Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Serum lipids in parents and siblings of children with Alagille syndrome: A pilot study

Background/Aims: Alagille syndrome, a dominant inherited disorder, is characterized by cholestatic liver disease, associated to interlobular bile duct paucity combined with; cardiac, skeletal, ocular and facial abnormalities. Increased levels of serum lipids are present in more than 80% of probands. Parents and siblings of children with Alagille syndrome are often found to have a mild expression of this probable disease gene; it is not known if dyslipidemia occurs in parents and siblings of children with Alagille syndrome. The aim of the study was to investigate the lipid profile in sibs and parents of children with Alagille syndrome. Methodology: Four children with Alagille syndrome and 21 first-degree relatives were studied. Setting: A pediatric referral hospital. Period: July-October 2005. Design: cross-sectional. Variables: Total, low-density, high-density cholesterol and triglyceride. Statistics: χ2, Mann-Whitney U and Kruskal-Wallis. Results: Probands had higher levels of total cholesterol, low-density cholesterol and triglycerides than their siblings (p<0.05); however, no differences with their parents were observed (p>0.05). Conclusions: Dyslipidemia does not seem to be a phenotypic expression in first degree relatives of children with Alagille syndrome. The increased level of serum lipids observed in some of the parents is similar to the expected prevalence of hypercholesterolemia in the adult Mexican population. © H.G.E. Update Medical Publishing S.A

Short-Term Effects on Substance Use of the Keeping It REAL Pilot Prevention Program: Linguistically Adapted for Youth in Jalisco, Mexico

Background/Aims: Alagille syndrome, a dominant inherited disorder, is characterized by cholestatic liver disease, associated to interlobular bile duct paucity combined with; cardiac, skeletal, ocular and facial abnormalities. Increased levels of serum lipids are present in more than 80% of probands. Parents and siblings of children with Alagille syndrome are often found to have a mild expression of this probable disease gene; it is not known if dyslipidemia occurs in parents and siblings of children with Alagille syndrome. The aim of the study was to investigate the lipid profile in sibs and parents of children with Alagille syndrome. Methodology: Four children with Alagille syndrome and 21 first-degree relatives were studied. Setting: A pediatric referral hospital. Period: July-October 2005. Design: cross-sectional. Variables: Total, low-density, high-density cholesterol and triglyceride. Statistics: ?2, Mann-Whitney U and Kruskal-Wallis. Results: Probands had higher levels of total cholesterol, low-density cholesterol and triglycerides than their siblings (p<0.05); however, no differences with their parents were observed (p>0.05). Conclusions: Dyslipidemia does not seem to be a phenotypic expression in first degree relatives of children with Alagille syndrome. The increased level of serum lipids observed in some of the parents is similar to the expected prevalence of hypercholesterolemia in the adult Mexican population. " H.G.E. Update Medical Publishing S.A.",,,,,,,,,"http://hdl.handle.net/20.500.12104/44499","http://www.scopus.com/inward/record.url?eid=2-s2.0-41549105363&partnerID=40&md5=47e0af19fa7fc383fc5cb74d60316182",,,,,,"81",,"Hepato-Gastroenterology",,"

Liver function test results predict nutritional status evaluated by arm anthropometric indicators

OBJECTIVES: To compare the anthropometric indicators based on weight and height with the anthropometric indicators based on arm measurements and to predict the anthropometric nutritional status with liver function tests (LFTs) in children with chronic liver disease (CLD). PATIENTS AND METHODS: A cross-sectional study in a referral pediatric hospital enrolled 79 children with CLD (mean age 72.6 � 61.8 months, 54% female). An independent variable of LFT was used to determine the outcome variable of nutritional status. Anthropometric indicators of height versus age, weight versus height, head circumference versus age, and arm indicators versus age were analyzed with Pearson correlation, the determination coefficient r, and multiple regression. RESULTS: A total of 44.3% of patients studied had growth impairment. The anthropomorphic indicator of weight for height identified malnutrition in 11.4%, compared with 43% identified by mid- to upper arm circumference (MUAC) and 40.5% identified with total arm area. MUAC (P < 0.001), total arm circumference (P < 0.001), arm muscle area (P = 0.009), and arm fat area (P = 0.023) identified more cases of z score less than -2 SD than weight/height. The presence of ascites misled weight-for-height measurements. Conjugated bilirubin and albumin had significant correlations with almost all of the anthropometric indicators. Alkaline phosphatase correlated significantly with all of the arm anthropometric indicators. A regression analysis led to 7 prediction models; the highest prediction of z score less than -2 SD was with triceps skinfold and conjugated bilirubin, albumin, and ?-glutamyltransferase; height-for-age z score less than -2 SD was predicted by measurements of conjugated bilirubin, prothrombin time, and alanine aminotransferase. CONCLUSIONS: The data presented underline the correlation between the liver damage severity evaluated by LFT and the nutritional status estimated by anthropometric indicators. In our view these observations reflect the close relationship between liver function and the degree of liver damage to growth and current nutritional status. � 2007 Lippincott Williams & Wilkins, Inc

Resistance patterns of patients with initial episodes and relapses due to M. tuberculosis and nontuberculous mycobacteria

Background: A recognized risk factor for drug resistance include previous treatment for tuberculosis. We report the current resistance patterns of patients with initial episodes as well as from relapses in Mexico's west. Objetive: To evaluate the resistance patterns of patients with initial episodes and relapses due to mycobacterial species. Methods: Since January 1992 all patients with a positive culture were analyzed, as initial or relapses cases. Susceptibility tests were done by the Canetti method. Results: 211 positive cultures from 189 patients were found. 132 from patients with an initial episode and 79 with relapses. Species isolated were: M. tuberculosis 126, M. avium-intraceilulare 20, M, bovis 19, M. triviale 14, M. gordonae 5, and others 31. Nontuberculous mycobacteria was isolated in 50% of patients with initial episodes and in 24 % of patients with relapses. Pulmonary location was seen in 70% of patients with initial episodes and in 86% in patients with relapses. 27% of Mycobaclerium tuberculosis and 48% of nontuberculous mycobacteria isolated from patients with initial episodes were resistant to isoniazid and rifampin. 60% of M. tuberculosis and 50% of nontuberculous mycobacteria isolated from relapses were resistant to isoniazid and rifampin. Conclusions: Extrapulmonary location and nontuberculous mycobacteria etiology are most common in patients with initial episodes. M. tuberculosis isolated from patients with initial episodes tend to be more sensitive than other

Resistance patterns of Mycobacterium tuberculosis isolated in Mexico's West

Background: The problem of multidrug resistant M, tuberculosis (MDR TB) has increased in recent years around the world. Objetive: To analyse the evolution of resistance patteras of M. tuberculosis. Methods: Cultures of M. tuberculosis isolated from patients of two terciary care hospitals of Guadalajara, México were analyzed. Susceptibility tests were earned out by the Canetti method. Results: The annual resistance percents of 262 cultures was: 1993 1994 1995 1996 Total (a=23) (a=26) (n=64) (n=149) (=262) Isomazid 74 77 53 78 71 Rifampin 43 42 41 40 41 Pyrazinamide 22 58 67 52 54 Ethambutol 65 62 47 77 53 Streptomycin 22 46 75 56 57 Ethionamide 22 27 50 49 45 Para-aminosalicyhc-acid(PAS) 30 46 41 45 43 Ciprofloxadn - 12 30 17 20 Ofloxacin - 15 30 39 34 MDR TB (isoniazid and rifampin) 43 27 31 36 31 Conclusions: The primary drugs resistance is high, the resistance to pyrazinamide, streptomycin, ethionamide and PAS has been increasing

Resistance patterns of Mycobacterium tuberculosis isolated in Mexico's West

Background: The problem of multidrug resistant M, tuberculosis (MDR TB) has increased in recent years around the world. Objetive: To analyse the evolution of resistance patteras of M. tuberculosis. Methods: Cultures of M. tuberculosis isolated from patients of two terciary care hospitals of Guadalajara, México were analyzed. Susceptibility tests were earned out by the Canetti method. Results: The annual resistance percents of 262 cultures was: 1993 1994 1995 1996 Total (a=23) (a=26) (n=64) (n=149) (=262) Isomazid 74 77 53 78 71 Rifampin 43 42 41 40 41 Pyrazinamide 22 58 67 52 54 Ethambutol 65 62 47 77 53 Streptomycin 22 46 75 56 57 Ethionamide 22 27 50 49 45 Para-aminosalicyhc-acid(PAS) 30 46 41 45 43 Ciprofloxadn - 12 30 17 20 Ofloxacin - 15 30 39 34 MDR TB (isoniazid and rifampin) 43 27 31 36 31 Conclusions: The primary drugs resistance is high, the resistance to pyrazinamide, streptomycin, ethionamide and PAS has been increasing

Death in hospital following ICU discharge : insights from the LUNG SAFE study

Altres ajuts: Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); Science Foundation Ireland Future Research Leaders Award; European Society of Intensive Care Medicine (ESICM), Brussels; St Michael's Hospital, Toronto; University of Milan-Bicocca, Monza, Italy.Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073

Resolved versus confirmed ARDS after 24&#160;h: insights from the LUNG SAFE study

Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24\ua0h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification. Results: Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01\u20131.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both\ua0resolved and confirmed\ua0ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each\ua0associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated\ua0with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal. Conclusions: ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population. Trial Registration: ClinicalTrials.gov NCT02010073. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM

Correction to: Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study

Correction to: Intensive Care Med (2016) 42:1865\u20131876 DOI 10.1007/s00134-016-4571-