Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016.
Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the global burden of disea...
- Autores:
-
Hay, SI
Abajobir, AA
Abate, Kalkidan Hassen
Abbafati, Cristiana
Abbas, KM
Abd-Allah, Foad
Abdulkader, Rizwan Suliankatchi
Abdulle, AM
Abebo, Teshome Abuka
Abera, SF
Alvis Guzman, Nelson
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2017
- Institución:
- Corporación Universidad de la Costa
- Repositorio:
- REDICUC - Repositorio CUC
- Idioma:
- eng
- OAI Identifier:
- oai:repositorio.cuc.edu.co:11323/4775
- Acceso en línea:
- https://hdl.handle.net/11323/4775
https://repositorio.cuc.edu.co/
- Palabra clave:
- Salud
Patrones epidemiológicos
Recursos en investigación
Health
Epidemiological patterns
Research resources
- Rights
- openAccess
- License
- Attribution-NonCommercial-ShareAlike 4.0 International
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dc.title.spa.fl_str_mv |
Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. |
dc.title.translated.spa.fl_str_mv |
Años de vida ajustados por discapacidad a nivel mundial, regional y nacional (dalys) para 333 enfermedades y lesiones y esperanza de vida saludable (hale) para 195 países y territorios, 1990-2016: un análisis sistemático para el estudio de la carga mundial de la enfermedad 2016. |
title |
Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. |
spellingShingle |
Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. Salud Patrones epidemiológicos Recursos en investigación Health Epidemiological patterns Research resources |
title_short |
Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. |
title_full |
Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. |
title_fullStr |
Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. |
title_full_unstemmed |
Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. |
title_sort |
Global, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. |
dc.creator.fl_str_mv |
Hay, SI Abajobir, AA Abate, Kalkidan Hassen Abbafati, Cristiana Abbas, KM Abd-Allah, Foad Abdulkader, Rizwan Suliankatchi Abdulle, AM Abebo, Teshome Abuka Abera, SF Alvis Guzman, Nelson |
dc.contributor.author.spa.fl_str_mv |
Hay, SI Abajobir, AA Abate, Kalkidan Hassen Abbafati, Cristiana Abbas, KM Abd-Allah, Foad Abdulkader, Rizwan Suliankatchi Abdulle, AM Abebo, Teshome Abuka Abera, SF Alvis Guzman, Nelson |
dc.subject.spa.fl_str_mv |
Salud Patrones epidemiológicos Recursos en investigación Health Epidemiological patterns Research resources |
topic |
Salud Patrones epidemiológicos Recursos en investigación Health Epidemiological patterns Research resources |
description |
Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the global burden of diseases, injuries, and risk factors study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (dalys) and healthy life expectancy (hale). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the socio-demographic index (sdi) |
publishDate |
2017 |
dc.date.issued.none.fl_str_mv |
2017 |
dc.date.accessioned.none.fl_str_mv |
2019-06-04T13:26:19Z |
dc.date.available.none.fl_str_mv |
2019-06-04T13:26:19Z |
dc.type.spa.fl_str_mv |
Artículo de revista |
dc.type.coar.fl_str_mv |
http://purl.org/coar/resource_type/c_2df8fbb1 |
dc.type.coar.spa.fl_str_mv |
http://purl.org/coar/resource_type/c_6501 |
dc.type.content.spa.fl_str_mv |
Text |
dc.type.driver.spa.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.redcol.spa.fl_str_mv |
http://purl.org/redcol/resource_type/ART |
dc.type.version.spa.fl_str_mv |
info:eu-repo/semantics/acceptedVersion |
format |
http://purl.org/coar/resource_type/c_6501 |
status_str |
acceptedVersion |
dc.identifier.uri.spa.fl_str_mv |
https://hdl.handle.net/11323/4775 |
dc.identifier.instname.spa.fl_str_mv |
Corporación Universidad de la Costa |
dc.identifier.reponame.spa.fl_str_mv |
REDICUC - Repositorio CUC |
dc.identifier.repourl.spa.fl_str_mv |
https://repositorio.cuc.edu.co/ |
url |
https://hdl.handle.net/11323/4775 https://repositorio.cuc.edu.co/ |
identifier_str_mv |
Corporación Universidad de la Costa REDICUC - Repositorio CUC |
dc.language.iso.none.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.spa.fl_str_mv |
10.1016/S0140-6736(17)32130-X |
dc.relation.references.spa.fl_str_mv |
1 Mathers CD, Sadana R, Salomon JA, Murray CJ, Lopez AD. Healthy life expectancy in 191 countries, 1999. Lancet 2001; 357: 1685–91. 2 Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197–223. 3 Murray CJ, Barber RM, Foreman KJ, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet 2015; 386: 2145–91. 4 Kassebaum NJ, Arora M, Barber RM, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1603–58. 5 Murray CJ, Salomon JA, Mathers CD, Lopez AD. Summary measures of population health. Concepts, ethics, measurement and applications. Geneva: World Health Organization, 2002. 6 Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ 1994; 72: 429–45. 7 GBD 2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1084–50. 8 GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211–59. 9 Sullivan DF. A single index of mortality and morbidity. HSMHA Health Rep 1971; 86: 347–54. 10 GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1151–210. 11 GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1343–420. 12 Murray CJ, Ezzati M, Flaxman AD, et al. GBD 2010: design, definitions, and metrics. Lancet 2012; 380: 2063–66. 13 Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet 2016; 388: e19–23. 14 Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. PLoS Med 2016; 13: e1002056. 15 Wang H, Naghavi M, Allen C, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1459–544. 16 Flaxman AD, Vos T, Murray CJ, eds. An integrative metaregression framework for descriptive epidemiology, first edn. Seattle: University of Washington Press, 2015. 17 Stanaway JD, Shepard DS, Undurraga EA, et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis 2016; 16: 712–23. 18 Gething PW, Casey DC, Weiss DJ, et al. Mapping Plasmodium falciparum mortality in Africa between 1990 and 2015. N Engl J Med 2016; 375: 2435–45. 19 Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2129–43. 20 Salomon JA, Haagsma JA, Davis A, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health 2015; 3: e712–23. 21 Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q 2005; 83: 731–5722 WHO. The world health report 2000. Health systems: improving performance. Geneva: World Health Organization, 2000. 23 Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR. The global economic burden of noncommunicable diseases. Geneva: World Economic Forum, 2011. 24 Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med 1980; 303: 130–35. 25 Mundel T. Honing the priorities and making the investment case for global health. PLoS Biol 2016; 14: e1002376. 26 Institute for Health Metrics and Evaluation. A hand up: global progress towards universal education. Seattle, Institute for Health Metrics and Evaluation, 2015. 27 Jamison DT, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–955. 28 Bhatt S, Weiss DJ, Cameron E, et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 2015; 526: 207–11. 29 Gakidou E, Cowling K, Lozano R, Murray CJ. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet 2010; 376: 959–74. 30 Wang H, Wolock TM, Carter A, et al. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV 2016; 3: e361–87. 31 Murray CJ, Lopez AD, eds. Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020, 1st edn. Cambridge: Harvard School of Public Health, 1996. 32 Stuckler D, King L, Robinson H, McKee M. WHO’s budgetary allocations and burden of disease: a comparative analysis. Lancet 2008; 372: 1563–69. 33 Catalá-López F, García-Altés A, Álvarez-Martín E, Gènova-Maleras R, Morant-Ginestar C. Does the development of new medicinal products in the European Union address global and regional health concerns? Popul Health Metr 2010; 8: 34. 34 Chalmers I, Bracken MB, Djulbegovic B, et al. How to increase value and reduce waste when research priorities are set. Lancet 2014; 383: 156–65. 35 Emdin CA, Odutayo A, Hsiao AJ, et al. Association between randomised trial evidence and global burden of disease: cross sectional study (Epidemiological Study of Randomized Trials— ESORT). BMJ 2015; 350: h117. 36 Lam J, Lord SJ, Hunter KE, Simes RJ, Vu T, Askie LM. Australian clinical trial activity and burden of disease: an analysis of registered trials in National Health Priority Areas. Med J Australia 2015; 203: 97–101. 37 Mitchell RJ, McClure RJ, Olivier J, Watson WL. Rational allocation of Australia’s research dollars: does the distribution of NHMRC funding by National Health Priority Area reflect actual disease burden? Med J Australia 2009; 191: 648–52. 38 Aoun S, Pennebaker D, Pascal R. To what extent is health and medical research funding associated with the burden of disease in Australia? Aust N Z J Public Health 2004; 28: 80–86. 39 Lamarre-Cliche M, Castilloux AM, LeLorier J. Association between the burden of disease and research funding by the Medical Research Council of Canada and the National Institutes of Health. A cross-sectional study. Clin Invest Med 2001; 24: 83–89. 40 WHO. Global Health Estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization, 2016. http://www.who.int/healthinfo/global_ burden_disease/estimates/en/index1.html (accessed March 14, 2017). 41 WHO. WHO methods and data sources for global burden of disease estimates 2000–2015. Geneva: World Health Organization, 2017. 42 WHO. WHO Member State DALY estimates, 2000–2015. http://www.who.int/healthinfo/global_burden_disease/estimates/ en/ (accessed April 24, 2017). 43 Kuznik A, Lamorde M, Nyabigambo A, Manabe YC. Antenatal syphilis screening using point-of-care testing in sub-Saharan African countries: a cost-effectiveness analysis. PLoS Med 10: e1001545. 44 Vogel JP, Habib NA, Souza JP, et al. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial. Reprod Health 2013; 10: 19. 45 Bhatt S, Weiss DJ, Cameron E, et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 2015; 526: 207–11. 46 Baird JK. Effectiveness of antimalarial drugs. N Engl J Med 2005; 352: 1565–77. 47 Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 2005; 5: 42–52. 48 Quinn TC. HIV epidemiology and the effects of antiviral therapy on long-term consequences. AIDS 2008; 22: S7–12. 49 Stover J, Johnson P, Hallett T, Marston M, Becquet R, Timaeus IM. The Spectrum projection package: improvements in estimating incidence by age and sex, mother-to-child transmission, HIV progression in children and double orphans. Sex Transm Infect 2010; 86: ii16–21. 50 WHO. Towards a grand convergence for child survival and health. A strategic review of options for the future building on lessons learnt from IMNCI. Geneva: World Health Organization, 2016. 51 GBD 2015 Healthcare Access and Quality Collaborators. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390: 231–66. 52 National AIDS and STI Control Programme. Kenya AIDS Indicator Survey 2012: final report. Nairobi: National AIDS and STI Control Programme, 2014. 53 Ministry of Health. Uganda AIDS Indicator Survey 2011. Kampala: Ministry of Health, 2012. 54 Uniting to Combat Neglected Tropical Diseases. The London Declaration on neglected tropical diseases. http://unitingtocombat ntds.org/resource/london-declaration (accessed May 8, 2017). 55 Hopkins DR. Disease eradication. N Engl J Med 2013; 368: 54–63. 56 Brun R, Blum J, Chappuis F, Burri C. Human African trypanosomiasis. Lancet 2010; 375: 148–59. 57 WHO. Fifth meeting of the Emergency Committee under the International Health Regulations (2005) regarding microcephaly, other neurological disorders and Zika virus. Nov 18, 2016. http://www.who.int/mediacentre/news/statements/2016/zika-fifthec/en/ (accessed May 8, 2017). 58 Bogoch II, Brady OJ, Kraemer MU, et al. Potential for Zika virus introduction and transmission in resource-limited countries in Africa and the Asia-Pacific region: a modelling study. Lancet Infect Dis 2016; 16: 1237–45. 59 Wikan N, Smith DR. Zika virus: history of a newly emerging arbovirus. Lancet Infect Dis 2016; 16: e119–26. 60 Pan American Health Organization. Zika cumulative cases. http://www.paho.org/hq/index.php?option=com_content&view=arti cle&id=12390:zika-cumulative-cases&catid=8424:contents&Itemid=4 2090&lang=en (accessed May 8, 2017). 61 GBD 2015 Eastern Mediterranean Region Collaborators, Mokdad AH. Danger ahead: the burden of diseases, injuries, and risk factors in the eastern Mediterranean region, 1990–2015. Int J Public Health 2017; published online Aug 3. DOI:10.1007/ s00038-017-1017-y. 62 Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, et al. Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016; 388: 2386–402. 63 O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376: 112–23. 64 Zhang LF, Yang J, Hong Z, et al. Proportion of different subtypes of stroke in China. Stroke 2003; 34: 2091–96. 65 Andrade LH, Alonso J, Mneimneh Z, et al. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med 2014; 44: 1303–17. 66 Degenhardt L, Glantz M, Evans-Lacko S, et al. Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health surveys. World Psychiatry (in press). 67 Mathers BM, Degenhardt L, Ali H, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 2010; 375: 1014–28. 68 Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017; 16: 90–99. 69 Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–81. 70 Global Burden of Disease Health Financing Collaborator Network. Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet 389: 1981–2004.s 71 Global Burden of Disease Health Financing Collaborator Network. Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet 389: 2005–30. 72 Dowell SF, Blazes D, Desmond-Hellmann S. Four steps to precision public health. Nature 2016; 540: 189–91. 73 Golding N, Burstein R, Longbottom J, et al. Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the Sustainable Development Goals. Lancet 2017. http://dx.doi.org/ S0140-6736(17)31758-0 (in press). 74 Roberts L. Hunger amplifies infectious diseases for millions fleeing the violence of Boko Haram. April 6, 2017. http://www. sciencemag.org/news/2017/04/hunger-amplifies-infectiousdiseases-millions-fleeing-violence-boko-haram (accessed March 24, 2017). 75 Hoff PD. A first course in Bayesian statistical methods. New York: Springer New York, 2009. |
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Hay, SIAbajobir, AAAbate, Kalkidan HassenAbbafati, CristianaAbbas, KMAbd-Allah, FoadAbdulkader, Rizwan SuliankatchiAbdulle, AMAbebo, Teshome AbukaAbera, SFAlvis Guzman, Nelson2019-06-04T13:26:19Z2019-06-04T13:26:19Z2017https://hdl.handle.net/11323/4775Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the global burden of diseases, injuries, and risk factors study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (dalys) and healthy life expectancy (hale). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the socio-demographic index (sdi)La medición de los cambios en la salud en todos los lugares es útil para comparar y contrastar los patrones epidemiológicos cambiantes con el desempeño del sistema de salud e identificar necesidades específicas para la asignación de recursos en investigación, desarrollo de políticas y toma de decisiones de programas. Usando la carga global de enfermedades, lesiones y factores de riesgo del estudio 2016, tomamos dos medidas de resumen ampliamente utilizadas para monitorear tales cambios en la salud de la población: años de vida ajustados por discapacidad (dalys) y esperanza de vida saludable (hale). Utilizamos estas medidas para rastrear las tendencias y comparar el progreso en comparación con las tendencias esperadas sobre la base del índice sociodemográfico (sdi)Hay, SI-3a467425-a264-47a2-b983-0c9f3e6761e1-0Abajobir, AA-99fc00b6-5220-488b-87e1-ba36f9f6a956-0Abate, Kalkidan Hassen-2d88c31c-6b33-45fb-b9f4-941eadd2de63-0Abbafati, Cristiana-b23057d5-6f5d-449a-894e-90322e3b6867-0Abbas, KM-bb552fd7-d1c9-429f-8a75-0bab0b36c113-0Abd-Allah, Foad-ddd527dd-5c2f-4c27-b1ba-7d61e94a2738-0Abdulkader, Rizwan Suliankatchi-4dc5c5e3-226d-4e18-9df9-26e91ea42267-0Abdulle, AM-09a56746-b02e-42dd-a2b1-7cfa556f7a17-0Abebo, Teshome Abuka-aecd30cf-aeda-4cb2-81fd-07ead9636a86-0Abera, SF-2bcd3a9f-5738-4c6c-99df-3a6dee403cc1-0Alvis Guzman, Nelson-8bd90d52-51ab-4917-ad57-b2424f106eac-0engThe Lancet10.1016/S0140-6736(17)32130-X1 Mathers CD, Sadana R, Salomon JA, Murray CJ, Lopez AD. Healthy life expectancy in 191 countries, 1999. Lancet 2001; 357: 1685–91. 2 Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197–223. 3 Murray CJ, Barber RM, Foreman KJ, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet 2015; 386: 2145–91. 4 Kassebaum NJ, Arora M, Barber RM, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1603–58. 5 Murray CJ, Salomon JA, Mathers CD, Lopez AD. Summary measures of population health. Concepts, ethics, measurement and applications. Geneva: World Health Organization, 2002. 6 Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ 1994; 72: 429–45. 7 GBD 2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1084–50. 8 GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211–59. 9 Sullivan DF. A single index of mortality and morbidity. HSMHA Health Rep 1971; 86: 347–54. 10 GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1151–210. 11 GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1343–420. 12 Murray CJ, Ezzati M, Flaxman AD, et al. GBD 2010: design, definitions, and metrics. Lancet 2012; 380: 2063–66. 13 Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet 2016; 388: e19–23. 14 Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. PLoS Med 2016; 13: e1002056. 15 Wang H, Naghavi M, Allen C, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1459–544. 16 Flaxman AD, Vos T, Murray CJ, eds. An integrative metaregression framework for descriptive epidemiology, first edn. Seattle: University of Washington Press, 2015. 17 Stanaway JD, Shepard DS, Undurraga EA, et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis 2016; 16: 712–23. 18 Gething PW, Casey DC, Weiss DJ, et al. Mapping Plasmodium falciparum mortality in Africa between 1990 and 2015. N Engl J Med 2016; 375: 2435–45. 19 Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2129–43. 20 Salomon JA, Haagsma JA, Davis A, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health 2015; 3: e712–23. 21 Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q 2005; 83: 731–5722 WHO. The world health report 2000. Health systems: improving performance. Geneva: World Health Organization, 2000. 23 Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR. The global economic burden of noncommunicable diseases. Geneva: World Economic Forum, 2011. 24 Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med 1980; 303: 130–35. 25 Mundel T. Honing the priorities and making the investment case for global health. PLoS Biol 2016; 14: e1002376. 26 Institute for Health Metrics and Evaluation. A hand up: global progress towards universal education. Seattle, Institute for Health Metrics and Evaluation, 2015. 27 Jamison DT, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–955. 28 Bhatt S, Weiss DJ, Cameron E, et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 2015; 526: 207–11. 29 Gakidou E, Cowling K, Lozano R, Murray CJ. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet 2010; 376: 959–74. 30 Wang H, Wolock TM, Carter A, et al. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV 2016; 3: e361–87. 31 Murray CJ, Lopez AD, eds. Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020, 1st edn. Cambridge: Harvard School of Public Health, 1996. 32 Stuckler D, King L, Robinson H, McKee M. WHO’s budgetary allocations and burden of disease: a comparative analysis. Lancet 2008; 372: 1563–69. 33 Catalá-López F, García-Altés A, Álvarez-Martín E, Gènova-Maleras R, Morant-Ginestar C. Does the development of new medicinal products in the European Union address global and regional health concerns? Popul Health Metr 2010; 8: 34. 34 Chalmers I, Bracken MB, Djulbegovic B, et al. How to increase value and reduce waste when research priorities are set. Lancet 2014; 383: 156–65. 35 Emdin CA, Odutayo A, Hsiao AJ, et al. Association between randomised trial evidence and global burden of disease: cross sectional study (Epidemiological Study of Randomized Trials— ESORT). BMJ 2015; 350: h117. 36 Lam J, Lord SJ, Hunter KE, Simes RJ, Vu T, Askie LM. Australian clinical trial activity and burden of disease: an analysis of registered trials in National Health Priority Areas. Med J Australia 2015; 203: 97–101. 37 Mitchell RJ, McClure RJ, Olivier J, Watson WL. Rational allocation of Australia’s research dollars: does the distribution of NHMRC funding by National Health Priority Area reflect actual disease burden? Med J Australia 2009; 191: 648–52. 38 Aoun S, Pennebaker D, Pascal R. To what extent is health and medical research funding associated with the burden of disease in Australia? Aust N Z J Public Health 2004; 28: 80–86. 39 Lamarre-Cliche M, Castilloux AM, LeLorier J. Association between the burden of disease and research funding by the Medical Research Council of Canada and the National Institutes of Health. A cross-sectional study. Clin Invest Med 2001; 24: 83–89. 40 WHO. Global Health Estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization, 2016. http://www.who.int/healthinfo/global_ burden_disease/estimates/en/index1.html (accessed March 14, 2017). 41 WHO. WHO methods and data sources for global burden of disease estimates 2000–2015. Geneva: World Health Organization, 2017. 42 WHO. WHO Member State DALY estimates, 2000–2015. http://www.who.int/healthinfo/global_burden_disease/estimates/ en/ (accessed April 24, 2017). 43 Kuznik A, Lamorde M, Nyabigambo A, Manabe YC. Antenatal syphilis screening using point-of-care testing in sub-Saharan African countries: a cost-effectiveness analysis. PLoS Med 10: e1001545. 44 Vogel JP, Habib NA, Souza JP, et al. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial. Reprod Health 2013; 10: 19. 45 Bhatt S, Weiss DJ, Cameron E, et al. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 2015; 526: 207–11. 46 Baird JK. Effectiveness of antimalarial drugs. N Engl J Med 2005; 352: 1565–77. 47 Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 2005; 5: 42–52. 48 Quinn TC. HIV epidemiology and the effects of antiviral therapy on long-term consequences. AIDS 2008; 22: S7–12. 49 Stover J, Johnson P, Hallett T, Marston M, Becquet R, Timaeus IM. The Spectrum projection package: improvements in estimating incidence by age and sex, mother-to-child transmission, HIV progression in children and double orphans. Sex Transm Infect 2010; 86: ii16–21. 50 WHO. Towards a grand convergence for child survival and health. A strategic review of options for the future building on lessons learnt from IMNCI. Geneva: World Health Organization, 2016. 51 GBD 2015 Healthcare Access and Quality Collaborators. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390: 231–66. 52 National AIDS and STI Control Programme. Kenya AIDS Indicator Survey 2012: final report. Nairobi: National AIDS and STI Control Programme, 2014. 53 Ministry of Health. Uganda AIDS Indicator Survey 2011. Kampala: Ministry of Health, 2012. 54 Uniting to Combat Neglected Tropical Diseases. The London Declaration on neglected tropical diseases. http://unitingtocombat ntds.org/resource/london-declaration (accessed May 8, 2017). 55 Hopkins DR. Disease eradication. N Engl J Med 2013; 368: 54–63. 56 Brun R, Blum J, Chappuis F, Burri C. Human African trypanosomiasis. Lancet 2010; 375: 148–59. 57 WHO. Fifth meeting of the Emergency Committee under the International Health Regulations (2005) regarding microcephaly, other neurological disorders and Zika virus. Nov 18, 2016. http://www.who.int/mediacentre/news/statements/2016/zika-fifthec/en/ (accessed May 8, 2017). 58 Bogoch II, Brady OJ, Kraemer MU, et al. Potential for Zika virus introduction and transmission in resource-limited countries in Africa and the Asia-Pacific region: a modelling study. Lancet Infect Dis 2016; 16: 1237–45. 59 Wikan N, Smith DR. Zika virus: history of a newly emerging arbovirus. Lancet Infect Dis 2016; 16: e119–26. 60 Pan American Health Organization. Zika cumulative cases. http://www.paho.org/hq/index.php?option=com_content&view=arti cle&id=12390:zika-cumulative-cases&catid=8424:contents&Itemid=4 2090&lang=en (accessed May 8, 2017). 61 GBD 2015 Eastern Mediterranean Region Collaborators, Mokdad AH. Danger ahead: the burden of diseases, injuries, and risk factors in the eastern Mediterranean region, 1990–2015. Int J Public Health 2017; published online Aug 3. DOI:10.1007/ s00038-017-1017-y. 62 Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, et al. Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016; 388: 2386–402. 63 O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376: 112–23. 64 Zhang LF, Yang J, Hong Z, et al. Proportion of different subtypes of stroke in China. Stroke 2003; 34: 2091–96. 65 Andrade LH, Alonso J, Mneimneh Z, et al. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med 2014; 44: 1303–17. 66 Degenhardt L, Glantz M, Evans-Lacko S, et al. Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health surveys. World Psychiatry (in press). 67 Mathers BM, Degenhardt L, Ali H, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 2010; 375: 1014–28. 68 Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017; 16: 90–99. 69 Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–81. 70 Global Burden of Disease Health Financing Collaborator Network. Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet 389: 1981–2004.s 71 Global Burden of Disease Health Financing Collaborator Network. Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet 389: 2005–30. 72 Dowell SF, Blazes D, Desmond-Hellmann S. Four steps to precision public health. Nature 2016; 540: 189–91. 73 Golding N, Burstein R, Longbottom J, et al. Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the Sustainable Development Goals. Lancet 2017. http://dx.doi.org/ S0140-6736(17)31758-0 (in press). 74 Roberts L. Hunger amplifies infectious diseases for millions fleeing the violence of Boko Haram. April 6, 2017. http://www. sciencemag.org/news/2017/04/hunger-amplifies-infectiousdiseases-millions-fleeing-violence-boko-haram (accessed March 24, 2017). 75 Hoff PD. A first course in Bayesian statistical methods. New York: Springer New York, 2009.Attribution-NonCommercial-ShareAlike 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2SaludPatrones epidemiológicosRecursos en investigaciónHealthEpidemiological patternsResearch resourcesGlobal, regional, and national disability-adjusted life-years (dalys) for 333 diseases and injuries and healthy life expectancy (hale) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016.Años de vida ajustados por discapacidad a nivel mundial, regional y nacional (dalys) para 333 enfermedades y lesiones y esperanza de vida saludable (hale) para 195 países y territorios, 1990-2016: un análisis sistemático para el estudio de la carga mundial de la enfermedad 2016.Artículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/acceptedVersionPublicationORIGINALGlobal, regional, and national disability-adjusted life-years.pdfGlobal, regional, and national disability-adjusted life-years.pdfapplication/pdf53514041https://repositorio.cuc.edu.co/bitstreams/8fede0e0-d694-40bb-85b3-1ae2c2e68b23/download489e7e0f60e6d017fd386db61832e999MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-81031https://repositorio.cuc.edu.co/bitstreams/02bdc27d-6467-480e-81ce-b7c8304d8fd9/download934f4ca17e109e0a05eaeaba504d7ce4MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repositorio.cuc.edu.co/bitstreams/02a723f0-ab78-45ac-ae49-b7dd56117c31/download8a4605be74aa9ea9d79846c1fba20a33MD53THUMBNAILGlobal, regional, and national disability-adjusted life-years.pdf.jpgGlobal, regional, and national disability-adjusted life-years.pdf.jpgimage/jpeg78607https://repositorio.cuc.edu.co/bitstreams/ea9ed45a-7f51-4c80-9de7-9a2afa743d60/download54c3aa6f557ad3e72786b003a14b146fMD55TEXTGlobal, regional, and national disability-adjusted life-years.pdf.txtGlobal, regional, and national disability-adjusted life-years.pdf.txttext/plain533524https://repositorio.cuc.edu.co/bitstreams/7ad66dc8-7449-4a25-abed-7b202a6dc18b/downloadee2b806900446f1126553f047feec83eMD5611323/4775oai:repositorio.cuc.edu.co:11323/47752024-09-17 10:58:23.251http://creativecommons.org/licenses/by-nc-sa/4.0/Attribution-NonCommercial-ShareAlike 4.0 Internationalopen.accesshttps://repositorio.cuc.edu.coRepositorio de la Universidad de la Costa CUCrepdigital@cuc.edu.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 |