Additional file 2 of The impact of the COVID-19 pandemic and associated suppression measures on the burden of tuberculosis in India

Additional file 2: Appendix S2. Additional covariate description and model analyses

Additional file 1 of The impact of the COVID-19 pandemic and associated suppression measures on the burden of tuberculosis in India

Additional file 1: Appendix S1. Subnational State and Territory Case Notification and counterfactual expected cases

Global and national Burden of diseases and injuries among children and adolescents between 1990 and 2013

Importance The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce.Objective To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study.Evidence Review Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14?244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35?620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates.Findings Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905?059 deaths; 95% UI, 810?304-998?125), diarrheal diseases among older children (38?325 deaths; 95% UI, 30?365-47?678), and road injuries among adolescents (115?186 deaths; 95% UI, 105?185-124?870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world’s deaths from neonatal encephalopathy. Half of the world’s diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia.Conclusions and Relevance Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.</p

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

SummaryBackground The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the fi rst of a series ofannual updates of the GBD. Risk factor quantifi cation, particularly of modifi able risk factors, can help to identifyemerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunityto update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriatecounterfactual risk distribution.Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs)have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meetingexplicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs:risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into ahierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the fi rst level of thehierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with moredetail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added:handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafesex, and low glomerular fi ltration rate. For most risks, data for exposure were synthesised with a Bayesian metaregressionmethod, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based onmeta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all riskscombined took into account evidence on the mediation of some risks such as high body-mass index (BMI) throughother risks such as high systolic blood pressure and high cholesterol.Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6%(40·1–43·0) of DALYs. Risks quantifi ed account for 87·9% (86·5?89·3) of cardiovascular disease DALYs, rangingto a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 milliondeaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs,child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 milliondeaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time.In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water,sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the MiddleEast, and in many other high-income countries, high BMI is the leading risk factor, with high systolic bloodpressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolicblood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and theMiddle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya toSouth Africa.Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortalityand more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, theattributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural riskfactors, behavioural and social science research on interventions for these risks should be strengthened. Manyprevention and primary care policy options are available now to act on key risks.</p