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Showing papers by "Christopher J L Murray published in 2008"


Posted Content
TL;DR: This paper measured response category incomparability via respondents' assessments, on the same scale as the self-assessments to be corrected, of hypothetical individuals described in short vignettes.
Abstract: We address two long-standing survey research problems: measuring complicated concepts, such as political freedom or efficacy, that researchers define best with reference to examples; and what to do when respondents interpret identical questions in different ways. Scholars have long addressed these problems with approaches to reduce incomparability, such as writing more concrete questions - with uneven success. Our alternative is to measure directly response category incomparability and to correct for it. We measure incomparability via respondents' assessments, on the same scale as the self-assessments to be corrected, of hypothetical individuals described in short vignettes. Since actual levels of the vignettes are invariant over respondents, variability in vignette answers reveals incomparability. Our corrections require either simple recodes or a statistical model designed to save survey administration costs. With analysis, simulations, and cross-national surveys, we show how response incomparability can drastically mislead survey researchers and how our approach can fix them.

916 citations


Journal ArticleDOI
TL;DR: In depth topics with major scientific challenges and institutional and cultural barriers that are slowing the development of the field are explored.

884 citations


Journal ArticleDOI
TL;DR: There was a steady increase in mortality inequality across the US counties between 1983 and 1999, resulting from stagnation or increased in mortality among the worst-off segment of the population.
Abstract: Background Counties are the smallest unit for which mortality data are routinely available, allowing consistent and comparable long-term analysis of trends in health disparities. Average life expectancy has steadily increased in the United States but there is limited information on longterm mortality trends in the US counties This study aimed to investigate trends in county mortality and cross-county mortality disparities, including the contributions of specific diseases to county level mortality trends. Methods and Findings We used mortality statistics (from the National Center for Health Statistics [NCHS]) and population (from the US Census) to estimate sex-specific life expectancy for US counties for every year between 1961 and 1999. Data for analyses in subsequent years were not provided to us by the NCHS. We calculated different metrics of cross-county mortality disparity, and also grouped counties on the basis of whether their mortality changed favorably or unfavorably relative to the national average. We estimated the probability of death from specific diseases for counties with above- or below-average mortality performance. We simulated the effect of cross-county migration on each county’s life expectancy using a time-based simulation model. Between 1961 and 1999, the standard deviation (SD) of life expectancy across US counties was at its lowest in 1983, at 1.9 and 1.4 y for men and women, respectively. Cross-county life expectancy SD increased to 2.3 and 1.7 y in 1999. Between 1961 and 1983 no counties had a statistically significant increase in mortality; the major cause of mortality decline for both sexes was reduction in cardiovascular mortality. From 1983 to 1999, life expectancy declined significantly in 11 counties for men (by 1.3 y) and in 180 counties for women (by 1.3 y); another 48 (men) and 783 (women) counties had nonsignificant life expectancy decline. Life expectancy decline in both sexes was caused by increased mortality from lung cancer, chronic obstructive pulmonary disease (COPD), diabetes, and a range of other noncommunicable diseases, which were no longer compensated for by the decline in cardiovascular mortality. Higher HIV/AIDS and homicide deaths also contributed substantially to life expectancy decline for men, but not for women. Alternative specifications of the effects of migration showed that the rise in crosscounty life expectancy SD was unlikely to be caused by migration.

334 citations


Journal ArticleDOI
TL;DR: Survey-based DTP3 immunisation coverage has improved more gradually and not to the level suggested by countries' official reports or WHO and UNICEF estimates, suggesting an urgent need for independent and contestable monitoring of health indicators in an era of global initiatives that are target-oriented and disburse funds based on performance.

277 citations


Posted Content
TL;DR: In this paper, the authors propose a simple, rigorous, and measurable definition of human security: the expected number of years of future life spent outside the state of generalized poverty, defined as the threshold in any key domain of human well-being.
Abstract: In the last two decades, the international community has begun to conclude that attempts to ensure the territorial security of nation-states through military power have failed to improve the human condition. Despite astronomical levels of military spending, deaths due to military conflict have not declined. Moreover, even when the borders of some states are secure from foreign threats, the people within those states do not necessarily have freedom from crime, enough food, proper health care, education, or political freedom. In response to these developments, the international community has gradually moved to combine economic development with military security and other basic human rights to form a new concept of "human security". Unfortunately, by common assent the concept lacks both a clear definition, consistent with the aims of the international community, and any agreed upon measure of it. In this paper, we propose a simple, rigorous, and measurable definition of human security: the expected number of years of future life spent outside the state of "generalized poverty". Generalized poverty occurs when an individual falls below the threshold in any key domain of human well-being. We consider improvements in data collection and methods of forecasting that are necessary to measure human security and then introduce an agenda for research and action to enhance human security that follows logically in the areas of risk assessment, prevention, protection, and compensation.

270 citations


Journal ArticleDOI
26 Jun 2008-BMJ
TL;DR: The use of data on sibling history from peacetime population surveys can retrospectively estimate mortality from war, and there is no evidence of a recent decline in war deaths.
Abstract: Objective To provide an accurate estimate of violent war deaths. Design Analysis of survey data on mortality, adjusted for sampling bias and censoring, from nationally representative surveys designed to measure population health. Estimated deaths compared with estimates in database of passive reports. Setting 2002-3 World health surveys, in which information was collected from one respondent per household about sibling deaths, including whether such deaths resulted from war injuries. Main outcome measure Estimated deaths from war injuries in 13 countries over 50 years. Results From 1955 to 2002, data from the surveys indicated an estimated 5.4 million violent war deaths (95% confidence interval 3.0 to 8.7 million) in 13 countries, ranging from 7000 in the Democratic Republic of Congo to 3.8 million in Vietnam. From 1995 to 2002 survey data indicate 36 000 war deaths annually (16 000 to 71 000) in the 13 countries studied. Data from passive surveillance, however, indicated a figure of only a third of this. On the basis of the relation between world health survey data and passive reports, we estimate 378 000 globalwar deaths annually from 1985-94, the last years for which complete passive surveillance data were available. Conclusions The use of data on sibling history from peacetime population surveys can retrospectively estimate mortality from war. War causes more deaths than previously estimated, and there is no evidence to support a recent decline in war deaths.

175 citations


Journal ArticleDOI
TL;DR: Self-reported data on hypertension diagnosis from the Behavioral Risk Factor Surveillance System can be used to obtain unbiased state-level estimates of blood pressure and uncontrolled hypertension as benchmarks for priority setting and for designing and evaluating intervention programs.
Abstract: Background— Blood pressure is an important risk factor for cardiovascular disease and mortality and has lifestyle and healthcare determinants that vary across states. Only self-reported hypertension status is measured at the state level in the United States. Our aim was to estimate levels and trends in state-level mean systolic blood pressure (SBP), the prevalence of uncontrolled systolic hypertension, and cardiovascular mortality attributable to all levels of higher-than-optimal SBP. Methods and Results— We estimated the relationship between actual SBP/uncontrolled hypertension and self-reported hypertension, use of blood pressure medication, and a set of health system and sociodemographic variables in the nationally representative National Health and Nutrition Examination Survey. We applied this relationship to identical variables from the Behavioral Risk Factor Surveillance System to estimate state-specific mean SBP and uncontrolled hypertension. We used the comparative risk assessment methods to estim...

142 citations


Journal ArticleDOI
05 Mar 2008-PLOS ONE
TL;DR: The DOTS technical package improved overall treatment success, and the impact of DOTS expansion had no effect on case detection, which is less optimistic than previous analyses.
Abstract: Author(s): Obermeyer, Ziad; Abbott-Klafter, Jesse; Murray, Christopher JL | Abstract: BackgroundNearly fifteen years after the start of WHO's DOTS strategy, tuberculosis remains a major global health problem. Given the lack of empirical evidence that DOTS reduces tuberculosis burden, considerable debate has arisen about its place in the future of global tuberculosis control efforts. An independent evaluation of DOTS, one of the most widely-implemented and longest-running interventions in global health, is a prerequisite for meaningful improvements to tuberculosis control efforts, including WHO's new Stop TB Strategy. We investigate the impact of the expansion of the DOTS strategy on tuberculosis case finding and treatment success, using only empirical data.Methods and findingsWe study the effect of DOTS using time-series cross-sectional methods. We first estimate the impact of DOTS expansion on case detection, using reported case notification data and controlling for other determinants of change in notifications, including HIV prevalence, GDP, and country-specific effects. We then estimate the effect of DOTS expansion on treatment success. DOTS programme variables had no statistically significant impact on case detection in a wide range of models and specifications. DOTS population coverage had a significant effect on overall treatment success rates, such that countries with full DOTS coverage benefit from at least an 18% increase in treatment success (95% CI: 5-31%).ConclusionsThe DOTS technical package improved overall treatment success. By contrast, DOTS expansion had no effect on case detection. This finding is less optimistic than previous analyses. Better epidemiological and programme data would facilitate future monitoring and evaluation efforts.

87 citations


Journal ArticleDOI
TL;DR: In this paper, the authors examined the relationship between the observed drop in mean systolic blood pressure (SBP) in Japan in 1986-2002 and the use of antihypertensive treatment and lifestyle factors, including body mass index, physical activity, alcohol consumption, cigarette smoking and dietary salt intake.
Abstract: Objective To assess the relationships between the observed drop in mean systolic blood pressure (SBP) in Japan in 1986–2002 and the use of antihypertensive treatment and lifestyle factors. Methods A nationally representative sample of 90 554 men and 101 903 women aged 20 years and over was obtained from pooled data of annual cross-sectional surveys in Japan during 1986–2002. Using two-stage least squares with an instrumental variable, we examined the association between SBP and antihypertensive medication and lifestyle factors, including body mass index (BMI), physical activity, alcohol consumption, cigarette smoking and dietary salt intake. In the surveys, regular exercise was defined as exercise for more than 30 minutes at a time more than twice a week for over 1 year. Current smoking was defined as either daily or occasional cigarette use. Current drinking was defined as an intake of more than one standard cup of Japanese sake, one large bottle of regular beer, or one double measure of whisky at a time more than three times a week. Changes in mean predicted SBP in each sex and age group between 1986 and 2002 were decomposed into the respective contributions of these explanatory variables. Findings Age-specific means of predicted SBP declined during this period by 1.8 (95% confidence interval, CI: 1.2–2.5) to 3.0 (95% CI: 2.4–3.6) mmHg in men and 3.7 (95% CI: 3.4–4.1) to 5.1 (95% CI: 4.5–5.7) mmHg in women. These reductions were partly explained by the increased use of medications across all sex and age groups and decreased mean BMI in women in their 30s and 40s. The contributions of treatment effects increased with age. Elevated mean BMI in men and elderly women offset part of the decline of their mean SBP. Conclusion Declining mean SBP in Japan between 1986 and 2002 was partly attributable to the increased use of antihypertensive medications, especially in the older population, and lowered mean BMI in young women. However, a substantial part of the decline was left unexplained and needs to be investigated further. A still greater decline in SBP would be expected through improvements in body weight management, salt and alcohol intake, and treatment and control of hypertension.

73 citations


Journal ArticleDOI
TL;DR: Chandramohan et al. as discussed by the authors argue that the major obstacles to sharing data are technical, managerial, and financial rather than proprietorial concerns about analysis and publication, and argue that DSS data in the INDEPTH database should be made available to all researchers worldwide, not just to those within the International Network for the Continuous Demographic Evaluation of Populations and Their Health (INDEPTH).
Abstract: BACKGROUND TO THE DEBATE: Demographic surveillance--the process of monitoring births, deaths, causes of deaths, and migration in a population over time--is one of the cornerstones of public health research, particularly in investigating and tackling health disparities. An international network of demographic surveillance systems (DSS) now operates, mostly in sub-Saharan Africa and Asia. Thirty-eight DSS sites are coordinated by the International Network for the Continuous Demographic Evaluation of Populations and Their Health (INDEPTH). In this debate, Daniel Chandramohan and colleagues argue that DSS data in the INDEPTH database should be made available to all researchers worldwide, not just to those within the INDEPTH Network. Basia Zaba and colleagues argue that the major obstacles to DSS sites sharing data are technical, managerial, and financial rather than proprietorial concerns about analysis and publication. This debate is further discussed in this month's Editorial.

50 citations


Journal ArticleDOI
TL;DR: In this paper, the authors used multinomial logistic regression to estimate the effects of individual and community factors on a death for which diabetes was recorded as one of the multiple contributing causes of death.
Abstract: OBJECTIVE —The aim of this study was to increase the cross-state comparability of diabetes mortality statistics related in the U.S. and Mexico. RESEARCH DESIGN AND METHODS —We used multinomial logistic regression to estimate the effects of individual and community factors on a death for which diabetes was recorded as one of the multiple contributing causes of death (MCD) being assigned to diabetes as the underlying cause of death (UCD) versus assignment to cardiovascular, other noncommunicable, or communicable diseases. We used the model to estimate state-level diabetes death rates that are standardized in the individual and community factors. RESULTS —Deaths with diabetes as one of the MCD were more likely to be assigned to cardiovascular causes as the UCD if they occurred in hospitals or if an autopsy was performed and if the decedents were from states with higher BMI and systolic blood pressure, were more educated, or had insurance. Adjusting for individual- and community-level factors substantially increased the cross-state correlation of diabetes as the UCD and diabetes as one of the MCD mortality rates. The adjustment also reduced the number of direct diabetes deaths by 10% in the U.S. and by 24% in Mexico. In the U.S., deaths with diabetes as the UCD declined most in Utah, New Mexico, New Jersey, and Louisiana and increased in California and Hawaii. In Mexico, the numbers of adjusted diabetes deaths were smaller than those observed in all states by 3–34%. An additional 126,300 deaths due to ischemic heart disease and stroke in the U.S. and 19,497 in Mexico were attributable to high blood glucose. CONCLUSIONS —There is a need to improve the comparability of diabetes cause-of-death assignment, especially in relation to cardiovascular diseases.


Journal ArticleDOI
TL;DR: The Bayesian method was found to be a significant improvement for generating estimates of incidence for many external causes and performed poorly in distinguishing between falls and road traffic injuries, both of which are characterized by similar injury codes in the authors' datasets.

Journal ArticleDOI
TL;DR: A new section, Global Health Tracking, will appear regularly in The Lancet and the Institute for Health Metrics and Evaluation (IHME) is pleased to announce a collaboration that should stimulate researchers around the world to apply the best science to the challenges of monitoring global health.

01 Jan 2008
TL;DR: In this debate, Daniel Chandramohan and colleagues argue that DSS data in the InDEPTH database should be made available to all researchers worldwide, not just to those within the INDEPTH Network.
Abstract: Background to the debate: Demographic surveillance— the process of monitoring births, deaths, causes of deaths, and migration in a population over time—is one of the cornerstones of public health research, particularly in investigating and tackling health disparities. An international network of demographic surveillance systems (DSS) now operates, mostly in sub-Saharan Africa and Asia. Thirty-eight DSS sites are coordinated by the International Network for the Continuous Demographic Evaluation of Populations and Their Health (INDEPTH). In this debate, Daniel Chandramohan and colleagues argue that DSS data in the INDEPTH database should be made available to all researchers worldwide, not just to those within the INDEPTH Network. Basia Z . aba and colleagues argue that the major obstacles to DSS sites sharing data are technical, managerial, and financial rather than proprietorial concerns about analysis and publication. This debate is further discussed in this month’s Editorial.

Journal Article
TL;DR: Declining mean SBP in Japan between 1986 and 2002 was partly attributable to the increased use of antihypertensive medications, especially in the older population, and lowered mean BMI in young women.
Abstract: Introduction Control of systolic blood pressure (SBP) is an important public health issue because elevated SBP is one of the independent risk factors for cardiovascular disease (CVD). (1-3) CVD is a leading contributor to the global burden of disease, accounting for 28% of 50 million deaths and 13% of 1.4 billion disability-adjusted life years in 2001. (4) Several prospective cohort studies revealed that lower SBP at baseline is associated with reduced CVD mortality and incidence. (2,3,5) It has been reported that even a decline of SBP at baseline by 2 mmHg is related to a reduction of 16-year mortality from CVD by 5%. (6) Effective control of SBP is thus essential for improving population health. However, the global trend of hypertension has been worsening. The estimated global prevalence of hypertension was more than 25% among adults in the year 2000 and it is projected to rise, especially in developing countries, between 2000 and 2025. (7) It is also noteworthy that mean SBP in the United States of America decreased during the 1970s and 1980s, but the trend has stagnated since the 1990s. (8-10) A declining trend of mean SBP has been observed in several general populations, including Japan. (8,11-15) Understanding why mean SBP has been decreasing in these populations is crucial for public health policy. Although population-wide and personal interventions might have been effective, the factors that actually contributed to the decline of mean SBP have not been investigated yet, largely due to the lack of longitudinal data based on a nationally representative sample. According to two previous studies of how individual SBP is distributed in the population and how the distribution had shifted over time, changes in population-wide behaviours and environmental conditions made a larger contribution to the trend than improved treatments. (16,17) However, the nature of the cross-sectional survey data that were used in these studies precluded further quantification of the contributions of individual factors. Japan has experienced a remarkable reduction in mean SBP since the late 1960s. (12,13,15,18) A study using published summary statistics attributed the decline of mean SBP between 1965 and 1980 to the improved treatment rate of CVD. (15) However, so far no one has examined why mean SBP further decreased since the 1980s in Japanese adults for which individual-level data on SBP and the use of antihypertensive medications are electronically available. The objective of this study was to explore the factors linked to the decline of mean SBP and evaluate their individual contributions by using a statistical model to address potential treatment bias in cross-sectional data and thereby obtain useful information for public health policies. Pooling data of nationally representative annual surveys in Japan between the mid 1980s and the early 2000s, this study assessed the relationships between the change in mean SBP and changes in the use of antihypertensive treatment and lifestyle factors in Japanese adults. Methods Data sources We used microdata of the National Nutrition Survey (NNS), which is a cross-sectional interview and examination survey conducted on a nationally representative sample every November by the Ministry of Health, Labour and Welfare. This survey aims at obtaining basic data on anthropometry, nutritional intake and diet, and lifestyles to establish measures for nationwide health promotion. (19) The methods of the NNS have been described in detail elsewhere. (20) Eligible respondents included all residents aged 1 year and older in 300 census tracts that were randomly selected from around 900 000 census tracts. Response rates of the NNS were estimated to be 60-70%, (21) and the sample was considered representative of the Japanese population. (22) In the NNS, all household members were asked to participate in physical examinations at a local community centre near their residence on a specific day during the survey period. …

Posted Content
TL;DR: The authors reviewed the limited knowledge on the health consequences of conflict, suggest ways to improve measurement, and discuss the potential for risk assessment and for preventing and ameliorating the consequences of conflicts.
Abstract: Armed conflict is a major cause of injury and death worldwide, but we need much better methods of quantification before we can accurately assess its effect. Armed conflict between warring states and groups within states have been major causes of ill health and mortality for most of human history. Conflict obviously causes deaths and injuries on the battlefield, but also health consequences from the displacement of populations, the breakdown of health and social services, and the heightened risk of disease transmission. Despite the size of the health consequences, military conflict has not received the same attention from public health research and policy as many other causes of illness and death. In contrast, political scientists have long studied the causes of war but have primarily been interested in the decision of elite groups to go to war, not in human death and misery. We review the limited knowledge on the health consequences of conflict, suggest ways to improve measurement, and discuss the potential for risk assessment and for preventing and ameliorating the consequences of conflict.

01 Jan 2008
TL;DR: The IHME will kick-start this call for papers with six or more reports each year, covering topics such as adult mortality, causes of death, burden of disease, eff ective coverage of inter ven tions, technical quality of providers, aid fl ows, national health accounts, and human resources.
Abstract: 1140 www.thelancet.com Vol 371 April 5, 2008 First, as with laboratory science, studies on global health monitoring must meet the benchmark of replication by other scientists. Replication requires that methods be described in suffi cient detail and that data used by authors in their analyses be available to interested researchers. Second, health statistics should be clearly identifi ed in tables, fi gures, and results as crude statistics, corrected statistics, or predicted statistics. Where crude data are presented, the onus is on the authors to justify why known biases should not be corrected. Where corrections have been made, these must be detailed as part of the methods. Where predicted statistics are used or incorporated with corrected data into regional and global fi gures, these hybrids must be clearly identifi ed. Third, uncertainty intervals should be reported that are grounded in some theory of measurement. Wherever possible, uncertainty intervals should refl ect not only sampling error, but also the uncertainty generated through correction for known biases and model fi tting. The Global Health Tracking section will be open to submissions from all scientists—at international agencies, academic institutions, and ministries. Final editorial decisions will be made exclusively by The Lancet. It is expected that the IHME will kick-start this call for papers with six or more reports each year, covering topics such as adult mortality, causes of death, burden of disease, eff ective coverage of inter ven tions, technical quality of providers, aid fl ows, national health accounts, and human resources. Please sub mit contributions to Global Health Tracking directly to The Lancet. We hope this initiative will signal a renewed commitment to global accountability for health goals.