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Christopher J L Murray

Bio: Christopher J L Murray is an academic researcher from Institute for Health Metrics and Evaluation. The author has contributed to research in topics: Population & Mortality rate. The author has an hindex of 209, co-authored 754 publications receiving 310329 citations. Previous affiliations of Christopher J L Murray include Harvard University & University of Washington.


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Journal ArticleDOI
TL;DR: The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets.
Abstract: In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed. The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets. The writing committee, which reflects Global Cardiovascular Disease Taskforce membership, engaged the Institute for Health Metrics and Evaluation, University of Washington, to develop region-specific estimates of premature cardiovascular mortality in 2025 based on various scenarios. Results show that >5 million premature CVD deaths among men and 2.8 million among women are projected worldwide by 2025, which can be reduced to 3.5 million and 2.2 million, respectively, if risk factor targets for blood pressure, tobacco use, diabetes mellitus, and obesity are achieved. However, global risk factor targets have various effects, depending on region. For most regions, United Nations targets for reducing systolic blood pressure and tobacco use have more substantial effects on future scenarios compared with maintaining current levels of body mass index and fasting plasma glucose. However, preventing increases in body mass index has the largest effect in some high-income countries. An approach achieving reductions in multiple risk factors has the largest impact for almost all regions. Achieving these goals can be accomplished only if countries set priorities, implement cost-effective population wide strategies, and collaborate in public-private partnerships across multiple sectors.

8 citations

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TL;DR: The USA consistently ranks below other developed nations and many developing nations for mental disorders despite spending 17·6% of its gross domestic product on health in 2010, with 5% of that on mental health, among the highest of any country.

8 citations

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TL;DR: In this article , the authors estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.

8 citations

Journal ArticleDOI
TL;DR: The use of incidence-preva-lence–mortality (IPM) models does not permit determination of whether inconsistencies in empirical dataare due to data inaccuracies or to past trends in incidence or mortality, and an improved software tool, DisMod II, is developed for use in GBD2000.
Abstract: Information about the incidence and preva-lenceofdiseasesandinjuriesatthepopulationlevelisfrequentlyrequiredforbenchmarking,for advocacy of particular policies, to assistin setting funding priorities, for monitoringachievements towards internationallyaccepted goals and targets, and to guidetechnical strategies and responses. In thisissue of the Bulletin (pp. 622–628), Kruijshaaret al. examine the use of incidence–preva-lence–mortality (IPM) models to improveestimates of disease epidemiology.The Global Burden of Disease (GBD)study (1, 2) developed explicit methods,including the DisMod software, to ensureinternal consistency of epidemiologicaland mortality estimates for specific causes.WHO is now undertaking a new assessmentof the GBD for the year 2000 (GBD 2000)and subsequent years (3). Explicit aims aretoprovidevalid,internallyconsistentestimatesof the incidence, prevalence, duration, andmortality for 135 disease and injury causesfor major geographical regions, and toanalyse the attributable burden of majorphysiological, behavioural, and social riskfactors. The use of IPM models is crucialfor achieving these objectives, and Murray& Barendregt have developed an improvedsoftware tool, DisMod II, for use in GBD2000. This is available at no cost from WHOfor use in other analyses (4).A disease process can be described bya number of variables, such as incidence,prevalence, remission, case fatality, duration,and mortality. In principle, these can all bemeasured in populations, but with differentdegrees of difficulty. Mortality, for example,can be relatively easily measured usingnational vital registration systems, but theunderlying cause of death can bemisreportedormisclassified.Nevertheless,manycountrieshave cause-of-death statistics that usuallyconstitute the most reliable and comparablesource of disease data at population level.Measuring incidence and prevalence ofdiseases, injuries, or impairments is usuallymuchmoredifficultthanmeasuringmortality.Data collection, when done, is often limitedin time and geographical area; and problemsof case definition abound. Not surprisingly,data are frequently incomplete, and theirvalidity may be in doubt. In particular, giventhe different nature of the disease variablesand the differences in the way the data arecollected, it is inevitable that the observationsare internally inconsistent. For example,when more incident cases than mortality aremissed, the observed incidence will be toosmall for the observed mortality.Both the GBD and national burdenof disease studies have identified inconsis-tencies between incidence, prevalence, andmortality data for specific diseases of publichealthimportance.Kruijshaaretal.givesomeexamples in their paper. Using IPM analysis,the Australian Burden of Disease and InjuryStudy found that incidence estimates froma recent meta-analysis of incidence ofdementia (5) were inconsistent with previousprevalence meta-analyses (6, 7) unlessimplausibly high case-fatality rates wereassumed (8). Such inconsistencies inepidemiological evidence are common, andto maximize the validity and usefulness ofsuchevidenceforhealthpolicy,itisimportantto assess internal consistency.Kruijshaar et al. conclude that use ofIPM models does not permit determinationof whether inconsistencies in empirical dataare due to data inaccuracies or to past trendsin incidence or mortality. To enable users toaddress this issue, both DisMod and DisModII include an option to specify past trendsin input parameters (which may be assessedfrom empirical evidence or expert opinion)in order to allow analysis of their effect oninternal consistency for the time periodof interest.When IPM models are used to analyseempirical evidence, it is crucial to includeexcess mortality from other causes as well asdirect mortality due to the cause of interest.Formanydiseases,andforinjuries,theremaybe excess mortality due to a wide range ofcausesassociatedwithcommonriskfactorsorwith disease or injury sequelae or treatment.Thus, for example, for many cancers thereis likely to be excess mortality from othercauses such as cardiovascular disease,diabetes, and chronic respiratory disease,associated with common dietary risk factorsand other behavioural, environmental, andgenetic risk factors. Failure to include allexcessmortalityriskintheIPMmodel,aswasthecasewiththeanalysesforthefourcancersreported by Kruijshaar et al., will result inincorrect assessment of consistency betweenincidence and prevalence observations.Health planning often proceeds on thebasis of incomplete or biased epidemiologicalevidence that is not comparable acrosspopulation groups. We argue that in all cases,health policy should be informed by validand internally consistent epidemiologicalestimates.Theremaywellbewideuncertaintyaround some estimates due to the lack ofreliable information, but the uncertaintyshould be quantified and relayed to decision-makers to aid their planning. In this respect,IPM models provide an important toolto assist in the development of evidence forhealth policy.

8 citations

Journal ArticleDOI
TL;DR: To predict ill-defined categories of death, adding relevant explanatory variables to gender and age is recommended.
Abstract: Objective To test the predictive ability of multinomial regression method in obtaining category of death distribution for cases with unknown/ill-defined mortality codes. Methods The authors evaluated the performance of the multinomial regression model by fitting the model to trial datasets from 2004 Mexican vital registration data. To predict category of death, the regression method makes use of explanatory variables, such as gender, age, place of crash, place of residence, education and insurance type. The authors compared the results of a full model regression with those of a reduced model that only contained gender and age as explanatory variables. For this comparison, the authors constructed two forms of data: dummy variable adjustment method and case-wise deleted method. The comparison was made through estimated area under the curve (AUC) for each outcome variable. Results The full model significantly outperformed the gender-age (reduced) model using both datasets. In the case-wise deleted method, the AUC was increased from 0.55 to 0.7 for the reduced model and from 0.64 to 0.84 for the full model. Improvement in AUC using the dummy variable adjustment method was less significant. Conclusions To predict ill-defined categories of death, adding relevant explanatory variables to gender and age is recommended. Multiple imputations may perform even better than this model especially when significant portion of the data are missing.

7 citations


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TL;DR: A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination, and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake.
Abstract: The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

52,293 citations

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TL;DR: A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.
Abstract: Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.

23,203 citations

Journal ArticleDOI
TL;DR: The results for 20 world regions are presented, summarizing the global patterns for the eight most common cancers, and striking differences in the patterns of cancer from region to region are observed.
Abstract: Estimates of the worldwide incidence and mortality from 27 cancers in 2008 have been prepared for 182 countries as part of the GLOBOCAN series published by the International Agency for Research on Cancer. In this article, we present the results for 20 world regions, summarizing the global patterns for the eight most common cancers. Overall, an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occur in 2008, with 56% of new cancer cases and 63% of the cancer deaths occurring in the less developed regions of the world. The most commonly diagnosed cancers worldwide are lung (1.61 million, 12.7% of the total), breast (1.38 million, 10.9%) and colorectal cancers (1.23 million, 9.7%). The most common causes of cancer death are lung cancer (1.38 million, 18.2% of the total), stomach cancer (738,000 deaths, 9.7%) and liver cancer (696,000 deaths, 9.2%). Cancer is neither rare anywhere in the world, nor mainly confined to high-resource countries. Striking differences in the patterns of cancer from region to region are observed.

21,040 citations

Journal ArticleDOI
TL;DR: It is recommended that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation.
Abstract: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

17,023 citations

Journal ArticleDOI
TL;DR: Findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant, and given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.
Abstract: OBJECTIVE —The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030. RESEARCH DESIGN AND METHODS —Data on diabetes prevalence by age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations’ population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries. RESULTS —The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age. CONCLUSIONS —These findings indicate that the “diabetes epidemic” will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.

16,648 citations