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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

ABSTRACT:

SUBMITTER: GBD 2013 Risk Factors Collaborators

PROVIDER: S-EPMC4685753 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

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

Lancet (London, England) 20150911 10010

<h4>Background</h4>The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distr ...[more]

PMID: 26364544

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Project description:BackgroundThe lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.MethodsWe used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.ResultsThe estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation.ConclusionsIn 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).

Project description:BackgroundUp-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.MethodsEstimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.FindingsDisease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.InterpretationAgeing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.FundingBill & Melinda Gates Foundation.

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Project description:BackgroundRemarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.MethodsWe generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.FindingsWe estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.InterpretationOnly 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.FundingBill & Melinda Gates Foundation, US Agency for International Development.

Dataset Information

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

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