Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
TL;DR: Prevalence and severity of health loss were weakly correlated and age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010, but population growth and ageing have increased YLD numbers and crude rates over the past two decades.
About: This article is published in The Lancet.The article was published on 2012-12-15 and is currently open access. It has received 7021 citations till now. The article focuses on the topics: Years of potential life lost & Global health.
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TL;DR: Although non-communicable diseases had the greatest burden in 2010, the challenge of communicable and maternal diseases for health system is not over yet and Iranians would greatly benefit from effective strategies to prevent injury and musculoskeletal disorders and expand mental care.
Abstract: BACKGROUND: we aimed to recap and highlight the major results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 by mortality and morbidity to clarify the current health priorities and challenges in Iran. METHODS: We estimated Iran's mortality and burden of 289 diseases with 67 risk factors and 1160 sequelae, which were used to clinically present each disease and its disability or cause of death. We produced several measures to report health loss and status: all-cause mortality, cause-specific mortality, years of life lost due to death (YLL), healthy years of life lost due to disability (YLD), disability-adjusted life years (DALYs), life expectancy, and healthy life expectancy, for three time periods: 1990, 2005, and 2010. RESULTS: We found out that life expectancy at birth was 71.6 years in men and 77.8 years in women. Almost 350 thousand deaths occurred in both sexes and all age groups in 2010. In both males and females and all age groups, ischemic heart disease was the main cause of death, claiming about 90 thousand lives. The main contributors to DALYs were: ischemic heart disease (9.1%), low back pain (9.0%), road injuries (7.3%), and unipolar depressive disorders (6.3%). The main causes of death under 5 years of age included: congenital anomalies (22.4%), preterm birth complications (18.3%), and other neonatal disorders (13.5%). The main causes of death among 15 - 49 year olds in both sexes included: injuries (23.6%) and ischemic heart disease (12.7%) The highest rates of YLDs were observed among 70+ year olds for both sexes (27,365 per 100,000), mainly due to low back pain, osteoarthritis, diabetes, falls, and major depressive disorder. The main risk factors to which deaths were attributable among children under 5 years included: suboptimal breast feeding, ambient PM pollution, tobacco smoking, and underweight. The most important risk factors among 15 to 49 year olds were: dietary risks, high blood pressure, high body mass index, physical inactivity, smoking, and ambient PM pollution. The pattern was similar among 50+ year olds. CONCLUSION: Although non-communicable diseases had the greatest burden in 2010, the challenge of communicable and maternal diseases for health system is not over yet. Diet and physiological risk factors appear to be the most important targets for public health policy in Iran. Moreover, Iranians would greatly benefit from effective strategies to prevent injury and musculoskeletal disorders and expand mental care. Persistent improvement is possible by strengthening the health information system to monitor the population health and evaluate current programs. Language: en
186 citations
TL;DR: Among patients with subthreshold depression, the use of a web-based guided self-help intervention compared with enhanced usual care reduced the incidence of MDD over 12 months.
Abstract: Importance Evidence-based treatments for major depressive disorder (MDD) are not very successful in improving functional and health outcomes. Attention has increasingly been focused on the prevention of MDD. Objective To evaluate the effectiveness of a web-based guided self-help intervention for the prevention of MDD. Design, Setting, and Participants Two-group randomized clinical trial conducted between March 1, 2013, and March 4, 2015. Participants were recruited in Germany from the general population via a large statutory health insurance company (ie, insurance funded by joint employer-employee contributions). Participants included 406 self-selected adults with subthreshold depression (Centre for Epidemiologic Studies Depression Scale score ≥16, no current MDD according to Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition, Text Revision] criteria). Interventions All participants had unrestricted access to usual care (visits to the primary care clinician) and were randomized to either a web-based guided self-help intervention (cognitive-behavioral and problem-solving therapy supported by an online trainer; n = 202) or a web-based psychoeducation program (n = 204). Main Outcomes and Measures The primary outcome was time to onset of MDD in the intervention group relative to the control group over a 12-month follow-up period as assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Results Among 406 randomized patients (mean age, 45 years; 73.9% women), 335 (82%) completed the telephone follow-up at 12 months. Fifty-five participants (27%) in the intervention group experienced MDD compared with 84 participants (41%) in the control group. Cox regression analyses controlling for baseline depressive symptom severity revealed a hazard ratio of 0.59 (95% CI, 0.42-0.82; P = .002) at 12-month follow-up. The number needed to treat to avoid 1 new case of MDD was 5.9 (95% CI, 3.9-14.6). Conclusions and Relevance Among patients with subthreshold depression, the use of a web-based guided self-help intervention compared with enhanced usual care reduced the incidence of MDD over 12 months. Further research is needed to understand whether the effects are generalizable to both first onset of depression and depression recurrence as well as efficacy without the use of an online trainer. Trial Registration German Clinical Trial Registry Identifier:DRKS00004709
185 citations
TL;DR: In the 23 years of the Global Burden of Disease project (GBD), from 1990 to 2013, headache has come from nowhere – wholly ignored, not thought even worth measuring – into the leading three of the several hundred contributors to the global burden of disease that GBD counts.
Abstract: From time to time, there is news that is of particular consequence to all people affected by headache.
In December 2012, Lancet published the Global Burden of Disease Study 2010 (GBD2010). We wrote then [1]: “Few reports are likely to have more profound meaning for people with headache, or carry greater promise for a better future, than the seven papers (and one in particular [2]) that were presented.” So it was: the essential finding – that migraine was the seventh highest specific cause of disability worldwide – has been widely cited in both scientific and informal literature, pointedly noted by health commentators, trumpeted loudly by lay organisations and quietly harnessed by those seeking grants for headache research. It has given legitimacy to arguments that headache disorders contribute in a big way to public ill-health and disability [3], and strong backing to pleas for political recognition of this fact [4].
Now there is more, from the Global Burden of Disease Study 2013 (GBD2013), and it is of similarly arresting significance. Published in Lancet earlier this month [5], its key findings for those whose interests focus on headache are threefold: migraine is the sixth highest cause of disability worldwide; medication-overuse headache (MOH) is included in these surveys for the first time and enters the top twenty causes of disability at 18th; and adding together just these two puts headache disorders third among the worldwide causes of disability, measured in years of life lost to disability (YLDs).
Thus in the 23 years of the Global Burden of Disease project (GBD), from 1990 to 2013, headache has come from nowhere – wholly ignored, not thought even worth measuring – into the leading three of the several hundred contributors to the global burden of disease that GBD counts. The background and a little of the history of this extraordinary transition should be told. What we are reporting here are the outcomes of huge, sustained, coordinated effort.
GBD itself is a massive, ongoing, iterative enterprise [6]. It was undertaken initially, in 1990 and 2000, by the World Health Organization (WHO) but now is led by the Institute of Health Metrics and Evaluation (IHME) of the University of Washington, Seattle, WA, USA. Its stated purpose now is to set out “a comprehensive picture of what disables and kills people across countries, time, age, and sex”; towards this, it provides “a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities can be eliminated” [6]. The data in GBD2013 came through a consortium of more than 1,000 researchers in over 100 countries, capturing premature death and disability in 188 countries from more than 300 diseases [6]. Our objective has been to secure among these diseases the rightful inclusion of migraine, tension-type headache (TTH) and MOH: headache disorders that we know cause substantial disability [3].
The Global Campaign against Headache was launched in 2003 with a clear ultimate purpose: to reduce the burden of headache worldwide [7]. At that time, 12 years ago, it was not at all clear what this burden was, either in scope or scale. As a result of some lobbying during discussions with WHO in the years prior to the Campaign’s launch, GBD2000 included migraine [8]. No other headache disorders made it, but this was nevertheless a major advance for those concerned about headache, not just because GBD1990 had ignored headache totally but far, far more because migraine was found – on the evidence submitted – to be in the leading 20 causes (19th) of disability worldwide [8]. This “discovery” propelled headache disorders into WHO’s priorities [3, 4].
For the Campaign this was merely a call to arms, because also clear at that time was that the evidence submitted to GBD2000 was seriously deficient. Of course it related only to migraine, which was neither the most prevalent nor the most disabling of headache disorders, but this was not the issue. Migraine was certainly the best studied of the headache disorders, from all aspects including epidemiologically, and the epidemiological evidence then available from all studies of acceptable quality had been thoroughly collated (it was later published as a review [9]). The problem was that it focused strongly on North and South America and Western Europe, with a small Far-East cluster of studies in Japan, Taiwan and the Korean peninsula; left unrepresented were most of the Western Pacific Region (including mainland China), all of South East Asia (including India), all of the Eastern Mediterranean Region, most of Africa and all of Eastern Europe (including Russia). The people unrepresented in these territories were more than half the world’s population.
Not long after the Global Campaign launched, data collection began for GBD2010 (which was initially to be GBD2005). Filling the largest of the data gaps was therefore the first priority of Lifting The Burden (LTB), the UK-registered charity conducting the Campaign [10, 11]. LTB had two objectives for GBD2010: to secure inclusion of the other headache disorders of public-health importance – TTH and MOH – and to show, as we then believed, that headache disorders collectively were among the top ten causes of disability worldwide. It became something of a race against time, firstly to develop the methodology for population-based door-to-door studies with a validated diagnostic questionnaire based on ICHD-II [12] and then to implement it in the big countries: China, India and Russia, home to 2.5 billion people. These things were done, and, with much better information, GBD2010 reported migraine more realistically as the seventh highest specific cause of disability measured in YLDs [1, 2]. This of course achieved LTB’s first objective. As for the second, TTH was included in the survey, but with a very low disability weight (DW) allocated to it. GBD2010 reported TTH as the second most prevalent disorder in the world (after dental caries), and migraine third [2], but despite this TTH added rather little compared with migraine to the global disability burden. What about MOH? This was initially included but not in the end reported because, it was argued – correctly, we believe, that prevalence data were not good enough to support regional estimates of burden attributable to this disorder. The particular difficulties of estimating MOH prevalence were recently discussed [13, 14]. Nonetheless, a DW was allocated to MOH, which was of crucial importance when it came to GBD2013.
In the interim, between GBD2010 and GBD2013, LTB had supported further Global Campaign studies in Nepal in South East Asia, in Saudi Arabia and Pakistan in Eastern Mediterranean and in Zambia and Ethiopia in Africa – huge knowledge gaps – while collaborating with GBD in collating data published by other workers. The particular importance of the LTB studies lay in their use of similar methodology [15], the inclusion of MOH in their enquiries and the purposive selection of countries for survey. GBD2013 was therefore considerably better informed than GBD2010, not only with more comprehensive regional data but also, and in particular, with greatly enhanced data on MOH (and a DW available from GBD2010 for YLD estimates).
LTB has prioritised this work on data gathering and our collaboration with GBD above all else. It has involved multiple complex studies in all world regions, and taken most of our resources, but as a policy we believe it has been strategically correct. If the ultimate purpose of the Campaign is to reduce the burden of headache worldwide, it must first be known what this burden is – the Campaign’s first objective [7]. At the same time, working with GBD does much to achieve the Campaign’s second objective, which is creation of awareness of this burden. Indeed this work of data gathering continues, with studies ongoing or planned in countries in Central and South America, North and West Africa and South East Asia. We have not forgotten children and adolescents, for which studies can be school-based [16]. All of these will not only benefit future iterations of GBD but also, just as importantly, serve as needs-assessment studies informing health policy locally, in the countries and regions where the data are gathered.
To end, it would be easy to claim the findings of GBD2013 as a triumphal conclusion of prolonged hard effort, since on a technical level they are, but that would overlook their tragic meaning. As we reported earlier [1], GBD measures disease burden as it is – alleviated by whatever treatments are made available. Headache disorders, we said at the time of GBD2010, were among the top ten causes of disability because they were common and disabling, but we asked: “For what conceivable reason do headache disorders remain among these ignominious top ten when they are largely treatable?” [1].
Now we must ask the chastening question: “Why are they among the top three?”
185 citations
TL;DR: In 3 randomized clinical trials of participants with chronic low back pain originating in the facet joints, sacroiliac joints, or a combination of facet joint, sacrosiliac joint, or intervertebral disks, radiofrequency denervation combined with a standardized exercise program resulted in either no improvement or no clinically important improvement in chronicLow back pain compared with aStandardized exercise program alone.
Abstract: IMPORTANCE Radiofrequency denervation is a commonly used treatment for chronic low back pain, but high-quality evidence for its effectiveness is lacking. OBJECTIVE To evaluate the effectiveness of radiofrequency denervation added to a standardized exercise program for patients with chronic low back pain. DESIGN, SETTING, AND PARTICIPANTS Three pragmatic multicenter, nonblinded randomized clinical trials on the effectiveness of minimal interventional treatments for participants with chronic low back pain (Mint study) were conducted in 16 multidisciplinary pain clinics in the Netherlands. Eligible participants were included between January 1, 2013, and October 24, 2014, and had chronic low back pain, a positive diagnostic block at the facet joints (facet joint trial, 251 participants), sacroiliac joints (sacroiliac joint trial, 228 participants), or a combination of facet joints, sacroiliac joints, or intervertebral disks (combination trial, 202 participants) and were unresponsive to conservative care. INTERVENTIONS All participants received a 3-month standardized exercise program and psychological support if needed. Participants in the intervention group received radiofrequency denervation as well. This is usually a 1-Time procedure, but the maximum number of treatments in the trial was 3. MAIN OUTCOMES AND MEASURES The primary outcomewas pain intensity (numeric rating scale, 0-10; whereby 0 indicated no pain and 10 indicated worst pain imaginable) measured 3 months after the intervention. The prespecified minimal clinically important difference was defined as 2 points or more. Final follow-up was at 12 months, ending October 2015. RESULTS Among 681 participants who were randomized (mean age, 52.2 years; 421 women [61.8%], mean baseline pain intensity, 7.1), 599 (88%) completed the 3-month follow-up, and 521 (77%) completed the 12-month follow-up. The mean difference in pain intensity between the radiofrequency denervation and control groups at 3 months was -0.18 (95%CI, -0.76 to 0.40) in the facet joint trial; -0.71 (95%CI, -1.35 to -0.06) in the sacroiliac joint trial; and -0.99 (95%CI, -1.73 to -0.25) in the combination trial. CONCLUSIONS AND RELEVANCE In 3 randomized clinical trials of participants with chronic low back pain originating in the facet joints, sacroiliac joints, or a combination of facet joints, sacroiliac joints, or intervertebral disks, radiofrequency denervation combined with a standardized exercise program resulted in either no improvement or no clinically important improvement in chronic low back pain compared with a standardized exercise program alone. The findings do not support the use of radiofrequency denervation to treat chronic low back pain from these sources.
184 citations
TL;DR: CT is a strong risk factor for MDD but may have greater effect in individuals with lower genetic liability for the disorder, and PRS provide a useful approach to investigating gene–environment interactions in complex traits.
Abstract: BACKGROUND:
Major depressive disorder (MDD) is a common and disabling condition with well-established heritability and environmental risk factors. Gene-environment interaction studies in MDD have typically investigated candidate genes, though the disorder is known to be highly polygenic. This study aims to test for interaction between polygenic risk and stressful life events (SLEs) or childhood trauma (CT) in the aetiology of MDD.
METHOD:
The RADIANT UK sample consists of 1605 MDD cases and 1064 controls with SLE data, and a subset of 240 cases and 272 controls with CT data. Polygenic risk scores (PRS) were constructed using results from a mega-analysis on MDD by the Psychiatric Genomics Consortium. PRS and environmental factors were tested for association with case/control status and for interaction between them.
RESULTS:
PRS significantly predicted depression, explaining 1.1% of variance in phenotype (p = 1.9 × 10-6). SLEs and CT were also associated with MDD status (p = 2.19 × 10-4 and p = 5.12 × 10-20, respectively). No interactions were found between PRS and SLEs. Significant PRSxCT interactions were found (p = 0.002), but showed an inverse association with MDD status, as cases who experienced more severe CT tended to have a lower PRS than other cases or controls. This relationship between PRS and CT was not observed in independent replication samples.
CONCLUSIONS:
CT is a strong risk factor for MDD but may have greater effect in individuals with lower genetic liability for the disorder. Including environmental risk along with genetics is important in studying the aetiology of MDD and PRS provide a useful approach to investigating gene-environment interactions in complex traits.
184 citations
References
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TL;DR: The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex, using the Cause of Death Ensemble model.
11,809 citations
Book•
31 Dec 1997
TL;DR: The aim of this study was to establish a database of histological groups and to provide a level of consistency and quality of data that could be applied in the design of future registries.
Abstract: 1. Techniques of registration 2. Classification and coding 3. Histological groups 4. Comparability and quality of data 5. Data processing 6. Age-standardization 7. Incidence data by site and sex for each registry 8. Summary tables presenting age-standardized rates 9. Data on histological type for selected sites
10,160 citations
TL;DR: Notably, major depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment, and while the recent increase in treatment is encouraging, inadequate treatment is a serious concern.
Abstract: ContextUncertainties exist about prevalence and correlates of major depressive
disorder (MDD).ObjectiveTo present nationally representative data on prevalence and correlates
of MDD by Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) criteria, and on study
patterns and correlates of treatment and treatment adequacy from the recently
completed National Comorbidity Survey Replication (NCS-R).DesignFace-to-face household survey conducted from February 2001 to December
2002.SettingThe 48 contiguous United States.ParticipantsHousehold residents ages 18 years or older (N = 9090) who responded
to the NCS-R survey.Main Outcome MeasuresPrevalence and correlates of MDD using the World Health Organization's
(WHO) Composite International Diagnostic Interview (CIDI), 12-month severity
with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR),
the Sheehan Disability Scale (SDS), and the WHO disability assessment scale
(WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.ResultsThe prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval
[CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95%
CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases
were independently classified as clinically significant using the QIDS-SR,
with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean
episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured
by SDS was substantial as indicated by 59.3% of 12-month cases with severe
or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%)
cases had comorbid CIDI/DSM-IV disorders, with MDD
only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases
received health care treatment for MDD, treatment was adequate in only 41.9%
(95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2)
of 12-month MDD being adequately treated. Sociodemographic correlates of treatment
were far less numerous than those of prevalence.ConclusionsMajor depressive disorder is a common disorder, widely distributed in
the population, and usually associated with substantial symptom severity and
role impairment. While the recent increase in treatment is encouraging, inadequate
treatment is a serious concern. Emphasis on screening and expansion of treatment
needs to be accompanied by a parallel emphasis on treatment quality improvement.
7,706 citations
Book•
01 Jan 1996
TL;DR: This is the first in a planned series of 10 volumes that will attempt to "summarize epidemiological knowledge about all major conditions and most risk factors" and use historical trends in main determinants to project mortality and disease burden forward to 2020.
Abstract: This is the first in a planned series of 10 volumes that will attempt to "summarize epidemiological knowledge about all major conditions and most risk factors;...generate assessments of numbers of deaths by cause that are consistent with the total numbers of deaths by age sex and region provided by demographers;...provide methodologies for and assessments of aggregate disease burden that combine--into the Disability-Adjusted Life Year or DALY measure--burden from premature mortality with that from living with disability; and...use historical trends in main determinants to project mortality and disease burden forward to 2020." This first volume includes chapters summarizing results from the project as a whole. (EXCERPT)
7,154 citations