caitlyn Steiner, Stephanie Teeple, Bernadette A Thomas, Mouhanad Hammami*, Jamie Hancock*, Alexis J Handal*,
Christopher Troeger, Joseph A Wagner, Haidong Wang, Graeme J Hankey*, Yuantao Hao*, Hilda L Harb*,
Valentine Wanga, Harvey A Whiteford, Leo Zoeckler, Sivadasanpillai Harikrishnan*, Josep Maria Haro*,
Amanuel Alemu Abajobir*, Kalkidan Hassen Abate*, Rasmus Havmoeller*, Roderick J Hay*, Ileana Beatriz Heredia-Pi*,
Cristiana Abbafati*, Kaja M Abbas*, Foad Abd-Allah*, Biju Abraham*, Pouria Heydarpour*, Hans W Hoek*, Masako Horino*,
Ibrahim Abubakar*, Laith J Abu-Raddad*, Niveen M E Abu-Rmeileh*, Nobuyuki Horita*, H Dean Hosgood*, Damian G Hoy*,
Ilana N Ackerman*, Akindele Olupelumi Adebiyi*, Zanna Ademi*, Aung Soe Htet*, Hsiang Huang*, John J Huang*,
Arsne Kouablan Adou*, Kossivi Agbelenko Afanvi*, Chantal Huynh*, Marissa Iannarone*, Kim Moesgaard Iburg*,
Emilie Elisabet Agardh*, Arnav Agarwal*, Aliasghar Ahmad Kiadaliri*, Kaire Innos*, Manami Inoue*, Veena J Iyer*, Kathryn H Jacobsen*,
Hamid Ahmadieh*, Oluremi N Ajala*, Rufus Olusola Akinyemi*, Nader Jahanmehr*, Mihajlo B Jakovljevic*, Mehdi Javanbakht*,
Nadia Akseer*, Ziyad Al-Aly*, Khurshid Alam*, Noore K M Alam*, Achala Upendra Jayatilleke*, Sun Ha Jee*, Panniyammakal Jeemon*,
Saleh Fahed Aldhahri*, Miguel Angel Alegretti*, Paul N Jensen*, Ying Jiang*, Tariku Jibat*, Aida Jimenez-Corona*,
Zewdie Aderaw Alemu*, Lily T Alexander*, Samia Alhabib*, Ye Jin*, Jost B Jonas*, Zubair Kabir*, Yogeshwar Kalkonde*,
Raghib Ali*, Alaa Alkerwi*, Franois Alla*, Peter Allebeck*, Ritul Kamal*, Haidong Kan*, Andr Karch*, Corine Kakizi Karema*,
Rajaa Al-Raddadi*, Ubai Alsharif*, Khalid A Altirkawi*, Chante Karimkhani*, Amir Kasaeian*, Anil Kaul*, Norito Kawakami*,
Nelson Alvis-Guzman*, Azmeraw T Amare*, Alemayehu Amberbir*, Peter Njenga Keiyoro*, Andrew Haddon Kemp*, Andre Keren*,
Heresh Amini*, Walid Ammar*, Stephen Marc Amrock*, Chandrasekharan Nair Kesavachandran*, Yousef Saleh Khader*,
Hjalte H Andersen*, Gregory M Anderson*, Benjamin O Anderson*, Abdur Rahman Khan*, Ejaz Ahmad Khan*, Young-Ho Khang*,
Carl Abelardo T Antonio*, Atsede Fantahun Aregay*, Johan rnlv*, Sahil Khera*, Tawk Ahmed Muthafer Khoja*, Jagdish Khubchandani*,
Al Artaman*, Hamid Asayesh*, Reza Assadi*, Suleman Atique*,
Christian Kieling*, Pauline Kim*, Cho-il Kim*, Daniel Kim*, Cassandra E I Szoeke*, Rafael Tabars-Seisdedos*, Jukka S Takala*,
Yun Jin Kim*, Niranjan Kissoon*, Luke D Knibbs*, Nikhil Tandon*, David Tanne*, Mohammad Tavakkoli*, Bineyam Taye*,
Ann Kristin Knudsen*, Yoshihiro Kokubo*, Dhaval Kolte*, Hugh R Taylor*, Braden J Te Ao*, Bemnet Amare Tedla*,
Jacek A Kopec*, Soewarta Kosen*, Georgios A Kotsakis*, Abdullah Sulieman Terkawi*, Alan J Thomson*,
Parvaiz A Koul*, Ai Koyanagi*, Michael Kravchenko*, Andrew L Thorne-Lyman*, Amanda G Thrift*, George D Thurston*,
Barthelemy Kuate Defo*, Burcu Kucuk Bicer*, Andreas A Kudom*, Ruoyan Tobe-Gai*, Marcello Tonelli*, Roman Topor-Madry*,
Ernst J Kuipers*, G Anil Kumar*, Michael Kutz*, Gene F Kwan*, Fotis Topouzis*, Bach Xuan Tran*, Zacharie Tsala Dimbuene*,
Aparna Lal*, Ratilal Lalloo*, Tea Lallukka*, Hilton Lam*, Miltiadis Tsilimbaris*, Abera Kenay Tura*, Emin Murat Tuzcu*,
Jennifer O Lam*, Sinead M Langan*, Anders Larsson*, Stefanos Tyrovolas*, Kingsley N Ukwaja*, Eduardo A Undurraga*,
Pablo M Lavados*, Janet L Leasher*, James Leigh*, Ricky Leung*, Chigozie Jesse Uneke*, Olalekan A Uthman*,
Miriam Levi*, Yichong Li*, Yongmei Li*, Juan Liang*, Shiwei Liu*, Coen H van Gool*, Yuri Y Varakin*, Tommi Vasankari*,
Yang Liu*, Belinda K Lloyd*, Warren D Lo*, Giancarlo Logroscino*, Narayanaswamy Venketasubramanian*, Raj Kumar Verma*,
Katharine J Looker*, Paulo A Lotufo*, Raimundas Lunevicius*, Francesco S Violante*, Sergey K Vladimirov*,
Ronan A Lyons*, Mark T Mackay*, Mohammed Magdy Abd El Razek*, Vasiliy Victorovich Vlassov*, Stein Emil Vollset*, Gregory R Wagner*,
Mahdi Mahdavi*, Marek Majdan*, Azeem Majeed*, Reza Malekzadeh*, Stephen G Waller*, Linhong Wang*, David A Watkins*,
Wagner Marcenes*, David Joel Margolis*, Jose Martinez-Raga*, Scott Weichenthal*, Elisabete Weiderpass*, Robert G Weintraub*,
Felix Masiye*, Joo Massano*, Stephen Theodore McGarvey*, Andrea Werdecker*, Ronny Westerman*, Richard A White*,
John J McGrath*, Martin McKee*, Brian J McMahon*, Peter A Meaney*, Hywel C Williams*, Charles Shey Wiysonge*, Charles D A Wolfe*,
Alem Mehari*, Fabiola Mejia-Rodriguez*, Alemayehu B Mekonnen*, Sungho Won*, Rachel Woodbrook*, Mamo Wubshet*, Denis Xavier*,
Yohannes Adama Melaku*, Peter Memiah*, Ziad A Memish*, Gelin Xu*, Ajit Kumar Yadav*, Lijing L Yan*, Yuichiro Yano*,
Walter Mendoza*, Atte Meretoja*, Tuomo J Meretoja*, Mehdi Yaseri*, Pengpeng Ye*, Henock Gebremedhin Yebyo*, Paul Yip*,
Francis Apolinary Mhimbira*, Ted R Miller*, Edward J Mills*, Naohiro Yonemoto*, Seok-Jun Yoon*, Mustafa Z Younis*,
Mojde Miraren*, Philip B Mitchell*, Charles N Mock*, Chuanhua Yu*, Zoubida Zaidi*, Maysaa El Sayed Zaki*, Hajo Zeeb*,
Alireza Mohammadi*, Shau Mohammed*, Lorenzo Monasta*, Maigeng Zhou*, Sanjay Zodpey*, Liesl Joanna Zuhlke*,
Julio Cesar Montaez Hernandez*, Marcella Montico*, Christopher J L Murray.
Meghan D Mooney*, Maziar Moradi-Lakeh*, Lidia Morawska*, *Authors listed alphabetically. Corresponding author.
Ulrich O Mueller*, Erin Mullany*, John Everett Mumford*,
Alliations
Michele E Murdoch*, Jean B Nachega*, Gabriele Nagel*,
Institute for Health Metrics and Evaluation (Prof T Vos PhD,
Aliya Naheed*, Luigi Naldi*, Vinay Nangia*, John N Newton*,
C Allen BA, M Arora BSA, R M Barber BS, A Brown MA, A Carter BS,
Marie Ng*, Frida Namnyak Ngalesoni*, Quyen Le Nguyen*,
D C Casey BA, F J Charlson PhD, A Z Chen BS, M Coggeshall BA,
Muhammad Imran Nisar*, Patrick Martial Nkamedjie Pete*,
L Cornaby BS, Prof L Dandona MD, D J Dicker BS, T Dilegge BS,
Joan M Nolla*, Ole F Norheim*, Rosana E Norman*,
H E Erskine PhD, A J Ferrari PhD, C Fitzmaurice MD, T Fleming BS,
Bo Norrving*, Bruno P Nunes*, Felix Akpojene Ogbo*,
M H Forouzanfar MD, N Fullman MPH, E M Goldberg BS,
In-Hwan Oh*, Takayoshi Ohkubo*, Pedro R Olivares*,
N Graetz MPH, J A Haagsma PhD, C O Johnson PhD,
Bolajoko Olubukunola Olusanya*, Jacob Olusegun Olusanya*,
N J Kassebaum MD, T Kawashima MS, L Kemmer PhD, I A Khalil MD,
Alberto Ortiz*, Majdi Osman*, Erika Ota*, Mahesh PA*, Eun-Kee Park*,
H H Kyu PhD, J Leung PhD, Prof S S Lim PhD, Prof A D Lopez PhD,
Mahboubeh Parsaeian*, Valria Maria de Azeredo Passos*,
L Marczak PhD, Prof A H Mokdad PhD, Prof M Naghavi PhD,
Angel J Paternina Caicedo*, Scott B Patten*, George C Patton*,
G Nguyen MPH, E Nsoesie PhD, H Olsen MAIS, D M Pigott DPhil,
David M Pereira*, Rogelio Perez-Padilla*, Norberto Perico*,
C Pinho BA, Z Rankin BS, N Reinig BS, L Sandar BS,
Konrad Pesudovs*, Max Petzold*, Michael Robert Phillips*,
A Smith BA, J Stanaway PhD, C Steiner MPH, S Teeple BA,
Frdric B Piel*, Julian David Pillay*, Farhad Pishgar*, Dietrich Plass*,
B A Thomas MD, C Troeger MPH, J A Wagner BS, H Wang PhD,
James A Platts-Mills*, Suzanne Polinder*, Constance D Pond*,
V Wanga MS, Prof H A Whiteford PhD, L Zoeckler BA,
Svetlana Popova*, Richie G Poulton*, Farshad Pourmalek*,
L T Alexander BA, G M Anderson MSEE, B Bell MLIS, K Bienho MA,
Dorairaj Prabhakaran*, Noela M Prasad*, Mostafa Qorbani*,
S Biryukov BS, J Blore PhD, J Brown MAIS, M M Coates MPH,
Rynaz H S Rabiee*, Amir Radfar*, Anwar Rafay*,
F Daoud BS, K Estep MPA, K Foreman PhD, J Fox BS, J Friedman BA,
Kazem Rahimi*, Vafa Rahimi-Movaghar*, Mahfuzar Rahman*,
J Frostad MPH, W W Godwin BS, J Hancock MLS, C Huynh BA,
Mohammad Hifz Ur Rahman*, Sajjad Ur Rahman*, Rajesh Kumar Rai*,
M Iannarone MSc, P Kim BA, M Kutz BS, F Masiye PhD,
Sasa Rajsic*, Usha Ram*, Puja Rao*, Amany H Refaat*,
M Miraren MPH, M D Mooney BS, M Moradi-Lakeh MD,
Marissa B Reitsma*, Giuseppe Remuzzi*, Serge Resniko*,
E Mullany BA, J E Mumford BA, M Ng PhD, P Rao MPH,
Alex Reynolds*, Antonio L Ribeiro*, Maria Jesus Rios Blancas*,
M B Reitsma BS, A Reynolds BA, G A Roth MD, K A Shackelford BA,
Hirbo Shore Roba*, David Rojas-Rueda*, Luca Ronfani*,
A Sivonda MHA, A Sligar MPH, P Sur BA, Prof S E Vollset DrPH,
Gholamreza Roshandel*, Gregory A Roth*, Dietrich Rothenbacher*,
R Woodbrook MLIS/MA, Prof M Zhou PhD, Prof C J L Murray DPhil),
Ambuj Roy*, Rajesh Sagar*, Ramesh Sahathevan*, Juan R Sanabria*,
Harborview/UW Medicine (R G Ellenbogen MD), School of Dentistry
Maria Dolores Sanchez-Nio*, Itamar S Santos*, Joo Vasco Santos*,
(G A Kotsakis DDS), Harborview Injury Prevention and Research Center
Rodrigo Sarmiento-Suarez*, Benn Sartorius*, Maheswar Satpathy*,
(C N Mock PhD), University of Washington, Seattle, WA, USA
Miloje Savic*, Monika Sawhney*, Michael P Schaub*,
(Prof B O Anderson MD, N D Futran MD, P N Jensen PhD,
Maria Ins Schmidt*, Ione J C Schneider*, Ben Schttker*,
D A Watkins MD); Centre of Excellence in Women and Child Health
David C Schwebel*, James G Scott*, Soraya Seedat*, Sadaf G Sepanlou*,
(Prof Z A Bhutta PhD), Aga Khan University, Karachi, Pakistan
Edson E Servan-Mori*, Katya A Shackelford*, Amira Shaheen*,
(M I Nisar MSc); Centre for Global Child Health, The Hospital for Sick
Masood Ali Shaikh*, Rajesh Sharma*, Upasana Sharma*, Jiabin Shen*,
Children, Toronto, ON, Canada (Prof Z A Bhutta PhD, N Akseer MSc);
Donald S Shepard*, Kevin N Sheth*, Kenji Shibuya*, Min-Jeong Shin*,
School of Public Health (F J Charlson PhD, H E Erskine PhD,
Rahman Shiri*, Ivy Shiue*, Mark G Shrime*, Inga Dora Sigfusdottir*,
A J Ferrari PhD, J Leung PhD, Prof H A Whiteford PhD,
Diego Augusto Santos Silva*, Dayane Gabriele Alves Silveira*,
A A Abajobir MPH, L D Knibbs PhD), School of Dentistry
Abhishek Singh*, Jasvinder A Singh*, Om Prakash Singh*,
(Prof R Lalloo PhD), Centre for Clinical Research (J G Scott PhD),
Prashant Kumar Singh*, Anna Sivonda*, Vegard Skirbekk*,
The University of Queensland, Brisbane, QLD, Australia
Jens Christoer Skogen*, Amber Sligar*, Karen Sliwa*, Michael Soljak*,
(N K M Alam MPH, H N Gouda PhD, Y Guo PhD, Prof J J McGrath
Kjetil Sreide*, Joan B Soriano*, Luciano A Sposato*,
MD); Queensland Centre for Mental Health Research, Brisbane, QLD,
Chandrashekhar T Sreeramareddy*, Vasiliki Stathopoulou*,
Australia (F J Charlson PhD, H E Erskine PhD, A J Ferrari PhD,
Nicholas Steel*, Dan J Stein*, Timothy J Steiner*, Sabine Steinke*,
J Leung PhD, Prof H A Whiteford PhD); Centre for Control of Chronic
Lars Stovner*, Konstantinos Stroumpoulis*, Bruno F Sunguya*,
Conditions (P Jeemon PhD), Public Health Foundation of India, New
Patrick Sur*, Soumya Swaminathan*, Bryan L Sykes*,
Delhi, India (Prof L Dandona MD, R Dandona PhD, G A Kumar PhD);
Department of Zoology (P W Gething PhD), Nueld Department of (H Ahmadieh MD, M Yaseri PhD), School of Public Health
Medicine (D Bisanzio PhD, A Deribew PhD), NIHR Musculoskeletal (N Jahanmehr PhD), Shahid Beheshti University of Medical Sciences,
Biomedical Research Centre (Prof C Cooper FMedSci), University of Tehran, Iran; Department of Ophthalmology, Labbanejad Medical
Oxford, Oxford, UK (R Ali FRCP, D A Bennett PhD, K Rahimi DM); Center, Tehran, Iran (H Ahmadieh MD); University of Pittsburgh
Centre for Research & Action in Public Health, Faculty of Health, Medical Center, McKeesport, PA, USA (O N Ajala MD); Newcastle
University of Canberra, Canberra, ACT, Australia (Y Kinfu PhD); University, Newcastle upon Tyne, UK (R O Akinyemi PhD); Washington
National Center for Chronic and Noncommunicable Disease Control University in Saint Louis, St Louis, MO, USA (Z Al-Aly MD); Sydney
and Prevention (L Duan MD, Y Li MPH, S Liu PhD, Y Jin MS, School of Public Health (Prof T R Driscoll PhD), The University of
Prof L Wang MD, P Ye MPH, Prof M Zhou PhD), Chinese Center for Sydney, Sydney, NSW, Australia (K Alam PhD, Prof A H Kemp PhD,
Disease Control and Prevention (Prof X Liang MD), Beijing, China; J Leigh PhD, A B Mekonnen MS); Queensland Health, Brisbane, QLD,
Melbourne School of Population and Global Health Australia (N K M Alam MPH); King Saud University, Riyadh, Saudi
(Prof A D Lopez PhD), Department of Paediatrics (P Azzopardi MEpi), Arabia (S F Aldhahri MD, K A Altirkawi MD); King Fahad Medical City,
The Peter Doherty Institute for Infection and Immunity Riyadh, Saudi Arabia (S F Aldhahri MD); Department of Preventive and
(K B Gibney FRACP), Department of Medicine (A Meretoja PhD), Social Medicine, Faculty of Medicine, University of the Republic,
Murdoch Childrens Research Institute (K Alam PhD, P Azzopardi Montevideo, Uruguay (M A Alegretti MD); Debre Markos University,
MEpi, R Borschmann PhD, S M Colquhoun PhD, Prof G C Patton MD, Debre Markos, Ethiopia (Z A Alemu MPH); King Abdullah Bin
R G Weintraub MBBS), Institute of Health and Ageing Abdulaziz University Hospital, Riyadh, Saudi Arabia (S Alhabib PhD);
(Prof C E I Szoeke PhD), The University of Melbourne, Melbourne, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
VIC, Australia (Z Ademi PhD, K Alam PhD, R Borschmann PhD, (A Alkerwi PhD); School of Public Health, University of Lorraine, Nancy,
S M Colquhoun PhD, Prof H R Taylor AC, R G Weintraub MBBS); France (Prof F Alla PhD, F Guillemin PhD); Department of Public
National Institute of Public Health, Cuernavaca, Mexico (R Lozano MD, Health Sciences (P Allebeck PhD, R H S Rabiee MPH), Department of
I R Campos-Nonato PhD, J C Campuzano PhD, H Gomez-Dantes MSc, Clinical Science, Intervention and Technology (Prof J J Carrero PhD),
I B Heredia-Pi PhD, F Mejia-Rodriguez MD, Department of Neurobiology, Care Sciences and Society (NVS)
J C Montaez Hernandez MSc, M J Rios Blancas MPH, (S M Fereshtehnejad PhD), Department of Medical Epidemiology and
Prof E E Servan-Mori MSc); Center for Translation Research and Biostatistics (E Weiderpass PhD), Karolinska Institutet, Stockholm,
Implementation Science, National Heart, Lung, and Blood Institute, Sweden (R Havmoeller PhD); Ministry of Health, Jeddah, Saudi Arabia
National Institutes of Health, Bethesda, MD, USA (G A Mensah MD); (R Al-Raddadi PhD); Charit Universittsmedizin, Berlin, Germany
Department of Global Health and Population (Prof J A Salomon PhD), (U Alsharif MPH); Universidad de Cartagena, Cartagena de Indias,
Department of Nutrition (A L Thorne-Lyman ScD), Harvard T H Chan Colombia (Prof N Alvis-Guzman PhD); School of Medicine
School of Public Health (O N Ajala MD, Prof T Brnighausen MD, (A T Amare MPH, Y A Melaku MPH), University of Adelaide, Adelaide,
I R Campos-Nonato PhD, E L Ding ScD, M S Farvid PhD, SA, Australia (L G Ciobanu MS); College of Medicine and Health
G R Wagner MD), Harvard Medical School (M Osman MD, Sciences, Bahir Dar University, Bahir Dar, Ethiopia (A T Amare MPH);
M G Shrime MD), Harvard University, Boston, MA, USA Dignitas International, Zomba, Malawi (A Amberbir PhD);
(J R A Fitchett MD); Jimma University, Jimma, Ethiopia Environmental Health Research Center, Kurdistan University of Medical
(K H Abate MS, T T Gebrehiwot MPH, A T Gebremedhin MPH); Sciences, Sanandaj, Iran (H Amini MSPH); Department of
La Sapienza, University of Rome, Rome, Italy (C Abbafati PhD); Epidemiology and Public Health (H Amini MSPH, T Frst PhD), Swiss
Virginia Tech, Blacksburg, VA, USA (Prof K M Abbas PhD); Tropical and Public Health Institute, Basel, Switzerland
Department of Neurology, Cairo University, Cairo, Egypt (C K Karema MSc); Ministry of Public Health, Beirut, Lebanon
(Prof F Abd-Allah MD); NMSM Government College Kalpetta, Kerala, (W Ammar PhD, H L Harb MPH); Oregon Health & Science University,
India (Prof B Abraham MPhil); Institute for Global Health Portland, OR, USA (S M Amrock MD); Center for Sensory-Motor
(Prof I Abubakar PhD), Farr Institute of Health Informatics Research Interaction, Department of Health Science and Technology, Faculty of
(A Banerjee DPhil), Department of Epidemiology and Public Health Medicine, Aalborg University, Aalborg, Denmark (H H Andersen MSc);
(H Benzian PhD), University College London, London, UK; Infectious Department of Health Policy and Administration, College of Public
Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Health, University of the Philippines Manila, Manila, Philippines
Doha, Qatar (L J Abu-Raddad PhD); Institute of Community and (C A T Antonio MD); School of Public Health (Y A Melaku MPH),
Public Health, Birzeit University, Ramallah, Palestine Mekelle University, Mekelle, Ethiopia (A F Aregay MS, B D Betsu MS,
(N M Abu-Rmeileh PhD); Department of Epidemiology and Preventive G B Hailu MSc, H G Yebyo MS); Department of Medical Sciences,
Medicine, School of Public Health and Preventive Medicine Uppsala University, Uppsala, Sweden (Prof J rnlv PhD,
(I N Ackerman PhD, Prof R Buchbinder PhD), School of Public Health Prof A Larsson PhD); Dalarna University, Falun, Sweden
and Preventive Medicine (Prof B Gabbe PhD), Department of Medicine, (Prof J rnlv PhD); Consultant, Windsor, ON, Canada
School of Clinical Sciences at Monash Health (Prof A G Thrift PhD), (A Artaman PhD); Department of Medical Emergency, School of
Monash University, Melbourne, VIC, Australia; College of Medicine Paramedic, Qom University of Medical Sciences, Qom, Iran
(A O Adebiyi MD), University of Ibadan, Ibadan, Nigeria (H Asayesh PhD); Mashhad University of Medical Sciences, Mashhad,
(R O Akinyemi PhD); University College Hospital, Ibadan, Nigeria Iran (R Assadi PhD); Graduate Institute of Biomedical Informatics,
(A O Adebiyi MD); University of Basel, Basel, Switzerland Taipei Medical University, Taipei, Taiwan (S Atique MS); Institut de
(Z Ademi PhD, T Frst PhD); Association Ivoirienne pour le Bien-tre Recherche Clinique du Bnin, Cotonou, Benin Republic
Familial, Abidjan, Cte dIvoire (A K Adou MD); Direction du District (E F G A Avokpaho MPH); Laboratoire dEtudes et de Recherche-Action
Sanitaire de Haho, Notse, Togo (K A Afanvi MD); Faculte des Sciences en Sant (LERAS Afrique), Parakou, Benin Republic
de Sante, Universite de Lome, Lome, Togo (K A Afanvi MD); Institution (E F G A Avokpaho MPH); Sanjay Gandhi Postgraduate Institute of
of Public Health Sciences, Stockholm, Sweden (E E Agardh PhD); Dalla Medical Sciences, Lucknow, India (A Awasthi MSc); The Judith Lumley
Lana School of Public Health (N Akseer MSc), Department of Centre for Mother, Infant and Family Health Research, La Trobe
Nutritional Sciences, Faculty of Medicine (A Badawi PhD), Centre for University, Melbourne, VIC, Australia (B P Ayala Quintanilla PhD);
Addiction and Mental Health (S Popova PhD), University of Toronto, Peruvian National Institute of Health, Lima, Peru
Toronto, ON, Canada (A Agarwal BHSc); McMaster University, (B P Ayala Quintanilla PhD); Wardliparingga Aboriginal Research Unit,
Hamilton, ON, Canada (A Agarwal BHSc); Department of Clinical South Australian Health and Medical Research Institute, Adelaide, SA,
Sciences Lund, Orthopedics, Clinical Epidemiology Unit Australia (P Azzopardi MEpi); School of Health Sciences, University of
(A Ahmad Kiadaliri PhD), Skane University Hospital, Department of Management and Technology, Lahore, Pakistan (U Bacha PhD); Public
Clinical Sciences Lund (Prof B Norrving PhD), Lund University, Lund, Health Agency of Canada, Toronto, ON, Canada (A Badawi PhD);
Sweden; Health Services Management Research Center, Institute for Department of Environmental Health Engineering, Sri Ramachandra
Futures Studies in Health, Kerman University of Medical Sciences, University, Chennai, India (K Balakrishnan PhD); Faculty of Medicine,
Kerman, Iran (A Ahmad Kiadaliri PhD); Ophthalmic Research Center University of Belgrade, Belgrade, Serbia (A Barac PhD); School of
Psychology, University of Auckland, Auckland, New Zealand Nursing, College of Medicine, National Taiwan University, Taipei,
(S L Barker-Collo PhD); Africa Health Research Institute, Mtubatuba, Taiwan (Prof J Chang PhD); Clinical Governance Unit, Gold Coast
South Africa (Prof T Brnighausen MD); Institute of Public Health, Health, Southport, QLD, Australia (P P Chiang PhD); National Center
Heidelberg University, Heidelberg, Germany (Prof T Brnighausen MD, for Child Health and Development, Setagaya, Japan (C E Chibueze PhD);
S Mohammed PhD); Department of Occupational and Environmental University of Zambia, Lusaka, Zambia (V H Chisumpa MPhil,
Health (Prof L Barregard MD), Health Metrics Unit F Masiye PhD); University of Witwatersrand, Johannesburg, South
(Prof M Petzold PhD), University of Gothenburg, Gothenburg, Sweden; Africa (V H Chisumpa MPhil); Seoul National University Medical
Department of Industrial Engineering, School of Engineering, Ponticia Library, Seoul, South Korea (J J Choi PhD); Department of Public Health
Universidad Javeriana, Bogot, Colombia (L H Barrero ScD); School of and Primary Care, University of Cambridge, Cambridge, UK
Health Sciences, University of Canterbury, Christchurch, New Zealand (R Chowdhury PhD); Bispebjerg University Hospital, Copenhagen,
(A Basu PhD); College of Medicine, Charles R Drew University of Denmark (Prof H Christensen DMSCi); Christian Medical College,
Medicine and Science, Los Angeles, CA, USA Vellore, India (Prof D J Christopher MD); University of Salerno,
(Prof S Bazargan-Hejazi PhD); David Geen School of Medicine, Baronissi, Italy (Prof M Cirillo MD); MRC Lifecourse Epidemiology
University of California, Los Angeles, Los Angeles, CA, USA Unit, University of Southampton, Southampton, UK
(Prof S Bazargan-Hejazi PhD); Kermanshah University of Medical (Prof C Cooper FMedSci); NIHR Biomedical Research Centre,
Science, Kermanshah, Iran (Prof S Bazargan-Hejazi PhD); School of University of Southampton and University Hospital Southampton
Medicine (K N Sheth MD), Yale University, New Haven, CT, USA NHS Foundation Trust, Southampton, UK (Prof C Cooper FMedSci);
(Prof M L Bell PhD, J J Huang MD); Internal Medicine Department IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
(Prof I S Santos PhD), University of So Paulo, So Paulo, Brazil (M Cortinovis Biotech D, N Perico MD, Prof G Remuzzi MD);
(I M Bensenor PhD, Prof P A Lotufo DrPH); Department of Centre for International Health, Dunedin School of Medicine
Epidemiology and Health Promotion, College of Dentistry (Prof J A Crump MD), Injury Prevention Research Unit, Department of
(H Benzian PhD), New York University, New York, NY, USA; Debre Preventive and Social Medicine, Dunedin School of Medicine
Berhane University, Debre Berhan, Ethiopia (A Berhane PhD); Division (Prof S Derrett PhD), University of Otago, Dunedin, New Zealand
of Health and Social Care Research (Prof C D Wolfe MD), Kings College (Prof R G Poulton PhD); Wolaita Sodo University, Wolaita Sodo, Ethiopia
London, London, UK (E Bernab PhD, Prof R J Hay DM); College of (S A Damtew MPH); School of Public Health (K Deribe MPH,
Health and Medical Sciences (H S Roba MPH), Haramaya University, A D Hailu MPH), Addis Ababa University, Addis Ababa, Ethiopia
Harar, Ethiopia (A S Beyene MPH); Queen Elizabeth Hospital (S A Damtew MPH, A Z Giref PhD, D Haile MPH, T Jibat MS,
Birmingham, Birmingham, UK (N Bhala DPhil); University of Otago B Taye PhD); Guys and St Thomas NHS Foundation Trust, London, UK
Medical School, Wellington, New Zealand (N Bhala DPhil); Department (Prof P I Dargan FRCP); i3S - Instituto de Investigao e Inovao em
of Infectious Disease Epidemiology (T Frst PhD), Department of Sade and INEB - Instituto de Engenharia Biomdica (J das Neves PhD),
Epidemiology and Biostatistics (F B Piel PhD), Division of Brain Faculty of Medicine (J Massano MD, J V Santos BHlthSc); University of
Sciences (Prof T J Steiner PhD), Imperial College London, London, UK Porto, Porto, Portugal; Wellcome Trust Brighton & Sussex Centre for
(S Bhatt DPhil, F Greaves PhD, Prof A Majeed MD, M Soljak PhD); Global Health Research, Brighton, UK (Prof G Davey MD); Public
Independent Public Health Consultants, Addis Ababa, Ethiopia Health England, London, UK (Prof A C Davis PhD, F Greaves PhD,
(S Biadgilign MPH); Department of Nephrology Issues of Transplanted Prof J N Newton FRCP, Prof N Steel PhD); Grith University, Brisbane,
Kidney, Academician V I Shumakov Federal Research Center of QLD, Australia (Prof D De Leo DSc); Stanford University, Stanford, CA,
Transplantology and Articial Organs, Moscow, Russia (B Bikbov MD); USA (L C Del Gobbo PhD); University of Colorado School of Medicine
Department of Community Medicine (Prof E Bjertness PhD), University and the Colorado School of Public Health, Aurora, CO, USA
of Oslo, Oslo, Norway (A S Htet MPhil); Transport and Road Safety (R P Dellavalle MD); Brighton and Sussex Medical School, Brighton, UK
(TARS) Research (S Boufous PhD), National Drug and Alcohol Research (K Deribe MPH); KEMRI-Wellcome Trust Research Programme, Kili,
Centre (Prof L Degenhardt PhD), Brien Holden Vision Institute Kenya (A Deribew PhD); Mount Sinai Beth Israel, New York, NY, USA
(Prof S Resniko MD), University of New South Wales, Kensington, (Prof D C Des Jarlais PhD); Icahn School of Medicine at Mount Sinai,
NSW, Australia (B Calabria PhD, Prof P B Mitchell MD); Danube- New York, NY, USA (Prof D C Des Jarlais PhD); Department of
University Krems, Krems, Austria (Prof M Brainin PhD); Faculty of Community Medicine, Faculty of Medicine, University of Peradeniya,
Health Sciences and Social Work, Department of Public Health, Trnava Peradeniya, Sri Lanka (S D Dharmaratne MD); Centre for Control of
University, Trnava, Slovakia (A Brazinova PhD, M Majdan PhD); Chronic Conditions (P Jeemon PhD), Public Health Foundation of India,
International Neurotrauma Research Organization, Vienna, Austria Gurgaon, India (P K Dhillon PhD, P Ganguly MD, Prof S Zodpey PhD);
(A Brazinova PhD); Departments of Pediatrics and Neurology Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(W D Lo MD), College of Medicine (J Shen PhD), The Ohio State (C Diaz-Torn MD); International Institute for Population Sciences,
University, Columbus, OH, USA (Prof N J K Breitborde PhD); Monash Mumbai, India (M Dubey MPhil, M H U Rahman MPhil,
Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Prof U Ram PhD, A Singh PhD, R K Verma MPhil, A K Yadav MPhil);
VIC, Australia (Prof R Buchbinder PhD); University of California, San Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Francisco, San Francisco, CA, USA (G C Buckle MD); Al Shifa Trust Eye (B B Duncan PhD, C Kieling MD, Prof M I Schmidt MD); University of
Hospital, Rawalpindi, Pakistan (Z A Butt PhD); National Centre for North Carolina, Chapel Hill, NC, USA (B B Duncan PhD);
Epidemiology and Population Health, Australian National University, Non-communicable Diseases Research Center, Endocrinology and
Canberra, ACT, Australia (B Calabria PhD, A Lal PhD); Department of Metabolism Population Sciences Institute (H Ebrahimi MD,
Biostatistics and Epidemiology, University of Oklahoma Health Sciences F Pishgar MD, F Farzadfar MD, A Kasaeian PhD, M Parsaeian PhD),
Center, Oklahoma City, OK, USA (H Carabin PhD); Metropolitan Liver and Pancreaticobiliary Diseases Research Center, Digestive Disease
Autonomous University, Mexico City, Mexico (R Crdenas ScD); Research Institute, Shariati Hospital (H Ebrahimi MD), Multiple
University at Albany, Rensselaer, NY, USA (Prof D O Carpenter MD); Sclerosis Research Center, Neuroscience Institute (P Heydarpour MD),
Colombian National Health Observatory, Instituto Nacional de Salud, Hematology-Oncology and Stem Cell Transplantation Research Center
Bogot, Colombia (C A Castaeda-Orjuela MSc); Epidemiology and (A Kasaeian PhD), Digestive Diseases Research Institute
Public Health Evaluation Group, Public Health Department, (Prof R Malekzadeh MD, G Roshandel PhD, S G Sepanlou PhD),
Universidad Nacional de Colombia, Bogot, Colombia Department of Epidemiology and Biostatistics, School of Public Health
(C A Castaeda-Orjuela MSc); Caja Costarricense de Seguro Social, San (M Parsaeian PhD), Uro-Oncology Research Center (F Pishgar MD),
Jose, Costa Rica (Prof J Castillo Rivas MPH); Universidad de Costa Rica, Sina Trauma and Surgery Research Center (Prof V Rahimi-Movaghar MD),
San Pedro, Montes de Oca, Costa Rica (Prof J Castillo Rivas MPH); Tehran University of Medical Sciences, Tehran, Iran (M Yaseri PhD);
Department of Medicine, University of Valencia/INCLIVA Health Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
Research Institute and CIBERSAM, Valencia, Spain (I Elyazar PhD); Charit University Medicine Berlin, Berlin, Germany
(F Catal-Lpez PhD); Clinical Epidemiology Program, Ottawa Hospital (Prof M Endres MD); Arba Minch University, Arba Minch, Ethiopia
Research Institute, Ottawa, ON, Canada (F Catal-Lpez PhD); School of (A Y Endries MPH); The Institute of Social and Economic Studies of
Population, Russian Academy of Sciences, Moscow, Russia (Prof S P Dubai, United Arab Emirates (S Hamidi PhD); Wayne County
Ermakov DSc); Federal Research Institute for Health Organization and Department of Health and Human Services, Detroit, MI, USA
Informatics, Ministry of Health of the Russian Federation, Moscow, (M Hammami MD); University of New Mexico, Albuquerque, NM, USA
Russia (Prof S P Ermakov DSc); Ministry of Health and Medical (A J Handal PhD); School of Medicine and Pharmacology, University
Education, Tehran, Iran (B Eshrati PhD); Arak University of Medical of Western Australia, Perth, WA, Australia (Prof G J Hankey MD);
Sciences, Arak, Iran (B Eshrati PhD); University of Louisville, Louisville, Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
KY, USA (T A Farid MD, A R Khan MD); DGS Directorate General of (Prof G J Hankey MD); Western Australian Neuroscience Research
Health, Lisboa, Portugal (C S E S Farinha MSc); Universidade Aberta, Institute, Nedlands, WA, Australia (Prof G J Hankey MD); School
Lisboa, Portugal (C S E S Farinha MSc); Federal University of Sergipe, of Public Health, Sun Yat-sen University, Guangzhou, China
Aracaju, Brazil (Prof A Faro PhD); Harvard/MGH Center on Genomics, (Prof Y Hao PhD); Sree Chitra Tirunal Institute for Medical Sciences
Vulnerable Populations, and Health Disparities, Mongan Institute for and Technology, Trivandrum, India (S Harikrishnan DM); Parc Sanitari
Health Policy, Massachusetts General Hospital, Boston, MA, USA Sant Joan de Du - CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain
(M S Farvid PhD); National Institute for Stroke and Applied (J M Haro MD); Universitat de Barcelona, Barcelona, Spain
Neurosciences (V L Feigin PhD), Auckland University of Technology, (J M Haro MD); International Foundation for Dermatology, London, UK
Auckland, New Zealand (B J Te Ao MPH); School of Medicine (Prof R J Hay DM); Department of Psychiatry, University Medical Center
(G F Kwan MD), Boston University, Boston, MA, USA Groningen (Prof H W Hoek MD), University of Groningen, Groningen,
(Prof D T Felson MD); Institute of Education and Sciences, German Netherlands (A K Tura MPH); Department of Epidemiology, Mailman
Hospital Oswaldo Cruz, So Paulo, Brazil (Prof J G Fernandes PhD); School of Public Health (Prof H W Hoek MD), Columbia University,
Centre for Experimental Medicine & Rheumatology, William Harvey New York, NY, USA (Prof V Skirbekk PhD); Nevada Division of Public
Research Institute, Barts and The London School of Medicine and Behavioral Health, Department of Health and Human Services,
& Dentistry, Queen Mary University of London, London, UK Carson City, NV, USA (M Horino MPH); Department of Pulmonology,
(J C Fernandes PhD); Bielefeld University, Bielefeld, Germany Yokohama City University Graduate School of Medicine, Yokohama,
(F Fischer MPH); Alzheimer Scotland Dementia Research Centre Japan (N Horita MD); Albert Einstein College of Medicine, Bronx, NY,
(I Shiue PhD), University of Edinburgh, Edinburgh, UK USA (Prof H D Hosgood PhD); Public Health Division, The Pacic
(Prof F G R Fowkes PhD); James Cook University, Townsville, QLD, Community, Noumea, New Caledonia (D G Hoy PhD); International
Australia (R C Franklin PhD); Department of Infectious Disease Relations Division, Ministry of Health, Nay Pyi Taw, Myanmar
Epidemiology (T Frst PhD), Department of Epidemiology and (A S Htet MPhil); Cambridge Health Alliance, Cambridge, MA, USA
Biostatistics (F B Piel PhD), Division of Brain Sciences (H Huang MD); Aarhus University, Aarhus, Denmark (K M Iburg PhD);
(Prof T J Steiner PhD), Imperial College London, London, UK National Institute for Health Development, Tallinn, Estonia
(F Greaves PhD, Prof A Majeed MD, M Soljak PhD); Indian Institute of (K Innos PhD); Graduate School of Medicine (M Inoue MD), School
Public Health Gandhinagar, Ahmedabad, India (P Ganguly MD, of Public Health (Prof N Kawakami MD), University of Tokyo, Tokyo,
V J Iyer MPH); Leras Afrique, Cotonou, Benin (F G Gankp MD); CHU Japan (K Shibuya MD); Department of Global and Community Health,
Hassan II, Fs, Morocco (F G Gankp MD); The Task Force for Global George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); Faculty
Health, Decatur, GA, USA (T Gebre PhD); Ludwig Maximilians of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
University, Munich, Germany (A T Gebremedhin MPH); Division (Prof M B Jakovljevic PhD); University of Aberdeen, Aberdeen, UK
of Human Nutrition (J M Geleijnse PhD), Wageningen University, (M Javanbakht PhD); Postgraduate Institute of Medicine, Colombo,
Wageningen, Netherlands (T Jibat MS); Agence de Mdecine Prventive, Sri Lanka (A U Jayatilleke PhD); Institute of Violence and Injury
Paris, France (B D Gessner MD); The Royal Melbourne Hospital, Prevention, Colombo, Sri Lanka (A U Jayatilleke PhD); Graduate School
Melbourne, VIC, Australia (K B Gibney FRACP); College of Medicine, of Public Health, Yonsei University, Seoul, South Korea (Prof S H Jee PhD);
University of Hail, Hail, Saudi Arabia (I A Ginawi MD); University Centre for Chronic Disease Control, New Delhi, India (P Jeemon PhD,
Hospital of Dijon, Dijon, France (Prof M Giroud MD); College of Health D Prabhakaran DM); Department of Health Development, Institute of
and Medical Sciences (H S Roba MPH), Haramaya University, Dire Industrial Ecological Sciences, University of Occupational and
Dawa, Ethiopia (M D Gishu MS, A K Tura MPH); Kersa Health Environmental Health, Kitakyushu, Japan (Y Jiang PhD); Department of
and Demographic Surveillance System, Harar, Ethiopia (M D Gishu MS); Ocular Epidemiology and Visual Health, Institute of Ophthalmology
Heller School for Social Policy and Management (E Glaser PhD), Conde de Valencia, Mexico City, Mexico (A Jimenez-Corona PhD);
Brandeis University, Waltham, MA, USA (Y A Halasa MS, General Directorate of Epidemiology, Ministry of Health, Mexico City,
Prof D S Shepard PhD, E A Undurraga PhD); University of Mexico (A Jimenez-Corona PhD); Department of Ophthalmology,
Massachusetts Boston, Boston, MA, USA (Prof P Gona PhD); Instituto Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg,
de Investigaciones Cienticas y Servicios de Alta Tecnologia- Mannheim, Germany (Prof J B Jonas MD); University College Cork,
INDICASAT-AIP, Ciudad del Saber, Panam (A Goodridge PhD); Cork, Ireland (Z Kabir PhD); Society for Education, Action and Research
Department of Health and Social Aairs, Government of the Federated in Community Health, Gadchiroli, India (Y Kalkonde MD); CSIR-Indian
States of Micronesia, Palikir, Federated States of Micronesia Institute of Toxicology Research, Lucknow, India (R Kamal MSc,
(S V Gopalani MPH); University of British Columbia, Vancouver, BC, C N Kesavachandran PhD); Fudan University, Shanghai, China
Canada (C C Gotay PhD, Prof N Kissoon MD, J A Kopec PhD, (H Kan MD); Epidemiological and Statistical Methods Research Group,
F Pourmalek PhD); Division of Epidemiology, Center for Public Health Helmholtz Centre for Infection Research, Braunschweig, Germany
Sciences (A Goto PhD), National Cancer Center, Tokyo, Japan (A Karch MD); Hannover-Braunschweig Site, German Center for
(M Inoue MD); Centre for International Health, Dunedin School Infection Research, Braunschweig, Germany (A Karch MD); Quality and
of Medicine (Prof J A Crump MD), Injury Prevention Research Unit, Equity Health Care, Kigali, Rwanda (C K Karema MSc); Case Western
Department of Preventive and Social Medicine, Dunedin School University Hospitals, Cleveland, OH, USA (C Karimkhani MD);
of Medicine (Prof S Derrett PhD), University of Otago, Wellington, Oklahoma State University, Tulsa, OK, USA (A Kaul MD); Institute
New Zealand (R Grainger PhD); West Virginia Bureau for Public Health, of Tropical and Infectious Diseases, Nairobi, Kenya (P N Keiyoro PhD);
Charleston, WV, USA (R Gupta MD); Eternal Heart Care Centre and School of Continuing and Distance Education, Nairobi, Kenya
Research Institute, Jaipur, India (R Gupta PhD); Department of (P N Keiyoro PhD); Farr Institute (Prof R A Lyons MD), Swansea
Anthropology, University of Delhi, Delhi, India (V Gupta PhD); National University, Swansea, UK (Prof A H Kemp PhD); Assuta Hospitals,
Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico Assuta Hashalom, Tel Aviv, Israel (Prof A Keren MD); Jordan University
(R A Gutirrez PhD); Department of Global Public Health and Primary of Science and Technology, Irbid, Jordan (Prof Y S Khader ScD); Health
Care (A K Knudsen PhD, Prof S E Vollset DrPH), University of Bergen, Services Academy, Islamabad, Pakistan (E A Khan MPH); College
Bergen, Norway (A D Hailu MPH, Prof O F Norheim PhD); Kilte of Medicine (Prof Y H Khang MD), Graduate School of Public Health
Awlaelo Health and Demographic Surveillance System, Mekelle, (Prof S Won PhD), Seoul National University, Seoul, South Korea;
Ethiopia (G B Hailu MSc); Arabian Gulf University, Manama, Bahrain New York Medical College, Valhalla, NY, USA (S Khera MD,
(Prof R R Hamadeh DPhil); Hamdan Bin Mohammed Smart University, M Tavakkoli MD); Executive Board of the Health Ministers Council
for Cooperation Council States, Riyadh, Saudi Arabia (Prof T A M Khoja Childrens Hospital of Philadelphia, Philadelphia, PA, USA
FRCP); Ball State University, Muncie, IN, USA (J Khubchandani PhD); (P A Meaney MD); College of Medicine, Howard University,
Hospital de Clnicas de Porto Alegre, Porto Alegre, Brazil Washington, DC, USA (A Mehari MD); University of Gondar, Gondar,
(C Kieling MD); Korea Health Industry Development Institute, Ethiopia (A B Mekonnen MS, B A Tedla BS); University of West Florida,
Cheongju-si, South Korea (C Kim PhD); Department of Health Sciences, Pensacola, FL, USA (P Memiah PhD); Saudi Ministry of Health, Riyadh,
Northeastern University, Boston, MA, USA (Prof D Kim DrPH); Saudi Arabia (Prof Z A Memish MD); College of Medicine, Alfaisal
Southern University College, Skudai, Malaysia (Y J Kim PhD); Centre for University, Riyadh, Saudi Arabia (Prof Z A Memish MD); United
Disease Burden (A K Knudsen PhD, Prof S E Vollset DrPH), Nations Population Fund, Lima, Peru (W Mendoza MD); Department of
Department of Health Promotion (J C Skogen PhD), Norwegian Neurology, Helsinki University Hospital, Helsinki, Finland
Institute of Public Health, Oslo, Norway (M Savic PhD, (A Meretoja PhD); Helsinki University Hospital, Comprehensive Cancer
Prof V Skirbekk PhD); Department of Preventive Cardiology, National Center, Breast Surgery Unit, Helsinki, Finland (T J Meretoja PhD);
Cerebral and Cardiovascular Center, Suita, Japan (Y Kokubo PhD); Ifakara Health Institute, Bagamoyo, Tanzania (F A Mhimbira MS);
Division of Cardiology (D Kolte MD), Brown University, Providence, Pacic Institute for Research & Evaluation, Calverton, MD, USA
RI, USA (Prof S T McGarvey PhD); Center for Community (T R Miller PhD); Centre for Population Health, Curtin University,
Empowerment, Health Policy and Humanities, NIHRD, Jakarta, Perth, WA, Australia (T R Miller PhD); University of Ottawa, Ottawa,
Indonesia (S Kosen MD); Sher-i-Kashmir Institue of Medical Sciences, ON, Canada (E J Mills PhD); Neuroscience Research Center, Baqiyatallah
Srinagar, India (Prof P A Koul MD); Research and Development Unit, University of Medical Sciences, Tehran, Iran (A Mohammadi PhD);
Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain Health Systems and Policy Research Unit, Ahmadu Bello University,
(A Koyanagi MD); Research Center of Neurology, Moscow, Russia Zaria, Nigeria (S Mohammed PhD); Institute for Maternal and Child
(M Kravchenko PhD, Prof Y Y Varakin MD); Department of Health, IRCCS Burlo Garofolo, Trieste, Italy (L Monasta DSc,
Demography and Public Health Research Institute M Montico MSc, L Ronfani PhD); Department of Community Medicine,
(Prof B Kuate Defo PhD), Department of Social and Preventive Gastrointestinal and Liver Disease Research Center, Preventive Medicine
Medicine, School of Public Health (Prof B Kuate Defo PhD), University and Public Health Research Center, Iran University of Medical Sciences,
of Montreal, Montreal, QC, Canada; Institute of Public Health, Tehran, Iran (M Moradi-Lakeh MD); International Laboratory for Air
Hacettepe University, Ankara, Turkey (B Kucuk Bicer PhD); University Quality and Health (L Morawska PhD), Institute of Health and
of Cape Coast, Cape Coast, Ghana (A A Kudom PhD); Department of Biomedical Innovation (R E Norman PhD), Queensland University of
Public Health (S Polinder PhD), Erasmus MC, University Medical Technology, Brisbane, QLD, Australia; Competence Center Mortality-
Center Rotterdam, Rotterdam, Netherlands (Prof E J Kuipers PhD); Follow-Up of the German National Cohort (A Werdecker PhD), Federal
Work Organizations, Work Disability Prevention, The Finnish Institute Institute for Population Research, Wiesbaden, Germany
of Occupational Health, Helsinki, Finland (T Lallukka PhD, (Prof U O Mueller PhD, R Westerman PhD); Graduate School of Public
R Shiri PhD); Department of Public Health, Faculty of Medicine Health (Prof J B Nachega PhD), Public Health Dynamics Laboratory
(T Lallukka PhD), University of Helsinki, Helsinki, Finland (A J Paternina Caicedo MD), University of Pittsburgh, Pittsburgh, PA,
(T J Meretoja PhD); Institute of Health Policy and Development Studies, USA; West Herts Hospitals NHS Trust, Watford, Hertfordshire, UK
National Institutes of Health, Manila, Philippines (Prof H Lam PhD); (M E Murdoch FRCP); Stellenbosch University, Cape Town, South Africa
Johns Hopkins Bloomberg School of Public Health (J O Lam PhD, (Prof J B Nachega PhD, Prof S Seedat PhD, Prof C S Wiysonge PhD);
Prof J B Nachega PhD), Johns Hopkins University, Baltimore, MD, USA Institute of Epidemiology and Medical Biometry, Ulm University, Ulm,
(B X Tran PhD); London School of Hygiene & Tropical Medicine, Germany (Prof G Nagel PhD, Prof D Rothenbacher MD); International
London, UK (S M Langan PhD, Prof M McKee DSc); Servicio de Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka,
Neurologia, Clinica Alemana, Universidad del Desarrollo, Santiago, Bangladesh (A Naheed PhD); Azienda Ospedaliera Papa Giovanni XXIII,
Chile (P M Lavados MD); College of Optometry, Nova Southeastern Bergamo, Italy (Prof L Naldi MD, Prof G Remuzzi MD); Suraj Eye
University, Fort Lauderdale, FL, USA (J L Leasher OD); State University Institute, Nagpur, India (V Nangia MD); Ministry of Health and Social
of New York, Albany, Rensselaer, NY, USA (R Leung PhD); Tuscany Welfare, Dar es Salaam, Tanzania (F N Ngalesoni MSc); Institute for
Regional Centre for Occupational Injuries and Diseases, Florence, Italy Global Health Innovations, Duy Tan University, Da Nang, Vietnam
(M Levi PhD); San Francisco VA Medical Center, San Francisco, CA, (Q L Nguyen MD); Institute For Research, Socio-Economic Development
USA (Y Li PhD); National Oce for Maternal and Child Health and Communication, Yaound, Cameroon (P M Nkamedjie Pete MS);
Surveillance, West China Second University Hospital, Sichuan Hospital Universitari de Bellvitge, LHospitalet, Spain (J M Nolla PhD);
University, Chengdu, China (Prof J Liang MD); Emory University, Federal University of Pelotas, Pelotas, Brazil (Prof B P Nunes PhD);
Atlanta, GA, USA (Prof Y Liu PhD, Prof M R Phillips MD); Eastern Centre for Health Research, Western Sydney University, Sydney, NSW,
Health Clinical School (B K Lloyd PhD), Monash University, Fitzroy, Australia (F A Ogbo MPH); Department of Preventive Medicine, School
VIC, Australia; Turning Point, Eastern Health, Melbourne, VIC, of Medicine, Kyung Hee University, Seoul, South Korea (Prof I Oh PhD);
Australia (B K Lloyd PhD); Nationwide Childrens Hospital, Columbus, Teikyo University School of Medicine, Tokyo, Japan
OH, USA (W D Lo MD); University of Bari, Bari, Italy (Prof T Ohkubo MD); Universidad Autonoma de Chile, Talca, Chile
(Prof G Logroscino PhD); University of Bristol, Bristol, UK (Prof P R Olivares PhD); Center for Healthy Start Initiative, Lagos,
(K J Looker PhD); Aintree University Hospital National Health Service Nigeria (B O Olusanya PhD, J O Olusanya MBA); IIS-Fundacion
Foundation Trust, Liverpool, UK (Prof R Lunevicius PhD); School of Jimenez Diaz-UAM, Madrid, Spain (Prof A Ortiz PhD); YBank,
Medicine, University of Liverpool, Liverpool, UK Cambridge, MA, USA (M Osman MD); St Lukes International
(Prof R Lunevicius PhD); Royal Childrens Hospital, Melbourne, VIC, University, Tokyo, Japan (E Ota PhD); JSS Medical College, JSS
Australia (M T Mackay MBBS, R G Weintraub MBBS); Aswan University University, Mysore, India (Prof Mahesh PA DNB); Department of
Hospital, Aswan Faculty of Medicine, Aswan, Egypt Medical Humanities and Social Medicine, College of Medicine, Kosin
(M Magdy Abd El Razek MBBCh); Social Security Organization Research University, Busan, South Korea (E Park PhD); Universidade Federal de
Institute, Tehran, Iran (M Mahdavi PhD); Institute of Health Policy and Minas Gerais, Belo Horizonte, Brazil (Prof V M D A Passos PhD);
Management, Erasmus University Rotterdam, Rotterdam, Netherlands Universidad de Cartagena, Cartagena, Colombia
(M Mahdavi PhD); Division of Population and Patient Health, Kings (A J Paternina Caicedo MD); Department of Community Health
College London Dental Institute, London, UK (Prof W Marcenes PhD); Sciences (Prof S B Patten PhD), University of Calgary, Calgary, AB,
Perelman School of Medicine (P A Meaney MD), University of Canada (Prof M Tonelli MD); REQUIMTE/LAQV, Laboratrio de
Pennsylvania, Philadelphia, PA, USA (D J Margolis PhD); University Farmacognosia, Departamento de Qumica, Faculdade de Farmcia,
Hospital Doctor Peset, University of Valencia, Valencia, Spain Universidade do Porto, Porto, Portugal (Prof D M Pereira PhD);
(J Martinez-Raga PhD); CEU Cardenal Herrera University, Moncada National Institute of Respiratory Diseases, Mexico City, Mexico
(Valencia), Spain (J Martinez-Raga PhD); Hospital Pedro Hispano/ULS (Prof R Perez-Padilla MD); Flinders University, Adelaide, SA, Australia
Matosinhos, Matosinhos, Portugal (J Massano MD); Alaska Native Tribal (Prof K Pesudovs PhD); University of the Witwatersrand, Johannesburg,
Health Consortium, Anchorage, AK, USA (B J McMahon MD); South Africa (Prof M Petzold PhD); Shanghai Jiao Tong University
School of Medicine, Shanghai, China (Prof M R Phillips MD); Durban (V Stathopoulou PhD); University of East Anglia, Norwich, UK
University of Technology, Durban, South Africa (J D Pillay PhD); (Prof N Steel PhD); South African Medical Research Council Unit on
Exposure Assessment and Environmental Health Indicators, German Anxiety & Stress Disorders, Cape Town, South Africa
Environment Agency, Berlin, Germany (D Plass DrPH); Department of (Prof D J Stein PhD); Department of Neuroscience, Norwegian
Anesthesiology (A S Terkawi MD), University of Virginia, Charlottesville, University of Science and Technology, Trondheim, Norway
VA, USA (J A Platts-Mills MD); University of Newcastle, Callaghan, (Prof T J Steiner PhD, Prof L J Stovner PhD); Department of
NSW, Australia (Prof C D Pond PhD); The Fred Hollows Foundation, Dermatology, University Hospital Muenster, Muenster, NRW, Germany
Sydney, NSW, Australia (N M Prasad DO); Centre for Eye Research (S Steinke DrMed); Norwegian Advisory Unit on Headache, St Olavs
Australia, Melbourne, VIC, Australia (N M Prasad DO); Department of Hospital, Trondheim, Norway (Prof L J Stovner PhD); Alexandra
Community Medicine, School of Medicine, Alborz University of Medical General Hospital of Athens, Athens, Greece (K Stroumpoulis PhD);
Sciences, Karaj, Iran (M Qorbani PhD); A T Still University, Kirksville, Centre Hospitalier Public du Cotentin, Cherbourg, France
MO, USA (A Radfar MD); Contech School of Public Health, Lahore, (K Stroumpoulis PhD); Muhimbili University of Health and Allied
Pakistan (A Rafay MS); Research and Evaluation Division, BRAC, Dhaka, Sciences, Dar es Salaam, Tanzania (B F Sunguya PhD); Indian Council
Bangladesh (M Rahman PhD); Hamad Medical Corporation, Doha, of Medical Research, New Delhi, India (S Swaminathan MD);
Qatar (S U Rahman FCPS); Society for Health and Demographic Departments of Criminology, Law & Society, Sociology, and Public
Surveillance, Suri, India (R K Rai MPH); ERAWEB Program, University Health, University of California, Irvine, Irvine, CA, USA
for Health Sciences, Medical Informatics and Technology, Hall in Tirol, (Prof B L Sykes PhD); Department of Medicine, University of Valencia,
Austria (S Rajsic MD); Walden University, Minneapolis, MN, USA INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
(Prof A H Refaat PhD); Suez Canal University, Ismailia, Egypt (Prof R Tabars-Seisdedos PhD); WSH Institute, Ministry of Manpower,
(Prof A H Refaat PhD); Department of Biomedical and Clinical Sciences Singapore, Singapore (J S Takala DSc); Tampere University of
L Sacco, University of Milan, Milan, Italy (Prof G Remuzzi MD); Technology, Tampere, Finland (J S Takala DSc); Chaim Sheba Medical
Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Center, Tel Hashomer, Israel (Prof D Tanne MD); Tel Aviv University,
Horizonte, Brazil (Prof A L Ribeiro MD); (ISGlobal) Instituto de Salud Tel Aviv, Israel (Prof D Tanne MD); James Cook University, Cairns, QLD,
Global de Barcelona, Barcelona, Spain (D Rojas-Rueda PhD); Golestan Australia (B A Tedla BS); Outcomes Research Consortium
Research Center of Gastroenterology and Hepatology, Golestan (A S Terkawi MD), Cleveland Clinic, Cleveland, OH, USA
University of Medical Sciences, Gorgan, Iran (G Roshandel PhD); (Prof E M Tuzcu MD); Department of Anesthesiology, King Fahad
All India Institute of Medical Sciences, New Delhi, India (A Roy DM, Medical City, Riyadh, Saudi Arabia (A S Terkawi MD);
R Sagar MD, M Satpathy PhD, Prof N Tandon PhD); Ballarat Health Adaptive Knowledge Management, Victoria, BC, Canada
Service, Ballarat, VIC, Australia (R Sahathevan PhD); Universiti (A J Thomson PhD); WorldFish, Penang, Malaysia
Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia (A L Thorne-Lyman ScD); Nelson Institute of Environmental Medicine,
(R Sahathevan PhD); Marshall University J Edwards School of Medicine, School of Medicine (Prof G D Thurston ScD), New York University,
Huntington, WV, USA (J R Sanabria MD); Case Western Reserve Tuxedo, NY, USA; National Center for Child Health and Development,
University, Cleveland, OH, USA (J R Sanabria MD); IIS-Fundacion Tokyo, Japan (R Tobe-Gai PhD); Institute of Public Health, Faculty of
Jimenez Diaz, Madrid, Spain (M D Sanchez-Nio PhD); Universidad Health Sciences, Jagiellonian University Medical College, Krakw,
Ciencias Aplicadas y Ambientales, Bogot, Colombia Poland (R Topor-Madry PhD); Faculty of Health Sciences, Wroclaw
(R Sarmiento-Suarez MPH); University of KwaZulu-Natal, Durban, Medical University, Wroclaw, Poland (R Topor-Madry PhD); Aristotle
South Africa (Prof B Sartorius PhD); Marshall University, Huntington, University of Thessaloniki, Thessaloniki, Greece (Prof F Topouzis PhD);
WV, USA (M Sawhney PhD); Swiss Research Institute of Public Health Hanoi Medical University, Hanoi, Vietnam (B X Tran PhD); Department
and Addiction (M P Schaub PhD), University of Zurich, Zurich, of Population Sciences and Development, Faculty of Economics and
Switzerland (H G Yebyo MS); Federal University of Santa Catarina, Management, University of Kinshasa, Kinshasa, Democratic Republic of
Florianpolis, Brazil (I J C Schneider PhD, D A S Silva PhD); German the Congo (Z Tsala Dimbuene PhD); African Population and Health
Cancer Research Center, Heidelberg, Germany (B Schttker MPH); Research Center, Nairobi, Kenya (Z Tsala Dimbuene PhD);
Institute of Health Care and Social Sciences, FOM University, Essen, Department of Medicine, University of Crete, Heraklion, Greece
Germany (B Schttker MPH); University of Alabama at Birmingham, (Prof M Tsilimbaris PhD); Parc Sanitari Sant Joan de Du, Fundaci
Birmingham, AL, USA (D C Schwebel PhD, J A Singh MD); Department Sant Joan de Du, Universitat de Barcelona, CIBERSAM, Barcelona,
of Public Health, An-Najah University, Nablus, Palestine (A Shaheen PhD); Spain (S Tyrovolas PhD); Department of Internal Medicine, Federal
Independent Consultant, Karachi, Pakistan (M A Shaikh MD); Indian Teaching Hospital, Abakaliki, Nigeria (K N Ukwaja MD); Ebonyi State
Institute of Technology Ropar, Rupnagar, India (R Sharma MA); ICMR University, Abakaliki, Nigeria (C J Uneke PhD); Warwick Medical
National Institute of Epidemiology, Chennai, India (U Sharma MPH); School, University of Warwick, Coventry, UK (O A Uthman PhD);
Research Institute at Nationwide Childrens Hospital, Columbus, OH, National Institute for Public Health and the Environment, Bilthoven,
USA (J Shen PhD); Department of Public Health Science, Graduate Netherlands (C H van Gool PhD); UKK Institute for Health Promotion
School (Prof M Shin PhD), Department of Preventive Medicine, College Research, Tampere, Finland (Prof T Vasankari PhD); Raes
of Medicine (S Yoon PhD), Korea University, Seoul, South Korea; Faculty Neuroscience Centre, Raes Hospital, Singapore, Singapore
of Health and Life Sciences, Northumbria University, Newcastle upon (N Venketasubramanian FRCP); University of Bologna, Bologna, Italy
Tyne, UK (I Shiue PhD); Reykjavik University, Reykjavik, Iceland (Prof F S Violante MD); Federal Research Institute for Health
(I D Sigfusdottir PhD); Braslia University, Braslia, Brazil Organization and Informatics, Moscow, Russia (S K Vladimirov PhD);
(D G A Silveira MD); Department of Medicine, Institute of Medical National Research University Higher School of Economics, Moscow,
Sciences, Banaras Hindu University, Varanasi, India (O P Singh PhD); Russia (Prof V V Vlassov MD); National Institute for Occupational Safety
Institute for Human Development, New Delhi, India (P K Singh PhD); and Health, Washington, DC, USA (G R Wagner MD); Uniformed
Alcohol and Drug Research Western Norway (J C Skogen PhD), Services University of Health Sciences, Bethesda, MD, USA
Stavanger University Hospital, Stavanger, Norway (K Sreide PhD); (Prof S G Waller MD); McGill University, Montreal, QC, Canada
Faculty of Health Sciences, Hatter Institute for Cardiovascular (S Weichenthal PhD); Department of Research, Cancer Registry of
Research in Africa (Prof K Sliwa PhD), Department of Psychiatry Norway, Institute of Population-Based Cancer Research, Oslo, Norway
(Prof D J Stein PhD), University of Cape Town, Cape Town, South Africa (E Weiderpass PhD); Department of Community Medicine, Faculty of
(D A Watkins MD); Instituto de Investigacin Hospital Universitario de Health Sciences, University of Troms, The Arctic University of Norway,
la Princesa, Universidad Autnoma de Madrid, Ctedra UAM-Linde, Troms, Norway (E Weiderpass PhD); Genetic Epidemiology Group,
Palma de Mallorca, Spain (Prof J B Soriano PhD); Department Folkhlsan Research Center, Helsinki, Finland (E Weiderpass PhD);
of Clinical Neurological Sciences, Western University, London, ON, German National Cohort Consortium, Heidelberg, Germany
Canada (L A Sposato MD); Department of Community Medicine, (R Westerman PhD); Department of Infectious Disease Epidemiology
International Medical University, Kuala Lumpur, Malaysia and Modelling (R A White PhD), Norwegian Institute of Public Health,
(C T Sreeramareddy MD); Attikon University Hospital, Athens, Greece Oslo, Norway (M Savic PhD, Prof V Skirbekk PhD); Centre of Evidence-
based Dermatology, University of Nottingham, Nottingham, UK grants from the Bill & Melinda Gates Foundation. Matthias Endres
(Prof H C Williams DSc); South African Medical Research Council, Cape reports that The Center for Stroke Research Berlin has received
Town, South Africa (Prof C S Wiysonge PhD); National Institute for institutional funding from the German Ministry for Research and
Health Research Comprehensive Biomedical Research Centre, Guys & Education (BMBF). Katharine J Looker has received funding from the
St Thomas NHS Foundation Trust and Kings College London, London, World Health Organization for the HSV-2 seroprevalence review which
UK (Prof C D Wolfe MD); St Pauls Hospital, Millennium Medical informs this work; during the study, KJL also received separate funding
College, Addis Ababa, Ethiopia (M Wubshet PhD); St Johns Medical from the World Health Organization, USAID/PATH, Sexual Health 24
College and Research Institute, Bangalore, India (Prof D Xavier MD); and the National Institute for Health Research (NIHR) Health Protection
Department of Neurology, Jinling Hospital, Nanjing University School of Research Unit (HPRU) in Evaluation of Interventions at the University
Medicine, Nanjing, China (Prof G Xu PhD); Global Health Research of Bristol; these funders had no role in the writing of the manuscript nor
Center, Duke Kunshan University, Kunshan, China (Prof L L Yan PhD); the decision to submit it for publication, and the views expressed in this
Department of Preventive Medicine, Northwestern University, Chicago, Article do not necessarily represent the views, decisions or policies of the
IL, USA (Y Yano MD); Social Work and Social Administration World Health Organization, the NHS, the NIHR, the Department of
Department and The Hong Kong Jockey Club Centre for Suicide Health or Public Health England. Donal Bisanzio is supported by
Research and Prevention, University of Hong Kong, Hong Kong, China Bill and Melinda Gates Foundation (#OPP1068048). Thomas Frst has
(Prof P Yip PhD); Department of Biostatistics, School of Public Health, received nancial support from the Swiss National Science Foundation
Kyoto University, Kyoto, Japan (N Yonemoto MPH); Jackson State (SNSF; project no P300P3-154634). Rodrigo Sarmiento-Suarez receives
University, Jackson, MS, USA (Prof M Z Younis DrPH); Department of institutional support from Universidad de Ciencias Aplicadas y
Epidemiology and Biostatistics, School of Public Health (Prof C Yu PhD), Ambientales, UDCA, Bogot Colombia. Ronan A Lyons is supported by
Global Health Institute (Prof C Yu PhD), Wuhan University, Wuhan, two grants: The Farr Institute of Health Informatics Research: Arthritis
China; University Hospital, Setif, Algeria (Prof Z Zaidi PhD); Faculty of Research UK, the British Heart Foundation, Cancer Research UK, the
Medicine, Mansoura University, Mansoura, Egypt (Prof M E Zaki PhD); Economic and Social Research Council, the Engineering and Physical
Leibniz Institute for Prevention Research and Epidemiology, Bremen, Sciences Research Council, the Medical Research Council, the National
Germany (Prof H Zeeb PhD); Red Cross War Memorial Childrens Institute of Health Research, the National Institute for Social Care and
Hospital, Cape Town, South Africa (L J Zuhlke PhD). Health Research (Welsh Assembly Government), the Chief Scientist
Oce (Scottish Government Health Directorates), and The Wellcome
Contributors
Trust. Grant No MR/K006525/1, and the National Centre for Population
Christopher J L Murray and Theo Vos prepared the rst draft.
Health and Wellbeing Research. Health and Care Research Wales.
Alan D Lopez and Christopher J L Murray conceived the study and
Stefanos Tyrovolass work is supported by the Foundation for Education
provided overall guidance. All other authors provided data, developed
and European Culture (IPEP), the Sara Borrell postdoctoral programme
models, reviewed results, initiated modelling infrastructure, and/or
(reference no CD15/00019 from the Instituto de Salud Carlos III
reviewed and contributed to the report.
(ISCIII - Spain) and the Fondos Europeo de Desarrollo Regional
Declaration of interests (FEDER). Manami Inoue is the beneciary of a nancial contribution
Bruce Bartholow Duncan and Maria Ins Schmidt have received from the AXA Research fund as chair holder of the AXA Department of
additional funding from the Brazilian Ministry of Health Health and Human Security, Graduate School of Medicine, The
(Process No 25000192049/2014-14). Itamar S Santos reports grants from University of Tokyo from Nov 1, 2012; the AXA Research Fund has no
FAPESP (Brazilian public agency), outside the submitted work. role in this work. Sinead M Langan holds an NIHR Clinician Scientist
Carl Abelardo T Antonio reports grants, personal fees and non-nancial Fellowship (NIHR/CS/010/014); the views expressed in this publication
support from Johnson & Johnson (Philippines), Inc, outside the are those of the authors and not necessarily those of the NHS, the
submitted work. Cyrus Cooper reports other from Alliance for Better NIHR, or the UK Department of Health. Scott Weichenthal
Bone Health, other from Amgen, other from Eli Lilly, other from GSK, acknowledges nancial support from the Cancer Research Society of
other from Medtronic, other from Merck, other from Novartis, other Canada. Yogeshwar Kalkonde is a Wellcome Trust/ DBT India Alliance
from Pzer, other from Roche, other from Servier, outside the submitted Intermediate Fellow in Public Health. John J McGrath received a
work. Walter Mendoza is currently employed by the Peru Country Oce NHMRC John Cade Fellowship (APP1056929). Sarah Derrett reports
of the United Nations Population Fund, an institution which does grants, personal fees, non-nancial support and other from EuroQol
not necessarily endorse this study. Donald S Shepard would Research Foundation, outside the submitted work. Dan J Stein reports
like to acknowledge grant support from Sano Pasteur. personal fees from Lundbeck, personal fees from Novartis, personal fees
Rafael Tabars-Seisdedos and Ferrn Catal-Lpez are supported in part from AMBRF, grants from NRGF, personal fees from Biocodex,
by grant PROMETEOII/2015/021 from Generalitat Valenciana, and personal fees from Sevier, grants from MRC, personal fees from SUN,
Rafael Tabars-Seisdedos is supported by the national grant PI14/00894 and personal fees from CIPLA, outside the submitted work. Tea Lallukka
from ISCIII-FEDER. Walter Mendoza is currently employed by the Peru reports funding from The Academy of Finland, grant #287488.
Country Oce of the United Nations Population Fund, an institution Charles D A Wolfes research was funded and supported by the National
which does not necessarily endorse this study. Veena J Iyer has received Institute for Health Research (NIHR) Biomedical Research Centre based
a Public Health Research Initiative Fellowship (2014-17) from the at Guys and St Thomas NHS Foundation Trust and Kings College
Department of Science and Technology (DST) for a project titled London. The views expressed are those of the author(s) and not
Relationship between Enteric Fever incidence and Climate in the city of necessarily those of the NHS, the NIHR, or the Department of Health.
Ahmedabad, 19902014. Pablo M Lavados reports grants, personal fees The other authors declare no competing interests.
and non-nancial support from BAYER, non-nancial support from
Acknowledgments
Boehringer Ingelheim, grants and personal fees from AstraZeneca,
We would like to thank the countless individuals who have contributed to
grants from CONICYT, and grants from The George Institute for Global
the Global Burden of Disease Study 2015 in various capacities. This paper
Health, outside the submitted work. Noela M Prasad reports and is an
uses data from SHARE Waves 1, 2, 3 (SHARELIFE), 4, and 5 (DOIs:
employee of an international NGO that raises funds from the Australian
10.6103/SHARE.w1.500, 10.6103/SHARE.w2.500, 10.6103/SHARE.w3.500,
Public, and holds a honorary position at CERA, which receives
10.6103/SHARE.w4.500, 10.6103/SHARE.w5.500), see Brsch-Supan et al
Operational Infrastructure Support from the Victorian Government.
(2013) for methodological details. The SHARE data collection has been
Bradford D Gessner reports grants from Crucell, GSK, Hilleman Labs,
primarily funded by the European Commission through FP5
Novartis, Pzer, Merck, and Sano Pasteur, outside the submitted work.
(QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE:
Ai Koyanagis work is supported by the Miguel Servet contract nanced
CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), and FP7
by the CP13/00150 and PI15/00862 projects, integrated into the National
(SHARE-PREP: N211909, SHARE-LEAP: N227822, SHARE M4:
R + D + I and funded by the ISCIII - General Branch Evaluation and
N261982). Additional funding from the German Ministry of Education
Promotion of Health Research - and the European Regional
and Research, the US National Institute on Aging (U01_AG09740-13S2,
Development Fund (ERDF-FEDER). Dorairaj Prabhakaran reports
P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169,
Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064) and from various national 14 Hausman DM. Health, well-being, and measuring the burden of
funding sources is gratefully acknowledged (see www.share-project.org). disease. Popul Health Metr 2012; 10: 13.
The data reported here have been supplied by the United States Renal 15 Nord E. Uncertainties about disability weights for the Global
Data System (USRDS). The interpretation and reporting of these data are Burden of Disease study. Lancet Glob Health 2015; 3: e66162.
the responsibility of the author(s) and in no way should be seen as an 16 GBD Mortality and Causes of Death Collaborators. Global,
ocial policy or interpretation of the US Government. The Palestinian regional, and national life expectancy, all-cause and cause-specic
Central Bureau of Statistics granted the researchers access to relevant data mortality for 249 causes of death, 19802015: a systematic analysis
in accordance with license no. SLN2014-3-170, after subjecting data to for the Global Burden of Disease Study 2015. Lancet
processing aiming to preserve the condentiality of individual data in 388: 1459544.
accordance with the General Statistics Law2000. The researchers are 17 Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and
solely responsible for the conclusions and inferences drawn upon Transparent Health Estimates Reporting: The GATHER statement.
Lancet 2016; published online June 28. http://dx.doi.org/10.1016/
available data. This study has been realised using the data collectved by
S0140-6736(16)30388-9.
the Swiss Household Panel (SHP), which is based at the Swiss Centre of
18 Kiyono P. An integrative metaregression framework for descriptive
Expertise in the Social Sciences FORS. The project is nanced by the
epidemiology, 1 edn. Seattle: University of Washington Press, 2015.
Swiss National Science Foundation. The following individuals would like
19 Clark DV, Kibuuka H, Millard M, et al. Long-term sequelae after
to acknowledge various forms of institutional support: Amanda G Thrift
Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort
is supported by a fellowship from the National Health and Medical study. Lancet Infect Dis 2015; 15: 90512.
Research Council (GNT1042600). Panniyammakal Jeemon is supported
20 Qureshi AI, Chughtai M, Loua TO, et al. Study of Ebola virus
by the Wellcome Trust-DBT India Alliance, Clinical and Public Health, disease survivors in Guinea. Clin Infect Dis 2015; 61: 103542.
Intermediate Fellowship (201520). Amador Goodridge would like to
21 Rowe AK, Bertolli J, Khan AS, et al. Clinical, virologic, and
acknowledge funding for me from Sistema Nacional de Investigadores de immunologic follow-up of convalescent Ebola hemorrhagic fever
Panam-SNI. Jos das Neves was supported in his contribution to this patients and their household contacts, Kikwit, Democratic Republic
work by a Fellowship from Fundao para a Cincia e a Tecnologia, of the Congo. J Infect Dis 1999; 179: S2835.
Portugal (SFRH/BPD/92934/2013). Boris Bikbov, Monica Cortinovis, 22 Bwaka MA, Bonnet M-J, Calain P, et al. Ebola Hemorrhagic Fever
Giuseppe Remuzzi, and Norberto Perico would like to acknowledge that in Kikwit, Democratic Republic of the Congo: clinical observations
their contribution to this paper has been on behalf of the International in 103 patients. J Infect Dis 1999; 179: S1S7.
Society of Nephrology (ISN) as a follow-up of the activities of the GBD 23 PRO-ACT. https://nctu.partners.org/ProACT/Data/Index?Length=0
2010 Genitourinary Diseases Expert Group. Lijing L Yan is supported by &LongLength=0&Rank=1&SyncRoot=System.Type%5B%5D&IsRea
the National Natural Sciences Foundation of China grants (71233001 and dOnly=False&IsFixedSize=True&IsSynchronized=False (accessed
71490732). Miriam Levi would like to acknowledge the institutional May 26, 2016).
support received from CeRIMP, Regional Centre for Occupational 24 Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability
Diseases and Injuries, Tuscany Region, Florence, Italy. No individuals (YLDs) for 1160 sequelae of 289 diseases and injuries
acknowledged received additional compensation for their eorts. 19902010: a systematic analysis for the Global Burden of Disease
Study 2010. Lancet 2012; 380: 216396.
References 25 Global, regional, and national age-sex specic all-cause
1 Atun R, de Jongh T, Secci F, Ohiri K, Adeyi O. Integration of and cause-specic mortality for 240 causes of death,
targeted health interventions into health systems: a conceptual 19902013: a systematic analysis for the Global Burden of Disease
framework for analysis. Health Policy Plan 2010; 25: 10411. Study 2013. Lancet 2015; 385: 11771.
2 Park J-H, Eum J-H, Bold B, Cheong H-K. Burden of disease due to 26 Murray CJL, Barber RM, Foreman KJ, et al. Global, regional, and
dementia in the elderly population of Korea: present and future. national disability-adjusted life years (DALYs) for 306 diseases and
BMC Public Health 2013; 13: 293. injuries and healthy life expectancy (HALE) for 188 countries,
3 George-Carey R, Adeloye D, Chan KY, et al. An estimate of the 19902013: quantifying the epidemiological transition. Lancet 2015;
prevalence of dementia in Africa: a systematic analysis. 386: 214591.
J Glob Health 2012; 2: 020401. 27 United Nations Development Programme. Human development report
4 Global Burden of Disease 2013 Collaborators. Global, regional, and 2015. http://hdr.undp.org/sites/default/les/2015_human_
national incidence, prevalence, and years lived with disability for development_report.pdf (accessed May 26, 2016).
301 acute and chronic diseases and injuries in 188 countries, 28 Goldman DP, Cutler D, Rowe JW, et al. Substantial health and
19902013: a systematic analysis for the Global Burden of Disease economic returns from delayed aging may warrant a mew focus for
Study 2013. Lancet 2015; 386: 743800. medical research. Health A (Millwood) 2013; 32: 1698705.
5 Prince MJ, Wu F, Guo Y, et al. The burden of disease in older people and 29 Dufouil C, Pereira E, Chne G, et al. Older age at retirement is
implications for health policy and practice. Lancet 2015; 385: 54962. associated with decreased risk of dementia. Eur J Epidemiol 2014;
6 Hallett TB, Zaba B, Stover J, et al. Embracing dierent approaches 29: 35361.
to estimating HIV incidence, prevalence and mortality. AIDS 2014; 30 Belbase A, Sanzenbacher G, Gillis CM. Does age-related decline in
28: S52332. ability correspond with retirement age? Rochester, NY: Social
7 Supervie V, Archibald CP, Costagliola D, et al. GBD 2013 and HIV Science Research Network, 2015 http://papers.ssrn.com/
incidence in high income countries. Lancet 2015; 385: 1177. abstract=2665830 (accessed June 24, 2016).
8 Cohen J, Vincent J-L, Adhikari NKJ, et al. Sepsis: a roadmap for 31 van Rijn RM, Robroek SJW, Brouwer S, Burdorf A. Inuence of
future research. Lancet Infect Dis 2015; 15: 581614. poor health on exit from paid employment: a systematic review.
9 Marshall JC. Understanding the global burden of pediatric sepsis. Occup Environ Med 2014; 71: 295301.
Am J Respir Crit Care Med 2015; 191: 109698. 32 Lahelma E, Pietilinen O, Rahkonen O, Lallukka T. Common
10 Anderson BO, Flanigan J. Novel methods for measuring global mental disorders and cause-specic disability retirement.
cancer burden: implications for global cancer control. Occup Environ Med 2015; 72: 18187.
JAMA Oncol 2015; 1: 42527. 33 Begg S, Vos T, Goss J, Mann N. An alternative approach to
11 Ton TGN, Mackenzie C, Molyneux DH. The burden of mental projecting health expenditure in Australia. Aust Health Rev 2008;
health in lymphatic lariasis. Infect Dis Poverty 2015; 4: 34. 32: 14855.
12 Wagner RG, Ibinda F, Tollman S, Lindholm L, Newton CR, 34 Desveaux L, Beauchamp M, Goldstein R, Brooks D. Community-based
Bertram MY. Diering methods and denitions inuence DALY exercise programs as a strategy to optimize function in chronic disease:
estimates: using population-based data to calculate the burden of a systematic review. Med Care 2014; 52: 21626.
convulsive epilepsy in rural South Africa. PLoS One 2015; 35 Jahanbin I, Hoseini Moghadam M, Nazarinia MA, Ghodsbin F,
10: e0145300. Bagheri Z, Ashraf AR. The eect of conditioning exercise
13 Alzheimers Disease International. World Alzheimer Report, 2015. on the health status and pain in patients with rheumatoid
https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf arthritis: a randomized controlled clinical trial.
(accessed May 26, 2016). Int J Community Based Nurs Midwifery 2014; 2: 16976.
36 Gay C, Chabaud A, Guilley E, Coudeyre E. Educating patients 54 Helsper CW, Hellinga HL, van Essen GA, et al. Real-life costs of
about the benets of physical activity and exercise for their hip and hepatitis C treatment. Neth J Med 2012; 70: 14553.
knee osteoarthritis. Systematic literature review. 55 Bhatt S, Weiss DJ, Cameron E, et al. The eect of malaria control
Ann Phys Rehabil Med 2016; 59: 17483. on Plasmodium falciparum in Africa between 2000 and 2015.
37 McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines Nature 2015; 526: 20711.
for the non-surgical management of knee osteoarthritis. 56 Cameron E, Battle KE, Bhatt S, et al. Dening the relationship
Osteoarthris Cartilage 2014; 22: 36388. between infection prevalence and clinical incidence of Plasmodium
38 Heimans L, Akdemir G, Boer KVCW, et al. Two-year results of falciparum malaria. Nat Commun 2015; 6: 8170.
disease activity score (DAS)-remission-steered treatment strategies 57 Bhatt S, Weiss DJ, Mappin B, et al. Coverage and system eciencies of
aiming at drug-free remission in early arthritis patients (the insecticide-treated nets in Africa from 2000 to 2017. eLife 2015; 4: e09672.
IMPROVED-study). Arthritis Res Ther 2016; 18: 23. 58 Aspiration to action. What will it take to end malaria? http://
39 Kleinman A, Estrin GL, Usmani S, et al. Time for mental health to endmalaria2040.org/assets/Aspiration-to-Action.pdf (accessed
come out of the shadows. Lancet 2016; 387: 227475. May 26, 2016).
40 Izutsu T, Tsutsumi A, Minas H, Thornicroft G, Patel V, Ito A. 59 WHO. World Malaria Report 2015. http://www.who.int/malaria/
Mental health and wellbeing in the Sustainable Development Goals. publications/world-malaria-report-2015/report/en/ (accessed
Lancet Psychiatry 2015; 2: 105254. Aug 5, 2016).
41 Patel V, Chisholm D, Parikh R, et al. Addressing the burden of 60 Globocan 2012. http://globocan.iarc.fr/Default.aspx (accessed
mental, neurological, and substance use disorders: key messages June 24, 2016).
from Disease Control Priorities, 3rd edn. Lancet 2016; 387: 167285. 61 Pizzarello L, Abiose A, Ffytche T, et al. VISION 2020: The Right to
42 Centers for Disease Control and Prevention. Drug-poisoning deaths Sight: a global initiative to eliminate avoidable blindness.
involving heroin: United States, 20002013. http://www.cdc.gov/ Arch Ophthalmol 1960 2004; 122: 61520.
nchs/products/databriefs/db190.htm (accessed June 24, 2016). 62 Baltussen R, Smith A. Cost eectiveness of strategies to combat
43 Centers for Disease Control and Prevention. Morbidity and vision and hearing loss in sub-Saharan Africa and South East Asia:
Mortality Weekly Report (MMWR). https://www.cdc.gov/mmwr/ mathematical modelling study. BMJ 2012; 344: e615.
preview/mmwrhtml/mm6401a10.htm (accessed June 24, 2016). 63 Currie J, Grenfell B, Farrar J. Beyond Ebola. Science 2016; 351: 81516.
44 Centers for Disease Control and Prevention. Opioid overdose 64 Baize S, Pannetier D, Oestereich L, et al. Emergence of Zaire Ebola
prevention programs providing naloxone to laypersonsUnited virus disease in Guinea. N Engl J Med 2014; 371: 141825.
States, 2014. http://origin.glb.cdc.gov/mmwr/preview/mmwrhtml/
65 Weaver SC. Arrival of Chikungunya virus in the new world:
mm6423a2.htm?s_cid=mm6423a2_w (accessed June 24, 2016).
prospects for spread and impact on public health.
45 Mathers BM, Degenhardt L, Ali H, et al. HIV prevention, treatment, PLoS Negl Trop Dis 2014; 8: e2921.
and care services for people who inject drugs: a systematic review of
66 Fauci AS, Morens DM. Zika Virus in the Americasyet another
global, regional, and national coverage. Lancet 2010; 375: 101428.
arbovirus threat. N Engl J Med 2016; 374: 60104.
46 GBD 2015 Risk Factors Collaborators. Global, regional, and national
67 Microcephaly in Infants, Pernambuco State, Brazil, 2015.
comparative risk assessment of 79 behavioural, environmental and
Emerg Infect Dis 2016; 22: 109093.
occupational, and metabolic risks or clusters of risks, 19902015:
a systematic analysis for the Global Burden of Disease Study 2015. 68 Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika Virus
Lancet 2016; 388: 1659724. and birth defectsreviewing the evidence for causality.
N Engl J Med 2016; 374: 198187.
47 Association AD. Economic costs of diabetes in the US in 2012.
Diabetes Care 2013; 36: 103346. 69 Jensen ET, Cook SF, Allen JK, et al. Enrollment factors and bias of
disease prevalence estimates in administrative claims data.
48 NCD Risk Factor Collaboration. Worldwide trends in diabetes since
Ann Epidemiol 2015; 25: 51925.
1980: a pooled analysis of 751 population-based studies with
44 million participants. Lancet 2016; 387: 151330. 70 Kottke TE, Baechler CJ, Parker ED. Accuracy of heart disease
prevalence estimated from claims data compared with an electronic
49 International Diabetes Federation. IDF diabetes atlas.
health record. Prev Chronic Dis 2012; 9: E141.
http://www.diabetesatlas.org/ (accessed June 25, 2016).
71 Salomon JA, Nordhagen S, Oza S, Murray CJL. Are Americans
50 Langa KM. Is the risk of Alzheimers disease and dementia
feeling less healthy? The puzzle of trends in self-rated health.
declining? Alzheimers Res Ther 2015; 7: 34.
Am J Epidemiol 2009; 170: 34351.
51 Matthews FE, Arthur A, Barnes LE, et al. A two-decade comparison
72 Salomon JA, Tandon A, Murray CJL. Comparability of self rated
of prevalence of dementia in individuals aged 65 years and older
health: cross sectional multi-country survey using anchoring
from three geographical areas of England: results of the Cognitive
vignettes. BMJ 2004; 328: 258.
Function and Ageing Study I and II. Lancet 2013; 382: 140512.
73 Meijer RR. Diagnosing item score patterns on a test using item
52 Rocca WA, Petersen RC, Knopman DS, et al. Trends in the
response theory-based person-t statistics. Psychol Methods 2003;
incidence and prevalence of Alzheimers disease, dementia, and
8: 7287.
cognitive impairment in the United States. Alzheimers Dement 2011;
7: 8093. 74 King G, Wand J. Comparing incomparable survey responses:
new tools for anchoring vignettes. Polit Anal 2007; 15: 4666.
53 Brookmeyer R, Evans DA, Hebert L, et al. National estimates of the
prevalence of Alzheimers disease in the United States.
Alzheimers Dement 2011; 7: 6173.