Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 79
Filter
1.
Lancet ; 398(10312): 1700-1712, 2021 11 06.
Article in English | MEDLINE | ID: covidwho-1815302

ABSTRACT

BACKGROUND: Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020. METHODS: We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders. FINDINGS: We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (-0·007 [-0·009 to -0·006; p=0·0001] for major depressive disorder, -0·003 [-0·005 to -0·002; p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020. INTERPRETATION: This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option. FUNDING: Queensland Health, National Health and Medical Research Council, and the Bill and Melinda Gates Foundation.


Subject(s)
Anxiety Disorders/epidemiology , COVID-19/epidemiology , Depression/epidemiology , Global Burden of Disease , Global Health , Humans , Pandemics , Prevalence , SARS-CoV-2 , Surveys and Questionnaires
2.
Lancet ; 398(10301): 685-697, 2021 08 21.
Article in English | MEDLINE | ID: covidwho-1815297

ABSTRACT

BACKGROUND: Associations between high and low temperatures and increases in mortality and morbidity have been previously reported, yet no comprehensive assessment of disease burden has been done. Therefore, we aimed to estimate the global and regional burden due to non-optimal temperature exposure. METHODS: In part 1 of this study, we linked deaths to daily temperature estimates from the ERA5 reanalysis dataset. We modelled the cause-specific relative risks for 176 individual causes of death along daily temperature and 23 mean temperature zones using a two-dimensional spline within a Bayesian meta-regression framework. We then calculated the cause-specific and total temperature-attributable burden for the countries for which daily mortality data were available. In part 2, we applied cause-specific relative risks from part 1 to all locations globally. We combined exposure-response curves with daily gridded temperature and calculated the cause-specific burden based on the underlying burden of disease from the Global Burden of Diseases, Injuries, and Risk Factors Study, for the years 1990-2019. Uncertainty from all components of the modelling chain, including risks, temperature exposure, and theoretical minimum risk exposure levels, defined as the temperature of minimum mortality across all included causes, was propagated using posterior simulation of 1000 draws. FINDINGS: We included 64·9 million individual International Classification of Diseases-coded deaths from nine different countries, occurring between Jan 1, 1980, and Dec 31, 2016. 17 causes of death met the inclusion criteria. Ischaemic heart disease, stroke, cardiomyopathy and myocarditis, hypertensive heart disease, diabetes, chronic kidney disease, lower respiratory infection, and chronic obstructive pulmonary disease showed J-shaped relationships with daily temperature, whereas the risk of external causes (eg, homicide, suicide, drowning, and related to disasters, mechanical, transport, and other unintentional injuries) increased monotonically with temperature. The theoretical minimum risk exposure levels varied by location and year as a function of the underlying cause of death composition. Estimates for non-optimal temperature ranged from 7·98 deaths (95% uncertainty interval 7·10-8·85) per 100 000 and a population attributable fraction (PAF) of 1·2% (1·1-1·4) in Brazil to 35·1 deaths (29·9-40·3) per 100 000 and a PAF of 4·7% (4·3-5·1) in China. In 2019, the average cold-attributable mortality exceeded heat-attributable mortality in all countries for which data were available. Cold effects were most pronounced in China with PAFs of 4·3% (3·9-4·7) and attributable rates of 32·0 deaths (27·2-36·8) per 100 000 and in New Zealand with 3·4% (2·9-3·9) and 26·4 deaths (22·1-30·2). Heat effects were most pronounced in China with PAFs of 0·4% (0·3-0·6) and attributable rates of 3·25 deaths (2·39-4·24) per 100 000 and in Brazil with 0·4% (0·3-0·5) and 2·71 deaths (2·15-3·37). When applying our framework to all countries globally, we estimated that 1·69 million (1·52-1·83) deaths were attributable to non-optimal temperature globally in 2019. The highest heat-attributable burdens were observed in south and southeast Asia, sub-Saharan Africa, and North Africa and the Middle East, and the highest cold-attributable burdens in eastern and central Europe, and central Asia. INTERPRETATION: Acute heat and cold exposure can increase or decrease the risk of mortality for a diverse set of causes of death. Although in most regions cold effects dominate, locations with high prevailing temperatures can exhibit substantial heat effects far exceeding cold-attributable burden. Particularly, a high burden of external causes of death contributed to strong heat impacts, but cardiorespiratory diseases and metabolic diseases could also be substantial contributors. Changes in both exposures and the composition of causes of death drove changes in risk over time. Steady increases in exposure to the risk of high temperature are of increasing concern for health. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
Cause of Death/trends , Cold Temperature/adverse effects , Global Burden of Disease/statistics & numerical data , Global Health/statistics & numerical data , Hot Temperature/adverse effects , Mortality/trends , Bayes Theorem , Heart Diseases/epidemiology , Humans , Metabolic Diseases/epidemiology
3.
Sci Rep ; 12(1): 5980, 2022 Apr 08.
Article in English | MEDLINE | ID: covidwho-1788316

ABSTRACT

The burdens and trends of gastric cancer are poorly understood, especially in high-prevalence countries. Based on the Global Burden of Disease Study 2019, we analyzed the incidence, death, and possible risk factors of gastric cancer in five Asian countries, in relation to year, age, sex, and sociodemographic index. The annual percentage change was calculated to estimate the trends in age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR). The highest ASIR per 100,000 person-years in 2019 was in Mongolia [44 (95% uncertainty interval (UI), 34 to 55)], while the lowest was in the Democratic People's Republic of Korea (DPRK) [23 (95% UI, 19 to 29)]. The highest ASDR per 100,000 person-years was in Mongolia [46 (95% UI, 37 to 57)], while the lowest was in Japan [14 (95% UI, 12 to 15)]. Despite the increase in the absolute number of cases and deaths from 1990 to 2019, the ASIRs and ASDRs in all five countries decreased with time and improved sociodemographic index but increased with age. Smoking and a high-sodium diet were two possible risk factors for gastric cancer. In 2019, the proportion of age-standardized disability-adjusted life-years attributable to smoking was highest in Japan [23% (95% UI, 19 to 28%)], and the proportions attributable to a high-sodium diet were highest in China [8.8% (95% UI, 0.21 to 33%)], DPRK, and the Republic of Korea. There are substantial variations in the incidence and death of gastric cancer in the five studied Asian countries. This study may be crucial in helping policymakers to make better decisions and allocate appropriate resources.


Subject(s)
Stomach Neoplasms , Global Burden of Disease , Global Health , Humans , Incidence , Quality-Adjusted Life Years , Risk Factors , Sodium , Stomach Neoplasms/epidemiology
4.
PLoS One ; 17(4): e0266495, 2022.
Article in English | MEDLINE | ID: covidwho-1785197

ABSTRACT

BACKGROUND: Vitamin A Supplementation (VAS) is a cost-effective intervention to decrease mortality associated with measles and diarrheal diseases among children aged 6-59 months in low-income countries. Recently, experts have suggested that other interventions like large-scale food fortification and increasing the coverage of measles vaccination might provide greater impact than VAS. In this study, we conducted a cost-effectiveness analysis of a VAS scale-up in three sub-Saharan African countries. METHODS: We developed an individual-based microsimulation using the Vivarium simulation framework to estimate the cost and effect of scaling up VAS from 2019 to 2023 in Nigeria, Kenya, and Burkina Faso, three countries with different levels of baseline coverage. We calibrated the model with disease and risk factor estimates from the Global Burden of Disease 2019 (GBD 2019). We obtained baseline coverage, intervention effects, and costs from a systematic review. After the model was validated against GBD inputs, we modeled an alternative scenario where we scaled-up VAS coverage from 2019 to a level that halved the exposure to lack of VAS in 2023. Based on the simulation outputs for DALYs averted and intervention cost, we determined estimates for the incremental cost-effectiveness ratio (ICER) in USD/DALY. FINDINGS: Our estimates for ICER are as follows: $860/DALY [95% UI; 320, 3530] in Nigeria, $550/DALY [240, 2230] in Kenya, and $220/DALY [80, 2470] in Burkina Faso. Examining the data for DALYs averted for the three countries over the time span, we found that the scale-up led to 21 [5, 56] DALYs averted per 100,000 person-years in Nigeria, 21 [5, 47] DALYs averted per 100,000 person-years in Kenya, and 14 [0, 37] DALYs averted per 100,000 person-years in Burkina Faso. CONCLUSIONS: VAS may no longer be as cost-effective in low-income regions as it has been previously. Updated estimates in GBD 2019 for the effect of Vitamin A Deficiency on causes of death are an additional driver of this lower estimate of cost-effectiveness.


Subject(s)
Global Burden of Disease , Measles , Child , Cost-Benefit Analysis , Dietary Supplements , Humans , Kenya , Vitamin A/therapeutic use
5.
Front Public Health ; 9: 740800, 2021.
Article in English | MEDLINE | ID: covidwho-1775894

ABSTRACT

Background: Exposure to ambient particulate matter pollution (APMP) is a global health issue that directly affects the human respiratory system. Thus, we estimated the spatiotemporal trends in the burden of APMP-related respiratory diseases from 1990 to 2019. Methods: Based on the Global Burden of Disease Study 2019, data on the burden of APMP-related respiratory diseases were analyzed by age, sex, cause, and location. Joinpoint regression analysis was used to analyze the temporal trends in the burden of different respiratory diseases over the 30 years. Results: Globally, in 2019, APMP contributed the most to chronic obstructive pulmonary disease (COPD), with 695.1 thousand deaths and 15.4 million disability-adjusted life years (DALYs); however, the corresponding age-standardized death and DALY rates declined from 1990 to 2019. Similarly, although age-standardized death and DALY rates since 1990 decreased by 24% and 40%, respectively, lower respiratory infections (LRIs) still had the second highest number of deaths and DALYs attributable to APMP. This was followed by tracheal, bronchus, and lung (TBL) cancer, which showed increased age-standardized death and DALY rates during the past 30 years and reached 3.78 deaths per 100,000 persons and 84.22 DALYs per 100,000 persons in 2019. Among children aged < 5 years, LRIs had a huge burden attributable to APMP, whereas for older people, COPD was the leading cause of death and DALYs attributable to APMP. The APMP-related burdens of LRIs and COPD were relatively higher among countries with low and low-middle socio-demographic index (SDI), while countries with high-middle SDI showed the highest burden of TBL cancer attributable to APMP. Conclusions: APMP contributed substantially to the global burden of respiratory diseases, posing a significant threat to human health. Effective actions aimed at air pollution can potentially avoid an increase in the PM2.5-associated disease burden, especially in highly polluted areas.


Subject(s)
Air Pollution , Respiratory Tract Diseases , Adult , Aged , Air Pollution/adverse effects , Child , Child, Preschool , Global Burden of Disease , Humans , Particulate Matter/adverse effects , Quality-Adjusted Life Years , Respiratory Tract Diseases/epidemiology
6.
Misganaw, Awoke, Naghavi, Mohsen, Walker, Ally, Mirkuzie, Alemnesh H.; Giref, Ababi Zergaw, Berheto, Tezera Moshago, Waktola, Ebba Abate, Kempen, John H.; Eticha, Getachew Tollera, Wolde, Tsigereda Kifle, Deguma, Dereje, Abate, Kalkidan Hassen, Abegaz, Kedir Hussein, Ahmed, Muktar Beshir, Akalu, Yonas, Aklilu, Addis, Alemu, Biresaw Wassihun, Asemahagn, Mulusew A.; Awedew, Atalel Fentahun, Balakrishnan, Senthilkumar, Bekuma, Tariku Tesfaye, Beyene, Addisu Shunu, Beyene, Misrak Getnet, Bezabih, Yihienew Mequanint, Birhanu, Biruk Tesfaye, Chichiabellu, Tesfaye Yitna, Dachew, Berihun Assefa, Dagnew, Amare Belachew, Demeke, Feleke Mekonnen, Demissie, Getu Debalkie, Derbew Molla, Meseret, Dereje, Nebiyu, Deribe, Kebede, Desta, Abebaw Alemayehu, Eshetu, Munir Kassa, Ferede, Tomas Y.; Gebreyohannes, Eyob Alemayehu, Geremew, Abraham, Gesesew, Hailay Abrha, Getacher, Lemma, Glenn, Scott D.; Hafebo, Aregash Samuel, Hashi, Abdiwahab, Hassen, Hamid Yimam, Hay, Simon I.; Hordofa, Diriba Fufa, Huluko, Dawit Hoyiso, Kasa, Ayele Semachew, Kassahun Azene, Getinet, Kebede, Ermiyas Mulu, Kebede, Hafte Kahsay, Kelkay, Bayew, Kidane, Samuel Z.; Legesse, Samson Mideksa, Manamo, Wondimu Ayele, Melaku, Yohannes Adama A.; Mengesha, Endalkachew Worku, Mengesha, Sisay Derso, Merie, Hayimro Edemealem, Mersha, Abera M.; Mersha, Amanual Getnet, Mirutse, Mizan Kiros, Mohammed, Ammas Siraj, Mohammed, Hussen, Mohammed, Salahuddin, Netsere, Henok Biresaw, Nigatu, Dabere, Obsa, Mohammed Suleiman, Odo, Daniel Bogale, Omer, Muktar, Regassa, Lemma Demissie, Sahiledengle, Biniyam, Shaka, Mohammed Feyisso, Shiferaw, Wondimeneh Shibabaw, Sidemo, Negussie Boti, Sinke, Abiy H.; Sintayehu, Yitagesu, Sorrie, Muluken Bekele, Tadesse, Birkneh Tilahun, Tadesse, Eyayou Girma, Tamir, Zemenu, Tamiru, Animut Tagele, Tareke, Amare Abera, Tefera, Yonas Getaye, Tekalegn, Yohannes, Tesema, Ayenew Kassie, Tesema, Tefera Tadele, Tesfay, Fisaha Haile, Tessema, Zemenu Tadesse, Tilahun, Tadesse, Tsegaye, Gebiyaw Wudie, Tusa, Biruk Shalmeno, Weledesemayat, Geremew Tassew, Yazie, Taklo Simeneh, Yeshitila, Yordanos Gizachew, Yirdaw, Birhanu Wubale, Zegeye, Desalegn Tegabu, Murray, Christopher J. L.; Gebremedhin, Lia Tadesse.
Lancet ; 399(10332): 1322-1335, 2022 Apr 02.
Article in English | MEDLINE | ID: covidwho-1768603

ABSTRACT

BACKGROUND: Previous Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) studies have reported national health estimates for Ethiopia. Substantial regional variations in socioeconomic status, population, demography, and access to health care within Ethiopia require comparable estimates at the subnational level. The GBD 2019 Ethiopia subnational analysis aimed to measure the progress and disparities in health across nine regions and two chartered cities. METHODS: We gathered 1057 distinct data sources for Ethiopia and all regions and cities that included census, demographic surveillance, household surveys, disease registry, health service use, disease notifications, and other data for this analysis. Using all available data sources, we estimated the Socio-demographic Index (SDI), total fertility rate (TFR), life expectancy, years of life lost, years lived with disability, disability-adjusted life-years, and risk-factor-attributable health loss with 95% uncertainty intervals (UIs) for Ethiopia's nine regions and two chartered cities from 1990 to 2019. Spatiotemporal Gaussian process regression, cause of death ensemble model, Bayesian meta-regression tool, DisMod-MR 2.1, and other models were used to generate fertility, mortality, cause of death, and disability rates. The risk factor attribution estimations followed the general framework established for comparative risk assessment. FINDINGS: The SDI steadily improved in all regions and cities from 1990 to 2019, yet the disparity between the highest and lowest SDI increased by 54% during that period. The TFR declined from 6·91 (95% UI 6·59-7·20) in 1990 to 4·43 (4·01-4·92) in 2019, but the magnitude of decline also varied substantially among regions and cities. In 2019, TFR ranged from 6·41 (5·96-6·86) in Somali to 1·50 (1·26-1·80) in Addis Ababa. Life expectancy improved in Ethiopia by 21·93 years (21·79-22·07), from 46·91 years (45·71-48·11) in 1990 to 68·84 years (67·51-70·18) in 2019. Addis Ababa had the highest life expectancy at 70·86 years (68·91-72·65) in 2019; Afar and Benishangul-Gumuz had the lowest at 63·74 years (61·53-66·01) for Afar and 64.28 (61.99-66.63) for Benishangul-Gumuz. The overall increases in life expectancy were driven by declines in under-5 mortality and mortality from common infectious diseases, nutritional deficiency, and war and conflict. In 2019, the age-standardised all-cause death rate was the highest in Afar at 1353·38 per 100 000 population (1195·69-1526·19). The leading causes of premature mortality for all sexes in Ethiopia in 2019 were neonatal disorders, diarrhoeal diseases, lower respiratory infections, tuberculosis, stroke, HIV/AIDS, ischaemic heart disease, cirrhosis, congenital defects, and diabetes. With high SDIs and life expectancy for all sexes, Addis Ababa, Dire Dawa, and Harari had low rates of premature mortality from the five leading causes, whereas regions with low SDIs and life expectancy for all sexes (Afar and Somali) had high rates of premature mortality from the leading causes. In 2019, child and maternal malnutrition; unsafe water, sanitation, and handwashing; air pollution; high systolic blood pressure; alcohol use; and high fasting plasma glucose were the leading risk factors for health loss across regions and cities. INTERPRETATION: There were substantial improvements in health over the past three decades across regions and chartered cities in Ethiopia. However, the progress, measured in SDI, life expectancy, TFR, premature mortality, disability, and risk factors, was not uniform. Federal and regional health policy makers should match strategies, resources, and interventions to disease burden and risk factors across regions and cities to achieve national and regional plans, Sustainable Development Goals, and universal health coverage targets. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
Global Burden of Disease , Global Health , Life Expectancy , Adult , Aged , Bayes Theorem , Cause of Death , Child , Ethiopia/epidemiology , Humans , Infant, Newborn , Quality-Adjusted Life Years , Risk Factors
7.
Turk J Med Sci ; 51(SI-1): 3182-3193, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1726153

ABSTRACT

Background/aim: The Covid-19 pandemic is one of those rare events that affects everyone on earth and changes our lives. The pandemic, which has killed over four million people worldwide, is putting unprecedented pressure on governments to maintain essential health and social services, as well as keep their economies running, even as the virus threatens people's daily life on every level. Thus, the purpose of this study is to discuss the short-term economic impact of the pandemic by assessing its costs using official economic data for both the world and Turkey. Furthermore, this research highlights possible economic, social, and political pathways for a postpandemic new world. Materials and methods: This study is a review article that overviews and tracks the economic development of the Covid-19 pandemic from the start, synthesizes and compares current data of reliable institutions, and provides an overall assessment. Results: The pandemic has certainly caused short-term and long-term damage to economies and living standards for many people. Although there are estimates on what this damage is, the exact degree of the damage is still unknown. However, it seems that the recovery will be gradual, long-lasting, and unpredictable due to the unprecedented uncertainty characteristic of the pandemic. Conclusion: Early economic growth projections show that there will be no ordinary recovery for the world economy since short-term countries' recovery paths are different. It is likely to remain uneven and depend on the effectiveness of the vaccination process, fiscal policy support, public health management, and hard-hit sectors' growth size in economies. Due to the uncertainty and lack of confidence, governments should ensure an equal and sustainable economic recovery from the Covid-19 pandemic by conducting flexible monetary and fiscal policies. However, without structural reforms, economies can not boost either in the short-term and long-term.


Subject(s)
COVID-19/economics , Commerce , Global Burden of Disease , Pandemics/economics , Humans , Pandemics/prevention & control , SARS-CoV-2 , Turkey/epidemiology
8.
Lancet Glob Health ; 9(10): e1372-e1379, 2021 10.
Article in English | MEDLINE | ID: covidwho-1701046

ABSTRACT

BACKGROUND: The tuberculosis targets for the UN Sustainable Development Goals (SDGs) call for a 90% reduction in tuberculosis deaths by 2030, compared with 2015, but meeting this target now seems highly improbable. To assess the economic impact of not meeting the target until 2045, we estimated full-income losses in 120 countries, including those due to excess deaths resulting from COVID-19-related disruptions to tuberculosis services, for the period 2020-50. METHODS: Annual mortality risk changes at each age in each year from 2020 to 2050 were estimated for 120 countries. This risk change was then converted to full-income risk by calculating a population-level mortality risk change and multiplying it by the value of a statistical life-year in each country and year. As a comparator, we assumed that current rates of tuberculosis continue to decline through the period of analysis. We calculated the full-income losses, and mean life expectancy losses per person, at birth and at age 35 years, under scenarios in which the SDG targets are met in 2030 and in 2045. We defined the cost of inaction as the difference in full-income losses and tuberculosis mortality between these two scenarios. FINDINGS: From 2020 to 2050, based on the current annual decrease in tuberculosis deaths of 2%, 31·8 million tuberculosis deaths (95% uncertainty interval 25·2 million-39·5 million) are estimated to occur, corresponding to an economic loss of US$17·5 trillion (14·9 trillion-20·4 trillion). If the SDG tuberculosis mortality target is met in 2030, 23·8 million tuberculosis deaths (18·9 million-29·5 million) and $13·1 trillion (11·2 trillion-15·3 trillion) in economic losses can be avoided. If the target is met in 2045, 18·1 million tuberculosis deaths (14·3 million-22·4 million) and $10·2 trillion (8·7 trillion-11·8 trillion) can be avoided. The cost of inaction of not meeting the SDG tuberculosis mortality target until 2045 (vs 2030) is, therefore, 5·7 million tuberculosis deaths (5·1 million-8·1 million) and $3·0 trillion (2·5 trillion-3·5 trillion) in economic losses. COVID-19-related disruptions add $290·3 billion (260·2 billion-570·1 billion) to this cost. INTERPRETATION: Failure to achieve the SDG tuberculosis mortality target by 2030 will lead to profound economic and health losses. The effects of delay will be greatest in sub-Saharan Africa. Affected countries, donor nations, and the private sector should redouble efforts to finance tuberculosis programmes and research because the economic dividend of such strategies is likely to be substantial. FUNDING: None.


Subject(s)
Life Expectancy , Tuberculosis/economics , Tuberculosis/mortality , COVID-19 , Global Burden of Disease/economics , HIV Infections/complications , Humans , Sustainable Development , Tuberculosis/prevention & control
9.
Murray, Christopher J. L.; Ikuta, Kevin Shunji, Sharara, Fablina, Swetschinski, Lucien, Robles Aguilar, Gisela, Gray, Authia, Han, Chieh, Bisignano, Catherine, Rao, Puja, Wool, Eve, Johnson, Sarah C.; Browne, Annie J.; Chipeta, Michael Give, Fell, Frederick, Hackett, Sean, Haines-Woodhouse, Georgina, Kashef Hamadani, Bahar H.; Kumaran, Emmanuelle A. P.; McManigal, Barney, Agarwal, Ramesh, Akech, Samuel, Albertson, Samuel, Amuasi, John, Andrews, Jason, Aravkin, Aleskandr, Ashley, Elizabeth, Bailey, Freddie, Baker, Stephen, Basnyat, Buddha, Bekker, Adrie, Bender, Rose, Bethou, Adhisivam, Bielicki, Julia, Boonkasidecha, Suppawat, Bukosia, James, Carvalheiro, Cristina, Castañeda-Orjuela, Carlos, Chansamouth, Vilada, Chaurasia, Suman, Chiurchiù, Sara, Chowdhury, Fazle, Cook, Aislinn J.; Cooper, Ben, Cressey, Tim R.; Criollo-Mora, Elia, Cunningham, Matthew, Darboe, Saffiatou, Day, Nicholas P. J.; De Luca, Maia, Dokova, Klara, Dramowski, Angela, Dunachie, Susanna J.; Eckmanns, Tim, Eibach, Daniel, Emami, Amir, Feasey, Nicholas, Fisher-Pearson, Natasha, Forrest, Karen, Garrett, Denise, Gastmeier, Petra, Giref, Ababi Zergaw, Greer, Rachel Claire, Gupta, Vikas, Haller, Sebastian, Haselbeck, Andrea, Hay, Simon I.; Holm, Marianne, Hopkins, Susan, Iregbu, Kenneth C.; Jacobs, Jan, Jarovsky, Daniel, Javanmardi, Fatemeh, Khorana, Meera, Kissoon, Niranjan, Kobeissi, Elsa, Kostyanev, Tomislav, Krapp, Fiorella, Krumkamp, Ralf, Kumar, Ajay, Kyu, Hmwe Hmwe, Lim, Cherry, Limmathurotsakul, Direk, Loftus, Michael James, Lunn, Miles, Ma, Jianing, Mturi, Neema, Munera-Huertas, Tatiana, Musicha, Patrick, Mussi-Pinhata, Marisa Marcia, Nakamura, Tomoka, Nanavati, Ruchi, Nangia, Sushma, Newton, Paul, Ngoun, Chanpheaktra, Novotney, Amanda, Nwakanma, Davis, Obiero, Christina W.; Olivas-Martinez, Antonio, Olliaro, Piero, Ooko, Ednah, Ortiz-Brizuela, Edgar, Peleg, Anton Yariv, Perrone, Carlo, Plakkal, Nishad, Ponce-de-Leon, Alfredo, Raad, Mathieu, Ramdin, Tanusha, Riddell, Amy, Roberts, Tamalee, Robotham, Julie Victoria, Roca, Anna, Rudd, Kristina E.; Russell, Neal, Schnall, Jesse, Scott, John Anthony Gerard, Shivamallappa, Madhusudhan, Sifuentes-Osornio, Jose, Steenkeste, Nicolas, Stewardson, Andrew James, Stoeva, Temenuga, Tasak, Nidanuch, Thaiprakong, Areerat, Thwaites, Guy, Turner, Claudia, Turner, Paul, van Doorn, H. Rogier, Velaphi, Sithembiso, Vongpradith, Avina, Vu, Huong, Walsh, Timothy, Waner, Seymour, Wangrangsimakul, Tri, Wozniak, Teresa, Zheng, Peng, Sartorius, Benn, Lopez, Alan D.; Stergachis, Andy, Moore, Catrin, Dolecek, Christiane, Naghavi, Mohsen.
Lancet ; 399(10325): 629-655, 2022 02 12.
Article in English | MEDLINE | ID: covidwho-1624565

ABSTRACT

BACKGROUND: Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen-drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date. METHODS: We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. We obtained data from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. We present final estimates aggregated to the global and regional level. FINDINGS: On the basis of our predictive statistical models, there were an estimated 4·95 million (3·62-6·57) deaths associated with bacterial AMR in 2019, including 1·27 million (95% UI 0·911-1·71) deaths attributable to bacterial AMR. At the regional level, we estimated the all-age death rate attributable to resistance to be highest in western sub-Saharan Africa, at 27·3 deaths per 100 000 (20·9-35·3), and lowest in Australasia, at 6·5 deaths (4·3-9·4) per 100 000. Lower respiratory infections accounted for more than 1·5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome. The six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000-1 270 000) deaths attributable to AMR and 3·57 million (2·62-4·78) deaths associated with AMR in 2019. One pathogen-drug combination, meticillin-resistant S aureus, caused more than 100 000 deaths attributable to AMR in 2019, while six more each caused 50 000-100 000 deaths: multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem-resistant A baumannii, fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae, and third-generation cephalosporin-resistant K pneumoniae. INTERPRETATION: To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the leading pathogen-drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this important human health threat. FUNDING: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.


Subject(s)
Anti-Bacterial Agents/pharmacology , Bacterial Infections/epidemiology , Drug Resistance, Bacterial , Global Burden of Disease , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Bacterial Infections/microbiology , Global Health , Humans , Models, Statistical
10.
JAMA Oncol ; 8(3): 420-444, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1664325

ABSTRACT

Importance: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. Objective: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. Evidence Review: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). Findings: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. Conclusions and Relevance: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.


Subject(s)
Global Burden of Disease , Neoplasms , Disability-Adjusted Life Years , Global Health , Humans , Incidence , Neoplasms/epidemiology , Prevalence , Quality-Adjusted Life Years , Risk Factors
11.
Lancet ; 398(10312): 1700-1712, 2021 11 06.
Article in English | MEDLINE | ID: covidwho-1590727

ABSTRACT

BACKGROUND: Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative. In this study, we aimed to quantify the impact of the COVID-19 pandemic on the prevalence and burden of major depressive disorder and anxiety disorders globally in 2020. METHODS: We conducted a systematic review of data reporting the prevalence of major depressive disorder and anxiety disorders during the COVID-19 pandemic and published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google Scholar, preprint servers, grey literature sources, and consulted experts. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population during the COVID-19 pandemic and had a pre-pandemic baseline. We used the assembled data in a meta-regression to estimate change in the prevalence of major depressive disorder and anxiety disorders between pre-pandemic and mid-pandemic (using periods as defined by each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 infection rate, and daily excess mortality rate). We then used this model to estimate the change from pre-pandemic prevalence (estimated using Disease Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and location. We used final prevalence estimates and disability weights to estimate years lived with disability and disability-adjusted life-years (DALYs) for major depressive disorder and anxiety disorders. FINDINGS: We identified 5683 unique data sources, of which 48 met inclusion criteria (46 studies met criteria for major depressive disorder and 27 for anxiety disorders). Two COVID-19 impact indicators, specifically daily SARS-CoV-2 infection rates and reductions in human mobility, were associated with increased prevalence of major depressive disorder (regression coefficient [B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 [7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders (0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and younger age groups were more affected than older age groups (-0·007 [-0·009 to -0·006; p=0·0001] for major depressive disorder, -0·003 [-0·005 to -0·002; p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by the pandemic in 2020, as measured with decreased human mobility and daily SARS-CoV-2 infection rate, had the greatest increases in prevalence of major depressive disorder and anxiety disorders. We estimated an additional 53·2 million (44·8 to 62·9) cases of major depressive disorder globally (an increase of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020. INTERPRETATION: This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option. FUNDING: Queensland Health, National Health and Medical Research Council, and the Bill and Melinda Gates Foundation.


Subject(s)
Anxiety Disorders/epidemiology , COVID-19/epidemiology , Depression/epidemiology , Global Burden of Disease , Global Health , Humans , Pandemics , Prevalence , SARS-CoV-2 , Surveys and Questionnaires
12.
Lancet ; 398(10311): 1593-1618, 2021 10 30.
Article in English | MEDLINE | ID: covidwho-1590726

ABSTRACT

BACKGROUND: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS: We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). FINDINGS: In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39-1·59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1-4 years (2·4%), and around a third less than in females aged 1-4 years (2·5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. INTERPRETATION: Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
Cause of Death/trends , Global Burden of Disease , Mortality/trends , Adolescent , Age Distribution , Child , Female , Humans , Male , Sex Distribution , Socioeconomic Factors , Young Adult
13.
Environ Res ; 204(Pt A): 112023, 2022 03.
Article in English | MEDLINE | ID: covidwho-1545000

ABSTRACT

INTRODUCTION: Understanding the latest global spatio-temporal pattern of lung cancer burden attributable to ambient fine particulate matter pollution (PM2.5) is crucial to prioritize global lung cancer prevention, as well as environment improvement. METHODS: Data on lung cancer attributable to ambient PM2.5 were downloaded from the Global Burden of Disease Study (GBD) 2019. The numbers and age-standardized rates on lung cancer mortality (ASMR) and disability-adjusted life years (ASDR) were estimated by age, sex, region, and country. We used estimated annual percentage change (EAPC) to quantify the temporal trends of ASMR and ASDR from 1990 to 2019. RESULTS: In 2019, the number of global lung cancer deaths and DALYs attributable to ambient PM2.5 was approximately 0.31 million and 7.02 million respectively, among which more deaths and DALYs occurred in males. At GBD region level, the heaviest burden occurred in East Asia, accounting for over 50% worldwide, with China ranked first worldwide. The number of ambient PM2.5 attributable lung cancer deaths and DALYs has over doubled from 1990 to 2019, but high sociodemographic index (SDI) region had a rapid decrease, with EAPC -2.21 in ASMR (95% CI: -2.32, -2.09). The age-specific mortality rate or DALY rate has increased in all age groups in low to middle SDI regions from 1990 to 2019. The ASMR or ASDR showed an inverted V-shaped association with SDI. The EAPC in ASMR or ASDR was highly negatively correlated with ASMR or ASDR in 1990 and SDI in 2019, with coefficients around 0.70. CONCLUSIONS: The number of ambient PM2.5-related lung cancer deaths and DALYs has largely increased because of the increase of exposure to PM2.5, population growth, and aging. Local governments should do economic activities under the consideration of public health, especially in high-burden areas.


Subject(s)
Lung Neoplasms , Particulate Matter , Disability-Adjusted Life Years , Global Burden of Disease , Global Health , Humans , Lung Neoplasms/epidemiology , Male , Particulate Matter/toxicity , Quality-Adjusted Life Years
14.
Epidemiol Prev ; 45(5): 411-415, 2021.
Article in Italian | MEDLINE | ID: covidwho-1543062

ABSTRACT

Childhood and adolescence are vulnerable and crucial phases for determining health in adulthood. Despite the enormous progress achieved in child and adolescent's health and well-being globally, the disability burden has remained almost unchanged. In 2019, in Italy and globally, low back pain, headache disorders, depression, and anxiety were among the first causes of disability. Through the analysis of the estimates of the Global Burden of Disease Study 2019, we propose a reflection on the state of health of the Italian paediatric and adolescent population in terms of disability, suggesting recommendations on preventive actions, and public health interventions. The aim is the improvement of their health, considering how the current COVID-19 pandemic is impacting on their quality of life.


Subject(s)
COVID-19 , Global Burden of Disease , Adolescent , Adult , Child , Global Health , Humans , Italy/epidemiology , Pandemics , Prevalence , Quality of Life , SARS-CoV-2
15.
BMJ Glob Health ; 6(11)2021 11.
Article in English | MEDLINE | ID: covidwho-1537945

ABSTRACT

BACKGROUND: Estimates of excess mortality are required to assess and compare the impact of the COVID-19 pandemic across populations. For India, reliable baseline prepandemic mortality patterns at national and subnational level are necessary for such assessments. However, available data from the Civil Registration System (CRS) is affected by incompleteness of death recording that varies by sex, age and location. METHODS: Under-reporting of CRS 2019 deaths was assessed for three age groups (< 5 years, 15-59 years and ≥60 years) at subnational level, through comparison with age-specific death rates from alternate sources. Age-specific corrections for under-reporting were applied to derive adjusted death counts by sex for each location. These were used to compute life expectancy (LE) at birth by sex in 2019, which were compared with subnational LEs from the Global Burden of Disease (GBD) 2019 Study. RESULTS: A total of 9.92 million deaths (95% UI 9.70 to 10.02) were estimated across India in 2019, about 2.28 million more than CRS reports. Adjustments to under-five and elderly mortality accounted for 30% and 56% of additional deaths, respectively. Adjustments in Bihar, Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh accounted for 75% of all additional deaths. Adjusted LEs were below corresponding GBD estimates by ≥2 years for males at national level and in 20 states, and by ≥1 year for females in 12 states. CONCLUSIONS: These results represent the first-ever subnational mortality estimates for India derived from CRS reported deaths, and serve as a baseline for assessing excess mortality from the COVID-19 pandemic. Adjusted life expectancies indicate higher mortality patterns in India than previously perceived. Under-reporting of infant deaths and those among women and the elderly is evident in many locations. Further CRS strengthening is required to improve the empirical basis for local mortality measurement across the country.


Subject(s)
COVID-19 , Aged , Child, Preschool , Female , Global Burden of Disease , Humans , India/epidemiology , Infant , Infant, Newborn , Male , Pandemics , SARS-CoV-2
16.
Lancet ; 398(10313): 1837-1850, 2021 11 13.
Article in English | MEDLINE | ID: covidwho-1510434

ABSTRACT

Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.


Subject(s)
Developing Countries , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/pathology , Diabetes Mellitus, Type 1/therapy , Global Burden of Disease/trends , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Adolescent , Child , Child, Preschool , Disease Management , History, 20th Century , History, 21st Century , Humans , Hypoglycemic Agents/economics , Hypoglycemic Agents/history , Insulin/economics , Insulin/history , Life Expectancy , Universal Health Insurance
17.
Arch Dis Child ; 106(11): 1050-1055, 2021 11.
Article in English | MEDLINE | ID: covidwho-1501685

ABSTRACT

BACKGROUND: Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS: A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS: The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. CONCLUSION: Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Global Burden of Disease/economics , Public Health Surveillance/methods , Wounds and Injuries/epidemiology , Accidental Falls/statistics & numerical data , Accidents, Traffic/statistics & numerical data , Adolescent , Animals , Bites and Stings/epidemiology , Burns/epidemiology , Child , Child, Preschool , Drowning/epidemiology , Emergency Service, Hospital/trends , Female , Humans , Male , Nepal/epidemiology , Poisoning/epidemiology , Prospective Studies , Trauma Severity Indices , Wounds and Injuries/mortality , Wounds and Injuries/prevention & control
18.
Eur Neuropsychopharmacol ; 54: 21-40, 2022 01.
Article in English | MEDLINE | ID: covidwho-1466347

ABSTRACT

INTRODUCTION: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study. MATERIAL AND METHODS: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed. CONCLUSIONS: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.


Subject(s)
Anxiety/epidemiology , COVID-19/complications , COVID-19/psychology , Depression/epidemiology , Mental Health , Adult , Anxiety/etiology , COVID-19/epidemiology , Depression/etiology , Female , Global Burden of Disease , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Stress, Psychological/etiology , Suicidal Ideation
19.
J Alzheimers Dis ; 83(4): 1563-1601, 2021.
Article in English | MEDLINE | ID: covidwho-1468319

ABSTRACT

Neurological disorders significantly impact the world's economy due to their often chronic and life-threatening nature afflicting individuals which, in turn, creates a global disease burden. The Group of Twenty (G20) member nations, which represent the largest economies globally, should come together to formulate a plan on how to overcome this burden. The Neuroscience-20 (N20) initiative of the Society for Brain Mapping and Therapeutics (SBMT) is at the vanguard of this global collaboration to comprehensively raise awareness about brain, spine, and mental disorders worldwide. This paper aims to provide a comprehensive review of the various brain initiatives worldwide and highlight the need for cooperation and recommend ways to bring down costs associated with the discovery and treatment of neurological disorders. Our systematic search revealed that the cost of neurological and psychiatric disorders to the world economy by 2030 is roughly $16T. The cost to the economy of the United States is $1.5T annually and growing given the impact of COVID-19. We also discovered there is a shortfall of effective collaboration between nations and a lack of resources in developing countries. Current statistical analyses on the cost of neurological disorders to the world economy strongly suggest that there is a great need for investment in neurotechnology and innovation or fast-tracking therapeutics and diagnostics to curb these costs. During the current COVID-19 pandemic, SBMT, through this paper, intends to showcase the importance of worldwide collaborations to reduce the population's economic and health burden, specifically regarding neurological/brain, spine, and mental disorders.


Subject(s)
Global Burden of Disease , International Cooperation , Mental Disorders , Nervous System Diseases , COVID-19/epidemiology , Global Burden of Disease/organization & administration , Global Burden of Disease/trends , Global Health/economics , Global Health/trends , Humans , Mental Disorders/economics , Mental Disorders/epidemiology , Mental Disorders/therapy , Nervous System Diseases/economics , Nervous System Diseases/epidemiology , Nervous System Diseases/therapy , Neurosciences/methods , Neurosciences/trends , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL