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Author Correction : Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 (Nature Medicine, (2020), 26, 5, (750-759), 10.1038/s41591-020-0807-6)
(2020-08-01) LBD Double Burden of Malnutrition Collaborators; Department of Psychology
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Estimating global injuries morbidity and mortality : Methods and data used in the Global Burden of Disease 2017 study
(2020) James, Spencer L.; Castle, Chris D.; Dingels, Zachary V.; Fox, Jack T.; Hamilton, Erin B.; Liu, Zichen; Roberts, Nicholas L.S.; Sylte, Dillon O.; Bertolacci, Gregory J.; Cunningham, Matthew; Henry, Nathaniel J.; Legrand, Kate E.; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abedi, Aidin; Abegaz, Kedir Hussein; Abosetugn, Akine Eshete; Abushouk, Abdelrahman I.; Adebayo, Oladimeji M.; Adsuar, Jose C.; Advani, Shailesh M.; Agudelo-Botero, Marcela; Ahmad, Tauseef; Ahmed, Muktar Beshir; Ahmed, Rushdia; Aichour, Miloud Taki Eddine; Alahdab, Fares; Alanezi, Fahad Mashhour; Alema, Niguse Meles; Alemu, Biresaw Wassihun; Alghnam, Suliman A.; Ali, Beriwan Abdulqadir; Ali, Saqib; Alinia, Cyrus; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi-Hashiani, Amir; Almasri, Nihad A.; Altirkawi, Khalid; Amer, Yasser Sami Abdeldayem; Andrei, Catalina Liliana; Ansari-Moghaddam, Alireza; Antonio, Carl Abelardo T.; Anvari, Davood; Appiah, Seth Christopher Yaw; Arabloo, Jalal; Arab-Zozani, Morteza; Arefi, Zohreh; Sigfusdottir, Inga Dora; Department of Psychology
Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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Electron Intensity Measurements by the Cluster/RAPID/IES Instrument in Earth's Radiation Belts and Ring Current
(2019-04) Smirnov, A. G.; Kronberg, E. A.; Latallerie, F.; Daly, P. W.; Aseev, N.; Shprits, Y. Y.; Kellerman, A.; Kasahara, S.; Turner, D.; Taylor, M. G.G.T.; Department of Engineering
The Cluster mission, launched in 2000, has produced a large database of electron flux intensity measurements in the Earth's magnetosphere by the Research with Adaptive Particle Imaging Detector (RAPID)/Imaging Electron Spectrometer (IES) instrument. However, due to background contamination of the data with high-energy electrons (>400 keV) and inner zone protons (230–630 keV) in the radiation belts and ring current, the data have been rarely used for inner-magnetospheric science. The current paper presents two algorithms for background correction. The first algorithm is based on the empirical contamination percentages by both protons and electrons. The second algorithm uses simultaneous proton observations. The efficiencies of these algorithms are demonstrated by comparison of the corrected Cluster/RAPID/IES data with Van Allen Probes/Magnetic Electron Ion Spectrometer measurements for 2012–2015. Both techniques improved the IES electron data in the radiation belts and ring current, as the yearly averaged flux intensities of the two missions show the ratio of measurements close to 1. We demonstrate a scientific application of the corrected IES electron data analyzing its evolution during solar cycle. Spin-averaged yearly mean IES electron intensities in the outer belt for energies 40–400 keV at L-shells between 4 and 6 showed high positive correlation with auroral electrojet index and solar wind dynamic pressure during 2001–2016. The relationship between solar wind dynamic pressure and IES electron measurements in the outer radiation belt was derived as a uniform linear-logarithmic equation.
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Global, regional, and national burden of suicide mortality 1990 to 2016 : Systematic analysis for the Global Burden of Disease Study 2016
(2019-01-01) Orpana, Heather M.; Marczak, Laurie B.; Arora, Megha; Abbasi, Nooshin; Abdulkader, Rizwan Suliankatchi; Abebe, Zegeye; Abraha, Haftom Niguse; Afarideh, Mohsen; Afshari, Mahdi; Ahmadi, Alireza; Aichour, Amani Nidhal; Aichour, Ibtihel; Aichour, Miloud Taki Eddine; Akseer, Nadia; Al‐raddadi, Rajaa M.; Alahdab, Fares; Alkerwi, Ala'a; Allebeck, Peter; Alvis‐guzman, Nelson; Anber, Nahla Hamed; Anjomshoa, Mina; Antonio, Carl Abelardo T.; Arora, Amit; Aryal, Krishna K.; Asgedom, Solomon Weldegebreal; Awasthi, Ashish; Quintanilla, Beatriz Paulina Ayala; Badali, Hamid; Barker‐collo, Suzanne Lyn; Bärnighausen, Till Winfried; Bazargan‐hejazi, Shahrzad; Benjet, Corina; Bensenor, Isabela M.; Berfeld, Noami; Beuran, Mircea; Bhutta, Zulfiqar A.; Biadgo, Belete; Bililign, Nigus; Borges, Guilherme; Borschmann, Rohan; Brazinova, Alexandra; Breitborde, Nicholas J.K.; Brugha, Traolach; Butt, Zahid A.; Carrero, Juan J.; Carvalho, Félix; Malta, Deborah Carvalho; Castañeda‐orjuela, Carlos A.; Catalá‐lópez, Ferrán; Sigfusdottir, Inga Dora; Department of Psychology
Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. Design Systematic analysis. Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education). Results The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%). Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates.
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories : a systematic analysis for the Global Burden of Disease Study 2017
(2018-11-10) GBD 2017 SDG Collaborators; Department of Psychology
Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. Funding: Bill & Melinda Gates Foundation.

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