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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.


Papers
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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 Article
TL;DR: The results of applying these methods to estimate the cause of death for over 120 diseases or injuries, by age, sex and region, are described in this article, in order to calculate the years of life lost due to premature death, one of the two components of overall disability-adjusted life years (DALYs) calculated for the 1993 World development report.
Abstract: Demographic estimation techniques suggest that worldwide about 50 million deaths occur each year, of which about 39 million are in the developing countries In countries with adequate registration of vital statistics, the age at death and the cause can be reliably determined Only about 30-35% of all deaths are captured by vital registration (excluding sample registration schemes); for the remainder, cause-of-death estimation procedures are required Indirect methods which model the cause-of-death structure as a function of the level of mortality can provide reasonable estimates for broad cause-of-death groups Such methods are generally unreliable for more specific causes In this case, estimates can be constructed from community-level mortality surveillance systems or from epidemiological evidence on specific diseases Some check on the plausibility of the estimates is possible in view of the hierarchical structure of cause-of-death lists and the well-known age-specific patterns of diseases and injuries The results of applying these methods to estimate the cause of death for over 120 diseases or injuries, by age, sex and region, are described The estimates have been derived in order to calculate the years of life lost due to premature death, one of the two components of overall disability-adjusted life years (DALYs) calculated for the 1993 World development report Previous attempts at cause-of-death estimation have been limited to a few diseases only, with little age-specific detail The estimates reported in detail here should serve as a useful reference for further public health research to support the determination of health sector priorities

151 citations

Journal ArticleDOI
TL;DR: Increased physical activity alone has a small impact on obesity prevalence at the county level in the US, and the rise in physical activity levels will have a positive independent impact on the health of Americans as it will reduce the burden of cardiovascular diseases and diabetes.
Abstract: Obesity and physical inactivity are associated with several chronic conditions, increased medical care costs, and premature death. We used the Behavioral Risk Factor Surveillance System (BRFSS), a state-based random-digit telephone survey that covers the majority of United States counties, and the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US civilian noninstitutionalized population. About 3.7 million adults aged 20 years or older participated in the BRFSS from 2000 to 2011, and 30,000 adults aged 20 or older participated in NHANES from 1999 to 2010. We calculated body mass index (BMI) from self-reported weight and height in the BRFSS and adjusted for self-reporting bias using NHANES. We calculated self-reported physical activity—both any physical activity and physical activity meeting recommended levels—from self-reported data in the BRFSS. We used validated small area estimation methods to generate estimates of obesity and physical activity prevalence for each county annually for 2001 to 2011. Our results showed an increase in the prevalence of sufficient physical activity from 2001 to 2009. Levels were generally higher in men than in women, but increases were greater in women than men. Counties in Kentucky, Florida, Georgia, and California reported the largest gains. This increase in level of activity was matched by an increase in obesity in almost all counties during the same time period. There was a low correlation between level of physical activity and obesity in US counties. From 2001 to 2009, controlling for changes in poverty, unemployment, number of doctors per 100,000 population, percent rural, and baseline levels of obesity, for every 1 percentage point increase in physical activity prevalence, obesity prevalence was 0.11 percentage points lower. Our study showed that increased physical activity alone has a small impact on obesity prevalence at the county level in the US. Indeed, the rise in physical activity levels will have a positive independent impact on the health of Americans as it will reduce the burden of cardiovascular diseases and diabetes. Other changes such as reduction in caloric intake are likely needed to curb the obesity epidemic and its burden.

150 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

Joshua A. Salomon, Theo Vos, Daniel R Hogan, Michael L. Gagnon, Mohsen Naghavi, Ali H. Mokdad, Nazma Begum, Ravi V. Shah, Muhammad Karyana, Soewarta Kosen, M.R. Farje, G. Moncada, Arup Dutta, Sunil Sazawal, Anthony Dyer, Jason F. S. Seiler, Victor Aboyans, L. Baker, Amanda J Baxter, Emelia J. Benjamin, Kavi Bhalla, Aref A. Bin Abdulhak, Fiona M. Blyth, Rupert R A Bourne, Tasanee Braithwaite, Peter Brooks, Traolach S. Brugha, Claire Bryan-Hancock, Rachelle Buchbinder, Peter Burney, Bianca Calabria, Honglei Chen, Sumeet S. Chugh, R. Cooley, Michael H. Criqui, Marita Cross, Kaustubh Dabhadkar, Nabila Dahodwala, Adrian Davis, Louisa Degenhardt, Cesar Diaz-Torne, E. R. Dorsey, Tim Driscoll, Karen Edmond, Alexis Elbaz, Majid Ezzati, Valery L. Feigin, Cleusa P. Ferri, Abraham D. Flaxman, Louise Flood, Marlene Fransen, K. Fuse, Belinda J. Gabbe, Richard F. Gillum, Juanita A. Haagsma, James Harrison, Rasmus Havmoeller, Roderick J. Hay, A. Hel-Baqui, Hans W. Hoek, Howard J. Hoffman, E. Hogeland, Damian G Hoy, Deborah Jarvis, Ganesan Karthikeyan, Lisa M. Knowlton, Tim Lathlean, Janet L Leasher, Stephen S Lim, Steven E. Lipshultz, Alan D. Lopez, Rafael Lozano, Ronan A Lyons, Reza Malekzadeh, Wagner Marcenes, Lyn March, David J. Margolis, Neil McGill, John J. McGrath, George A. Mensah, A.C. Meyer, Catherine Michaud, Andrew E. Moran, Rintaro Mori, M. E. Murdoch, Luigi Naldi, Charles R. Newton, Rosana E. Norman, Saad B. Omer, Richard H. Osborne, Neil Pearce, Fernando Perez-Ruiz, Norberto Perico, Konrad Pesudovs, David Phillips, Farshad Pourmalek, Martin Prince, Jürgen Rehm, G. Remuzzi, Kathryn Richardson, Robin Room, Sukanta Saha, Uchechukwu Sampson, Lidia Sanchez-Riera, Maria Segui-Gomez, Saeid Shahraz, Kenji Shibuya, Deo Singh, Karen Sliwa, Emma Smith, Isabelle Soerjomataram, Timothy J. Steiner, Wilma A. Stolk, Lars Jacob Stovner, Christopher R. Sudfeld, Hugh R. Taylor, Imad M. Tleyjeh, M.J. Van Der Werf, W.L. Watson, David J. Weatherall, Robert G. Weintraub, Marc G. Weisskopf, Harvey Whiteford, James D. Wilkinson, Anthony D. Woolf, Zhi Jie Zheng, Christopher J L Murray 
01 Jan 2012
TL;DR: This study represents the most extensive empirical effort as yet to measure disability weights and reports strong evidence of highly consistent results.
Abstract: NOTE: This article is free to read on the journal website provided you register (which is free). BACKGROUND Measurement of the global burden of disease with disability-adjusted life-years (DALYs) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury. There has been extensive debate about a range of conceptual and methodological issues concerning the definition and measurement of these weights. Our primary objective was a comprehensive re-estimation of disability weights for the Global Burden of Disease Study 2010 through a large-scale empirical investigation in which judgments about health losses associated with many causes of disease and injury were elicited from the general public in diverse communities through a new, standardised approach. METHODS We surveyed respondents in two ways: household surveys of adults aged 18 years or older (face-to-face interviews in Bangladesh, Indonesia, Peru, and Tanzania; telephone interviews in the USA) between Oct 28, 2009, and June 23, 2010; and an open-access web-based survey between July 26, 2010, and May 16, 2011. The surveys used paired comparison questions, in which respondents considered two hypothetical individuals with different, randomly selected health states and indicated which person they regarded as healthier. The web survey added questions about population health equivalence, which compared the overall health benefits of different life-saving or disease-prevention programmes. We analysed paired comparison responses with probit regression analysis on all 220 unique states in the study. We used results from the population health equivalence responses to anchor the results from the paired comparisons on the disability weight scale from 0 (implying no loss of health) to 1 (implying a health loss equivalent to death). Additionally, we compared new disability weights with those used in WHO's most recent update of the Global Burden of Disease Study for 2004. FINDINGS 13,902 individuals participated in household surveys and 16,328 in the web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0·9 or higher in all surveys except in Bangladesh (r=0·75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0·05. Five (11%) states had weights below 0·01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0·76) and severe multiple sclerosis (0·71). We identified a broad pattern of agreement between the old and new weights (r=0·70), particularly in the moderate-to-severe range. However, in the mild range below 0·2, many states had significantly lower weights in our study than previously. INTERPRETATION This study represents the most extensive empirical effort as yet to measure disability weights. By contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, we have reported strong evidence of highly consistent results.

148 citations


Cited by
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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

Journal ArticleDOI
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