Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. LANCET. 2016;388(10053):1659-1724.Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd

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

Mineria de trajectòries de cotxes per la detecció d'esdeveniments

Thanks to an increase in the use of devices that come with a builtin gps sensor, a large number of gps data is available. This work presents an algorithm to extract concrete patterns from GPS data based on the changes on the behaviour of the car drivers when the weather drastically changes. The data used in this project comes from a week when the Typhoon Roke struck Japan, the algorithm will try to select the most likely areas affected by an accident like floods, banned roads, etc. This data is excelent for this pourpose but there is a need to built a visual and interactiv

Mineria de trajectòries de cotxes per la detecció d'esdeveniments

Thanks to an increase in the use of devices that come with a builtin gps sensor, a large number of gps data is available. This work presents an algorithm to extract concrete patterns from GPS data based on the changes on the behaviour of the car drivers when the weather drastically changes. The data used in this project comes from a week when the Typhoon Roke struck Japan, the algorithm will try to select the most likely areas affected by an accident like floods, banned roads, etc. This data is excelent for this pourpose but there is a need to built a visual and interactiv

Caracterització del canal i estudi de la propagació del senyal per acoblament galvànic en sensors corporals

Projecte realitzat en el marc d’un programa de mobilitat amb la Northeastern University[ANGLES`] New medical procedures involving continuous patient monitoring through human body sensors are becoming commonplace with micro-scale implanted sensors transferring information to on-surface macro-scale sensors for further data retrieval and analysis. Traditional forms of radio frequency-based wireless communication find limited use in such scenarios owing the limited penetration of electromagnetic waves through human tissue, and the need for frequent battery replacements. Instead, we propose a radically different form of wireless communication in this paper that involves galvanic coupling using extremely low energy electrical signals. The main contributions in this paper are: (i) developing a theoretical model suite to estimate the channel gain, where the body itself serves as the communication channel, (ii) obtaining an estimate for the observed noise and achievable data rates, and (iii) identifying the optimal transmission frequency and electrode placements for signal propagation through tissue. We propose two equivalent circuit models to characterize the channel, based on the theories of two-port and lumped element circuit design, which are then validated through extensive simulations using finite element method and known experimental measurements. Our results reveal a close agreement between theory, simulation and experimental findings, suggesting a promising case for the adoption of galvanic coupling-based communication for future intra-body sensors.[CASTELLÀ] Muchos de los procedimientos médicos actuales requieren un monitoreo constante del paciente a través de macro-sensores situados sobre el cuerpo humano o bien con micro-sensores implantados. Las formas tradicionales de comunicación sin hilos se han quedado limitadas delante de este escenario dado la limitada penetración de las ondas electromagnéticas a través del cuerpo humano, y la necesidad de recargar las baterías a causa de la perdida de energía asociada a tales comunicaciones. En su lugar, nosotros proponemos un sistema de comunicación sin hilos radicalmente diferente donde interviene el acoplamiento galvánico, con el cual solo se requiere una extremada baja energía para enviar la información a través del cuerpo humano. Las contribuciones principales de este trabajo son: (i) desarrollo de un modelo teórico capaz de estimar la ganancia del canal, donde el mismo cuerpo sirve de canal, (ii) formular una estimación del ruido y las interferencias presentes en este canal y cuantificar posibles velocidades de datos, y (iii) identificar la frecuencia optima de transmisión así como la posición de los electrodos para la propagación del señal en la capa de tejido dada. Proponemos dos modelos de circuitos equivalentes basados en la teoría de modelos de 2-puertos y elementos de circuito básicos, los cuales después son validados usando extensas simulaciones basadas en “finit element modeling” (FEM) y mesuras experimentales. Los resultados revelan un claro acuerdo entre la teoría, simulación y experimentos, sugiriendo un prometedor caso de adopción de los sistemas de comunicación basados en acoplamiento galvánico para futuros sistemas de sensores en el cuerpo humano.[CATALÀ] Molts dels procediments mèdics actuals requereixen una monitoratge constant del pacient a traves de macro-sensors situats sobre el cos humà o be amb micro-sensors implantats. Les formes tradicionals de comunicació sense fils s’han quedat limitades davant d’aquest escenari donada la limitada penetració de les ones electromagnètiques a traves del cos humà, i la necessitat de carregar les bateries a causa de la pèrdua d’energia associada a tals comunicacions. En el seu lloc, nosaltres proposem un sistema de comunicació sense fils radicalment diferent on intervé el acoblament galvànic, amb el qual nomes és requereix transmetre una extremada baixa energia per enviar la informació a traves del cos humà. Les contribucions principals d’aquest treball són: (i) desenvolupament d’un model teòric per estimar el guany del canal, on el mateix cos serveix de canal de comunicació, (ii) formular una estimació del soroll i les interferències presents en aquest canal i quantificar possibles velocitats de dades, i (iii) identificar la freqüència optima de transmissió així com la posició dels elèctrodes per la propagació del senyal en la capa de teixit donada. Proposem dos models de circuits equivalents per caracteritzar el canal, basats en la teoria de models de 2-ports i elements circuitals bàsics, el quals després son validats utilitzant extenses simulacions fent servir “finit element modeling” (FEM) i mesures experimentals. Els nostres resultats revelen un clar acord entre la teoria, simulació i experiments, suggerint un prometedor cas per l’adopció dels sistemes de comunicació basats en acoblament galvànic per futurs sistemes de sensors en el cos humà

Mineria de trajectòries de cotxes per la detecció d'esdeveniments

Thanks to an increase in the use of devices that come with a builtin gps sensor, a large number of gps data is available. This work presents an algorithm to extract concrete patterns from GPS data based on the changes on the behaviour of the car drivers when the weather drastically changes. The data used in this project comes from a week when the Typhoon Roke struck Japan, the algorithm will try to select the most likely areas affected by an accident like floods, banned roads, etc. This data is excelent for this pourpose but there is a need to built a visual and interactiv

Caracterització del canal i estudi de la propagació del senyal per acoblament galvànic en sensors corporals

Projecte realitzat en el marc d’un programa de mobilitat amb la Northeastern University[ANGLES`] New medical procedures involving continuous patient monitoring through human body sensors are becoming commonplace with micro-scale implanted sensors transferring information to on-surface macro-scale sensors for further data retrieval and analysis. Traditional forms of radio frequency-based wireless communication find limited use in such scenarios owing the limited penetration of electromagnetic waves through human tissue, and the need for frequent battery replacements. Instead, we propose a radically different form of wireless communication in this paper that involves galvanic coupling using extremely low energy electrical signals. The main contributions in this paper are: (i) developing a theoretical model suite to estimate the channel gain, where the body itself serves as the communication channel, (ii) obtaining an estimate for the observed noise and achievable data rates, and (iii) identifying the optimal transmission frequency and electrode placements for signal propagation through tissue. We propose two equivalent circuit models to characterize the channel, based on the theories of two-port and lumped element circuit design, which are then validated through extensive simulations using finite element method and known experimental measurements. Our results reveal a close agreement between theory, simulation and experimental findings, suggesting a promising case for the adoption of galvanic coupling-based communication for future intra-body sensors.[CASTELLÀ] Muchos de los procedimientos médicos actuales requieren un monitoreo constante del paciente a través de macro-sensores situados sobre el cuerpo humano o bien con micro-sensores implantados. Las formas tradicionales de comunicación sin hilos se han quedado limitadas delante de este escenario dado la limitada penetración de las ondas electromagnéticas a través del cuerpo humano, y la necesidad de recargar las baterías a causa de la perdida de energía asociada a tales comunicaciones. En su lugar, nosotros proponemos un sistema de comunicación sin hilos radicalmente diferente donde interviene el acoplamiento galvánico, con el cual solo se requiere una extremada baja energía para enviar la información a través del cuerpo humano. Las contribuciones principales de este trabajo son: (i) desarrollo de un modelo teórico capaz de estimar la ganancia del canal, donde el mismo cuerpo sirve de canal, (ii) formular una estimación del ruido y las interferencias presentes en este canal y cuantificar posibles velocidades de datos, y (iii) identificar la frecuencia optima de transmisión así como la posición de los electrodos para la propagación del señal en la capa de tejido dada. Proponemos dos modelos de circuitos equivalentes basados en la teoría de modelos de 2-puertos y elementos de circuito básicos, los cuales después son validados usando extensas simulaciones basadas en “finit element modeling” (FEM) y mesuras experimentales. Los resultados revelan un claro acuerdo entre la teoría, simulación y experimentos, sugiriendo un prometedor caso de adopción de los sistemas de comunicación basados en acoplamiento galvánico para futuros sistemas de sensores en el cuerpo humano.[CATALÀ] Molts dels procediments mèdics actuals requereixen una monitoratge constant del pacient a traves de macro-sensors situats sobre el cos humà o be amb micro-sensors implantats. Les formes tradicionals de comunicació sense fils s’han quedat limitades davant d’aquest escenari donada la limitada penetració de les ones electromagnètiques a traves del cos humà, i la necessitat de carregar les bateries a causa de la pèrdua d’energia associada a tals comunicacions. En el seu lloc, nosaltres proposem un sistema de comunicació sense fils radicalment diferent on intervé el acoblament galvànic, amb el qual nomes és requereix transmetre una extremada baixa energia per enviar la informació a traves del cos humà. Les contribucions principals d’aquest treball són: (i) desenvolupament d’un model teòric per estimar el guany del canal, on el mateix cos serveix de canal de comunicació, (ii) formular una estimació del soroll i les interferències presents en aquest canal i quantificar possibles velocitats de dades, i (iii) identificar la freqüència optima de transmissió així com la posició dels elèctrodes per la propagació del senyal en la capa de teixit donada. Proposem dos models de circuits equivalents per caracteritzar el canal, basats en la teoria de models de 2-ports i elements circuitals bàsics, el quals després son validats utilitzant extenses simulacions fent servir “finit element modeling” (FEM) i mesures experimentals. Els nostres resultats revelen un clar acord entre la teoria, simulació i experiments, suggerint un prometedor cas per l’adopció dels sistemes de comunicació basats en acoblament galvànic per futurs sistemes de sensors en el cos humà