Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Welfare Impacts of Rising Food Prices in Rural Ethiopia: a Quadratic Almost Ideal Demand System Approach

Ethiopia has experienced high food prices since early 2004. This paper examines the welfare impacts of rising food prices in rural Ethiopia using Quadratic Almost Ideal Demand System (QUAIDS) approach controlled for expenditure endogeniety and zero consumption expenditure. The elasticity coefficients from QUAIDS are used to estimate Compensated Variations (CV), which explicitly accounts for profit function and substitution effects. The study uses Ethiopia Rural Household Survey (ERHS) panel data in four waves encompassing both low and high price periods. The results have shown high food prices in recent years (between 2004 and 2009) increased welfare gain of rural households by about 10.5 percent on aggregate, as compared to less than 1 percent for the reference period (between 1994 and 2004). The welfare gains further improved to 18 percent (high price periods) with substitution effects, compared to 7.2 percent (low price periods). The welfare gains at aggregate level may not be equally distributed among rural households as about 37-46 percent of the sample households were net-cereal buyers (major staple crops) over the survey periods. However, the analysis has revealed high food price benefits not only net-cereal sellers but also autarkic and net-cereal buyers. The autarkic and net-cereal buyers could diversify income sources and benefits from high prices of other commodities such as such as pluses, fruits & vegetables, animal and animal products. They could also diversify to off-farm activities as average income from wage and transfer has indeed increased in 2009. Only poor families with limited farm and non-farm income need to be supported with safety net programs (both input and consumption support). It should be noted that, in the long-run, high prices could encourage net-sellers to invest and increase production which will eventually lead to lower food prices, which in turn benefit net-buyers. Meanwhile, many current net buyers could become net-sellers if grain prices are stable and favourable and if productive inputs are made available and affordable

Welfare Impacts of Rising Food Prices in Rural Ethiopia: a Quadratic Almost Ideal Demand System Approach

Ethiopia has experienced high food prices, especially since 2005. This paper examines the welfare impacts of rising food prices in rural Ethiopia using Quadratic Almost Ideal Demand System (QUAIDS) approach controlled for expenditure endogeniety and zero consumption expenditure. The elasticity coefficients from QUAIDS are used to estimate Compensated Variations (CV), which explicitly accounts for profit function and substitution effects. The study uses Ethiopia Rural Household Survey (ERHS) panel data, encompassing both low and high price periods. Prices of all food and agricultural products increased during the entire survey period of 1994 to 2009 but the increases were much higher in recent years, 2004 – 2009, compared to the earlier period of 1994 - 2004. The results have shown that the price hikes in recent years increased welfare gain of rural households by about 10.5% on aggregate, as compared to less than 1% for the reference period (1994 - 2004). The welfare gains further improved to 18% for the high price period and 7.2% for the low price period with substitution effects. It could be argued that the welfare gains at aggregate level is not equally distributed among rural households as 37 to 46% of the sample households were net-cereal buyers (major staple crops) during the survey period. However, the analysis revealed that high food and agricultural prices benefit not only net-cereal sellers but also autarkic and net-cereal buying families. Autarkic households and net-cereal buyers apparently seem to have benefited from high prices of commodities such as pluses, fruits & vegetables, live animals and animal products. They also appear to have gained from increased off-farm income as average income from wage and transfer has indeed increased in 2009. Only very poor families with limited farm and non-farm income need to be supported with safety net programs (both input and consumption support). In the long-run, high agricultural prices would encourage net-sellers to expand production, leading to lower food prices for net-buyers. More importantly, many current net buyers could become net-sellers if grain prices are stable and remunerative for producers

MAPPING LOCAL PATTERNS OF CHILDHOOD OVERWEIGHT AND WASTING IN LOW- AND MIDDLE-INCOME COUNTRIES BETWEEN 2000 AND 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic