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Showing papers by "Christopher J L Murray published in 2009"


Journal ArticleDOI
TL;DR: Examination of US data on risk factor exposures and disease-specific mortality finds that smoking and hypertension, which both have effective interventions, are responsible for the largest number of deaths.
Abstract: Background: Knowledge of the number of deaths caused by risk factors is needed for health policy and priority setting. Our aim was to estimate the mortality effects of the following 12 modifiable dietary, lifestyle, and metabolic risk factors in the United States (US) using consistent and comparable methods: high blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure; overweight–obesity; high dietary trans fatty acids and salt; low dietary polyunsaturated fatty acids, omega-3 fatty acids (seafood), and fruits and vegetables; physical inactivity; alcohol use; and tobacco smoking. Methods and Findings: We used data on risk factor exposures in the US population from nationally representative health surveys and disease-specific mortality statistics from the National Center for Health Statistics. We obtained the etiological effects of risk factors on disease-specific mortality, by age, from systematic reviews and meta-analyses of epidemiological studies that had adjusted (i) for major potential confounders, and (ii) where possible for regression dilution bias. We estimated the number of disease-specific deaths attributable to all non-optimal levels of each risk factor exposure, by age and sex. In 2005, tobacco smoking and high blood pressure were responsible for an estimated 467,000 (95% confidence interval [CI] 436,000–500,000) and 395,000 (372,000–414,000) deaths, accounting for about one in five or six deaths in US adults. Overweight–obesity (216,000; 188,000–237,000) and physical inactivity (191,000; 164,000–222,000) were each responsible for nearly 1 in 10 deaths. High dietary salt (102,000; 97,000–107,000), low dietary omega-3 fatty acids (84,000; 72,000–96,000), and high dietary trans fatty acids (82,000; 63,000–97,000) were the dietary risks with the largest mortality effects. Although 26,000 (23,000–40,000) deaths from ischemic heart disease, ischemic stroke, and diabetes were averted by current alcohol use, they were outweighed by 90,000 (88,000–94,000) deaths from other cardiovascular diseases, cancers, liver cirrhosis, pancreatitis, alcohol use disorders, road traffic and other injuries, and violence. Conclusions: Smoking and high blood pressure, which both have effective interventions, are responsible for the largest number of deaths in the US. Other dietary, lifestyle, and metabolic risk factors for chronic diseases also cause a substantial number of deaths in the US. Please see later in the article for the Editors’ Summary.

2,751 citations


Journal ArticleDOI
TL;DR: Adjuvant external beam radiotherapy cannot be recommended as part of routine treatment for women with intermediate-risk or high-risk early-stage endometrial cancer with the aim of improving survival and a meta-analysis of trials confirmed that there was no benefit in terms of overall survival.

539 citations


Journal ArticleDOI
TL;DR: The substantial rise of resources for global health in recent years has been accompanied by major changes in the institutional landscape of global health, with global health initiatives such as the Global Fund and GAVI having a central role in mobilising and channelling global health funds.

535 citations


Journal ArticleDOI
TL;DR: In this article, the authors explore what determines people's satisfaction with the health-care system above and beyond their experience as patients, and find that patient experience was significantly associated with satisfaction with health care system and explained 10.4% of the variation around the concept of satisfaction.
Abstract: OBJECTIVE: To explore what determines people's satisfaction with the health-care system above and beyond their experience as patients. METHODS: Data on health system responsiveness, which refers to the manner and environment in which people are treated when they seek health care, provides a unique opportunity to better understand the determinants of people's satisfaction with the health-care system and how strongly this is influenced by an individual's experience as a patient. The data were obtained from 21 European Union countries in the World Health Survey for 2003. Additive ordinary least-squares regression models were used to assess the extent to which variables commonly associated with satisfaction with the health-care system, as recorded in the literature, explain the variation around the concept of satisfaction. A residual analysis was used to identify other predictors of satisfaction with the health-care system. FINDINGS: Patient experience was significantly associated with satisfaction with the health-care system and explained 10.4% of the variation around the concept of satisfaction. Other factors such as patient expectations, health status, type of care, and immunization coverage were also significant predictors of health system satisfaction; although together they explained only 17.5% of the observed variation, while broader societal factors may largely account for the unexplained portion of satisfaction with the health-care system. CONCLUSION: Contrary to published reports, people's satisfaction with the health-care system depends more on factors external to the health system than on the experience of care as a patient. Thus, measuring the latter may be of limited use as a basis for quality improvement and health system reform.

444 citations


Journal Article
TL;DR: In this article, the authors explored the factors underlying people's degree of satisfaction with the health-care system and the extent to which the latter reflects their experience of care using data from the response module of the World Health Survey for 2003.
Abstract: Introduction Across the United States of America and Europe, consumer satisfaction is playing an increasingly important role in quality of care reforms and health-care delivery more generally However, consumer satisfaction studies are challenged by the lack of a universally accepted definition or measure (1-6) and by a dual focus: while some researchers focus on patient satisfaction with the quality and type of health-care services received, (7-10) others focus on people's satisfaction with the health system more generally (11-14) The importance of both perspectives has been demonstrated in the literature For example, satisfied patients are more likely to complete treatment regimens and to be compliant and cooperative (14,15) Research on health system satisfaction, which is largely comparative, has identified ways to improve health, reduce costs and implement reform (16) The absence of a solid conceptual basis and consistent measurement tool for consumer satisfaction has led, over the past 10 years, to a proliferation of surveys that focus exclusively on patient experience, ie aspects of the care experience such as waiting times, the quality of basic amenities, and communication with health-care providers, all of which help identify tangible priorities for quality improvement In the future, measures of patient experience, intended to capture the "responsiveness" of the health system, (17) a concept developed by WHO, are likely to receive even greater attention as physicians and hospitals come under growing pressure to improve the quality of care, enhance patient safety and lower the cost of services Health system responsiveness specifically refers to the manner and environment in which people are treated when they seek health care The increasing importance of patient experience and the sustained interest in comparing people's satisfaction with the health system across different countries and time periods suggests the need to characterize the relationship between them Research relating global satisfaction ratings with patient experience has revealed strong associations between the two (18) Yet, to what extent patient experience explains satisfaction with the health-care system remains unclear The literature suggests that much of the remaining variation in health system satisfaction after adjusting for factors commonly used to measure the concept is a reflection of patient experience (19,20) We disagree and hypothesize that patient experience accounts for only a small fraction of the unexplained variation in health system satisfaction, even after adjustments for the demographic, health and institutional factors with which such satisfaction is commonly associated (16-18,21-24) In particular, we expect most of the variation in satisfaction with the health-care system to be explained by factors above and beyond patient experience In this paper, we explore the factors underlying people's degree of satisfaction with the health-care system and the extent to which the latter reflects their experience of care Data from the module on health system responsiveness in the World Health Survey for 2003 (25) provided a unique opportunity to better understand the determinants of people's satisfaction with the health-care system, besides their experience as patients, in 21 countries of the European Union (EU) Throughout the paper, we use WHO'S term "responsiveness" to refer to satisfaction with the health system from the perspective of patient experience Methods Study data The conceptual basis and design of the responsiveness module in the World Health Survey have been described extensively in the literature (22,24) This paper presents results from the responsiveness module of the World Health Survey that was fielded in 71 countries in 2002 and 2003 (the survey instrument is available at: http://wwwwhoint/ healthinfo/survey/whslongindividuala pdf) This paper focuses on the EU, given the similarity in health outcomes among its member countries (26) and the relevance of consumer satisfaction to quality of care reforms in that region …

428 citations


Journal ArticleDOI
TL;DR: While young adults are at high risk in non-fatal crashes, the elderly have the highest total death rates, largely due to pedestrian crashes, while motorised two-wheeler riders dominate hospital admissions, outpatient visits and health burden in Iran.
Abstract: Objective: To use a range of existing information sources to develop a national snapshot of the burden of road traffic injuries in one developing country—Iran. Methods: The distribution of deaths was estimated by using data from the national death registration system, hospital admissions and outpatient visits from a timelimited hospital registry in 12 of 30 provinces, and injuries that received no institutional care using the 2000 demographic and health survey. Results were extrapolated to national annual incidence of health burden differentiated by age, sex, external cause, nature of injuries and institutional care. Results: In 2005, 30 721 Iranians died annually in road traffic crashes and over one million were injured. The death rate (44 per 100 000) is the highest of any country in the world for which reliable estimates are available. Road traffic injuries are the third leading cause of death in Iran. While young adults are at high risk in non-fatal crashes, the elderly have the highest total death rates, largely due to pedestrian crashes. While car occupants lead the death count, motorised two-wheeler riders dominate hospital admissions, outpatient visits and health burden. Conclusions: Reliable estimates of the burden of road traffic injuries are an essential input for rational priority setting. Most low income countries are unlikely to have national injury surveillance systems for several decades. Thus national estimates of the burden of injuries should be built by collating information from all existing information sources by appropriately correcting for source specific shortcomings.

157 citations


Journal ArticleDOI
TL;DR: A comprehensive comparative analysis of responses to a common self-rated health question in 4 national surveys from 1971 to 2007 suggests that self- rated health may be unsuitable for monitoring changes in population health over time.
Abstract: Although self-rated health is proposed for use in public health monitoring, previous reports on US levels and trends in self-rated health have shown ambiguous results. This study presents a comprehensive comparative analysis of responses to a common self-rated health question in 4 national surveys from 1971 to 2007: the National Health and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, and Current Population Survey. In addition to variation in the levels of self-rated health across surveys, striking discrepancies in time trends were observed. Whereas data from the Behavioral Risk Factor Surveillance System demonstrate that Americans were increasingly likely to report "fair" or "poor" health over the last decade, those from the Current Population Survey indicate the opposite trend. Subgroup analyses revealed that the greatest inconsistencies were among young respondents, Hispanics, and those without a high school education. Trends in "fair" or "poor" ratings were more inconsistent than trends in "excellent" ratings. The observed discrepancies elude simple explanations but suggest that self-rated health may be unsuitable for monitoring changes in population health over time. Analyses of socioeconomic disparities that use self-rated health may be particularly vulnerable to comparability problems, as inconsistencies are most pronounced among the lowest education group. More work is urgently needed on robust and comparable approaches to tracking population health.

152 citations


Journal ArticleDOI
TL;DR: The magnitude of both out-of-pocket and catastrophic spending on health is affected by the choice of recall period and the number of items, and it is crucial to establish a method to generate valid, reliable and comparable information on private health spending.
Abstract: OBJECTIVE: To investigate the effect of survey design, specifically the number of items and recall period, on estimates of household out-of-pocket and catastrophic expenditure on health. METHODS: We used results from two surveys - the World Health Survey and the Living Standards Measurement Study - that asked the same respondents about health expenditures in different ways. Data from the World Health Survey were used to compare estimates of average annual out-of-pocket spending on health care derived from a single-item and from an eight-item measure. This was done by calculating the ratio of the average obtained with the single-item measure to that obtained with the eight-item measure. Estimates of catastrophic spending from the two measures were also compared. Data from the Living Standards Measurement Study from three countries (Bulgaria, Jamaica and Nepal) with different recall periods and varying numbers of items in different modules were used to compare estimates of average annual out-of-pocket spending derived using various methods. FINDINGS: In most countries, a lower level of disaggregation (i.e. fewer items) gave a lower estimate for average health spending, and a shorter recall period yielded a larger estimate. However, when the effects of aggregation and recall period are combined, it is difficult to predict which of the two has the greater influence. CONCLUSION: The magnitude of both out-of-pocket and catastrophic spending on health is affected by the choice of recall period and the number of items. Thus, it is crucial to establish a method to generate valid, reliable and comparable information on private health spending.

149 citations


Journal ArticleDOI
TL;DR: Diabetes prevalence is highest in the Southern and Appalachian states and lowest in the Midwest and the Northeast, and better diabetes diagnosis is needed in a number of states.
Abstract: Current US surveillance data provide estimates of diabetes using laboratory tests at the national level as well as self-reported data at the state level. Self-reported diabetes prevalence may be biased because respondents may not be aware of their risk status. Our objective was to estimate the prevalence of diagnosed and undiagnosed diabetes by state. We estimated undiagnosed diabetes prevalence as a function of a set of health system and sociodemographic variables using a logistic regression in the National Health and Nutrition Examination Survey (2003-2006). We applied this relationship to identical variables from the Behavioral Risk Factor Surveillance System (2003-2007) to estimate state-level prevalence of undiagnosed diabetes by age group and sex. We assumed that those who report being diagnosed with diabetes in both surveys are truly diabetic. The prevalence of diabetes in the U.S. was 13.7% among men and 11.7% among women ≥ 30 years. Age-standardized diabetes prevalence was highest in Mississippi, West Virginia, Louisiana, Texas, South Carolina, Alabama, and Georgia (15.8 to 16.6% for men and 12.4 to 14.8% for women). Vermont, Minnesota, Montana, and Colorado had the lowest prevalence (11.0 to 12.2% for men and 7.3 to 8.4% for women). Men in all states had higher diabetes prevalence than women. The absolute prevalence of undiagnosed diabetes, as a percent of total population, was highest in New Mexico, Texas, Florida, and California (3.5 to 3.7 percentage points) and lowest in Montana, Oklahoma, Oregon, Alaska, Vermont, Utah, Washington, and Hawaii (2.1 to 3 percentage points). Among those with no established diabetes diagnosis, being obese, being Hispanic, not having insurance and being ≥ 60 years old were significantly associated with a higher risk of having undiagnosed diabetes. Diabetes prevalence is highest in the Southern and Appalachian states and lowest in the Midwest and the Northeast. Better diabetes diagnosis is needed in a number of states.

133 citations


Journal ArticleDOI
TL;DR: Logistic regression is performed to adjust for biases in self-reported impairments by using measured performance may be useful in various health domains.
Abstract: Trends in the prevalence of hearing loss among US adults remain ambiguous because of variation across surveys in question wording and limited use of audiometric examinations. Pooling samples of participants aged 20–69 years in 4 nationally representative cross-sectional survey series conducted from 1976 to 2006 (N ¼ 990,609), the authors performed logistic regression to quantify self-reporting biases compared with audiometric measurements. Statistically significant underreporting or overreporting of hearing loss was observed, with various patterns of bias across age groups and surveys. Substantial upward reporting biases appeared among young adults in the National Health and Nutrition Examination Survey since 1999 and in the National Health Interview Survey since 1997. Trends in age-standardized prevalence of bilateral hearing loss were estimated with corrections for self-reporting biases. Prevalence in men shifted from 9.6% (95% confidence interval (CI): 7.8, 11.8) in 1978 to 12.2% (95% CI: 10.1, 14.7) in 1993 and declined to 8.1% (95% CI: 7.0, 9.5) in 2000. In women, prevalence was relatively constant at approximately 6%–7% until the early 1990s and decreased from 7.0% (95% CI: 5.5, 9.1) in 1993 to 4.2% (95% CI: 3.4, 5.3) in 2000. Prevalence was stable in both sexes in the early 2000s. This approach to adjust for biases in self-reported impairments by using measured performance may be useful in various health domains. adult; cross-sectional studies; health surveys; hearing loss; logistic models; prevalence; United States; validation studies

35 citations