Global Burden Of Disease Project Research Articles

Predicting the effectiveness of interventions on population-level sodium reduction: A simulation modeling study.

Background and AimsInterventions that significantly reduce dietary sodium intake are anticipated to decrease gastric cancer (GCa) burden. However, the optimal restriction strategies remain unknown at present. This study aims to understand where and to what extent policies modifying sodium consumption change the distribution of GCa burden, and the effects of potential salt reduction strategies in China.MethodsThe synthetic population in this microscopic simulation study is close to reality. We incorporated estimates of dietary patterns and GCa risk into the model of excess salt consumption. These estimates and simulated population were obtained from the China Health and Nutrition Survey, Global Burden of Disease Project, and the sixth census of China's National Bureau of Statistics, respectively.ResultsIn the no intervention scenario, we estimated that disease burdens due to excess sodium intake would be at 472.9 million disability‐adjusted life years (DALYs) nationally between 2010 and 2030 (95% credible interval [CrI]: 371.1–567.7). The GCa burden caused by high sodium is projected to have a disproportionate impact on the central and southern provinces of China (9.2 and 4.5 million DALYs, respectively). Implementing a cooking salt substitute strategy would be expected to avoid a larger portion of GCa burden (about 67.2%, 95% CrI: 66.8%–67.6%) than the salt‐restriction spoon program (about 16.7%, 95% CrI: 16.1%–17.4%).ConclusionDietary salt reduction policy is very powerfully effective in reducing the GCa burden overall. It is expected that proposed salt substitutes are more effective than traditional salt‐restriction spoons to avoid increased inequality.

Global, regional, and national time trends in mortality for congenital heart disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study.

SummaryBackgroundCongenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort.MethodsCause-specific CHD mortality estimates were derived from the Global Burden of Disease 2019 study. We utilised an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0 to 4 to 65–69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period, and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care.FindingsCHD is the leading cause of deaths from non-communicable diseases (NCDs) in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval 177,000–262,000). There were 129 countries with at least 50 deaths. India, China, Pakistan, and Nigeria had the highest mortality, accounting for 39.7% of deaths globally. Between 1990 and 2019, the net drift of CHD mortality ranged from –2.41% per year (95% confidence interval [CI] –2.55, –2.67) in high Socio-demographic Index (SDI) countries to –0.62% per year (95% CI: –0.82, –0.42) in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from paediatric to adult populations, except for an increasing trend of mortality in those aged 10–34 years in Mexico and Pakistan. During the past 30 years, favourable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = –4.0% [95% CI –4.8 to –3.1] per year) and the United States (–2.3% [–2.5 to –2.0]), and also in many middle-SDI countries like Brazil (–2.7% [–3.1 to 2.4]) and South Africa (–2.5% [–3.2 to –1.8]). However, 52 of 129 countries had either increasing trends (net drifts ≥0.0%) or stagnated reductions (≥–0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts amongst high- and high-middle-SDI countries, with the exceptions of Saudi Arabia and Kazakhstan. 14 middle-SDI countries such as Ecuador and Mexico, and 16 low-middle-SDI countries including India and 20 low-SDI countries including Pakistan, had unfavourable or worsening risks for recent periods and birth cohorts.InterpretationCHD mortality is a useful and accessible indicator of trends in the provision of congenital cardiac care both in early childhood and across later life. Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally over the past three decades, unfavourable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age groups. These failings carry significant implications for the likelihood of achieving the Sustainable Development Goal targets for under-5 years and NCD mortality.FundingSupported by the 10.13039/501100001809National Natural Science Foundation of China (81525002, 31971048, 82073573 to ZZ and HZ), Shanghai Outstanding Medical Academic Leader program (2019LJ22 to HZ), and Collaborative Innovation Program of Shanghai Municipal Health Commission (2020CXJQ01 to HZ), the Bill & Melinda Gates Foundation for the Global Burden of Disease Project (to NJK) and NHMRC fellowship administered through the University of Melbourne (to GCP).

Herpes zoster epidemiology in Latin America: A systematic review and meta-analysis.

The epidemiology and burden of Herpes Zoster (HZ) are largely unknown, and there are no recent reviews summarizing the available evidence from the Latin America and Caribbean (LAC) region. We conducted a systematic review and meta-analysis to characterize the epidemiology and burden of HZ in LAC. Bibliographic databases and grey literature sources were consulted to find studies published (January 2000 -February 2020) with epidemiological endpoints: cumulative incidence and incidence density (HZ cases per 100,000 person-years), prevalence, case-fatality rates, HZ mortality, hospitalization rates, and rates of each HZ complication. Twenty-six studies were included with most studies coming from Brazil. No studies reported the incidence of HZ in the general population. In population at higher risk, the cumulative incidence ranged from 318-3,423 cases of HZ per 100,000 persons per year of follow-up. The incidence density was 6.4-36.5 cases per 1,000 person-years. Age was identified as a major risk factor towards HZ incidence which increase significantly in people >50 years of age. Hospitalization rates ranged from 3%-35.7%. The in-hospital HZ mortality rate ranged from 0%-36%. Overall, HZ mortality rates were found to be higher in females across all age groups and countries. The incidence of HZ complications (such as post-herpetic neuralgia, ophthalmic herpes zoster, and Ramsay Hunt syndrome) was higher in the immunosuppressed compared to the immunocompetent population. Acyclovir was the most frequently used therapy. Epidemiological data from Ministry of Health databases (Argentina, Brazil, Colombia, Chile y Mexico) and Institute for Health Metrics and Evaluation's Global Burden of Disease project reported stable rates of hospitalizations and deaths over the last 10 years. High-risk groups for HZ impose a considerable burden in LAC. They could benefit from directed healthcare initiatives, including adult immunization, to prevent HZ occurrence and its complications.

Analysis of maternal mortality trend and age-period-cohort model in China from 1992 to 2017

Objective: To understand the trend of maternal mortality in China from 1992 to 2017, and to evaluate the effects of age, period and cohort of maternal mortality by using the age-period-cohort (APC) model. Methods: The data of maternal mortality in China from 1992 to 2017 were collected from the Global Burden of Disease project. The maternal mortality rate was adopted to describe the trend of death. The APC model and the estimable function algorithm were used to evaluate the impact of age, period and birth cohort factors on maternal mortality risk in China. Results: From1992 to 2017, the maternal mortality rate in China fluctuated slightly and then continued to decline and finally increased slightly. During this period, the net drift was -10.00% per year (95%CI:-10.92% to -9.08% per year), and all the local drifts were lower than zero in all age groups of 10-54 years old (P<0.05). The results of the APC model analysis showed that the maternal mortality risk of women in their life stage showed a trend of rapid decrease, then a slow climb and finally a rapid increase. The period relative risk and cohort relative risk of maternal mortality both showed a monotonous decreasing trend. Conclusion: From 1992 to 2017, the maternal mortality rate in China generally shows a downward trend, and the risk of maternal mortality has significant age, period and cohort effects.

PRO28 Healthcare Resource Use (HCRU) of Patients with Aromatic L-Amino Acid Decarboxylase Deficiency (AADC-D) in France

AADC-d is an ultra-rare autosomal recessive neurometabolic disorder leading to hypotonia, movement disorders, developmental delay and autonomic symptoms from birth. Given the lack of healthcare resource utilization (HCRU) information, the aim of this study, part of a global burden of disease project, was to generate French data to feed a cost-effectiveness model to support HTA submission.

Fact or fiction: “Skin diseases are the fourth largest cause of disability worldwide”

Skin diseases represent a much larger burden of disease than commonly believed in wider society. The Global Burden of Disease (GBD) project found that skin diseases were the fourth leading cause of disability worldwide in 2010 and 2013.¹ The GBD project remains the main source of global disease burden estimates, and accordingly, the results are used to establish research priorities, set health policies, monitor international health goals, and more. The accuracy of their findings is therefore paramount to achieving equity in global health, especially in terms of appropriate resource allocation. To discuss the veracity of the statement: “Skin diseases are the fourth largest cause of disability worldwide,” we will first explore the concept of disability in the context of skin disease, discuss how disability should most accurately be measured, and finally, analyse how the GBD study came to this conclusion in order to explore the validity and implications of such a finding.

Prevalence and pattern of hearing loss among meningitis survivors in the Pacific Islands: a prospective, observational study protocol

Background Permanent hearing loss is the most common neurological sequelae among meningitis survivors in low- and middle-income countries. It is preventable through the availability and optimal population coverage of immunization programs. The most recent Global Burden of Disease Project reported that mortality and morbidity rates associated with meningitis are in decline in the Pacific Islands. While the report is encouraging, clinical and rehabilitation services for meningitis survivors remain important for regions where immunization delivery is unable to reach optimal levels. The aim of the proposed study is to assess the prevalence and pattern of hearing impairment among meningitis survivors in Samoa, a Polynesian nation of the Pacific Islands. Methods and analysis This will be a prospective observational study design. All patients admitted to Tupua Tamasese Meaole Hospital with a meningitis diagnosis from January 2021 to December 2022 will be eligible for the study. All meningitis survivors will be referred to the Ear, Nose and Throat (ENT)/audiology clinic prior to discharge for an ear and hearing assessment. The dependent variables will be otoscopic result and audiometry result for each ear. The independent variables will be age, gender, causal meningitis pathogen, and place of residence (urban/rural/remote). Ethics and conclusions We publish this protocol to facilitate similar research studies, especially among our Pacific Island neighbours. This research protocol may be a useful resource for the development of clinical procedures for routine ENT/audiology assessments for patients following infection with known causes of hearing loss. This study was approved by the Government of Samoa Ministry of Health Ethical Research Committee and the University of Queensland Medical Ethics Research Committee.

Assessment of oral health status and treatment needs in hemodialysis patients at Raichur district, Karnataka, India

Introduction: According to the World Health Organization (WHO) global burden of disease project, chronic kidney disease is the 12th leading cause of death and 17th leading cause of disability in the world. Statistics show that 90% of the patients suffering from chronic renal failure face oral health-related problems. The objective of the study was to assess the oral health status and treatment needs in hemodialysis patients at Raichur district, Karnataka.Materials and Methods: A cross-sectional study was carried out on 110 patients undergoing hemodialysis at Raichur district, Karnataka. Oral health status was assessed using the WHO assessment form 1997. Oral Hygiene Index – Simplified (1964) was used to assess the Oral Hygiene Status.Results: The mean age of the patients was 43.99 ± 12.80 years and the mean Decayed Teeth, Missing Teeth, Filled Teeth (FT), and Decayed Missing FT was 2.53 ± 2.39, 4.39 ± 7.57, 0.08 ± 0.30, and 7.00 ± 7.01, respectively. The prevalence of dental caries was 94.5%. Calculus was seen in 60.9% of the patients. Oral hygiene status was poor in 49.5% of the patients. The mean number of teeth required treatment was 4.4.Conclusion: This special population has high prevalence of dental caries and poor oral hygiene which needed periodic health education and intervention.

The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017.

The Global Burden of Disease (GBD) Study provides an annually updated resource to study disease-related morbidity and mortality worldwide. Here we present the burden estimates for atopic dermatitis (AD), including data from inception of the GBD project in 1990 until 2017. Data on the burden of AD were obtained from the GBD Study. Atopic dermatitis (AD) ranks 15th among all nonfatal diseases and has the highest disease burden among skin diseases as measured by disability-adjusted life-years (DALYs). Overall, the global DALY rate for AD in 1990 was 121 [95% uncertainty interval (UI) 65·4-201] and remained similar in 2017 at 123 (95% UI 66·8-205). The three countries with the highest DALY rates of AD were Sweden (327, 95% UI 178-547), the UK (284, 95% UI 155-478) and Iceland (277, 95% UI 149-465), whereas Uzbekistan (85·1, 95% UI 45·2-144), Armenia (85·1, 95% UI 45·8-143) and Tajikistan (85·1, 95% UI 46·1-143) ranked lowest. The global prevalence rate of AD has remained stable from 1990 to 2017. However, the distribution of AD by age groups shows a bimodal curve with the highest peak in early childhood, decreasing in prevalence among young adults, and a second peak in middle-aged and older populations. We also found a moderate positive correlation between a country's gross domestic product and disease burden. GBD data confirm the substantial worldwide burden of AD, which has remained stable since 1990 but shows significant geographical variation. Lifestyle factors, partially linked to affluence, are likely important disease drivers. However, the GBD methodology needs to be developed further to incorporate environmental risk factors, such as ultraviolet exposure, to understand better the geographical and age-related variations in disease burden.

Disease burden of colorectal cancer in China: any changes in recent years?

Objective: To update the disease burden of colorectal cancer (CRC) in Chinese population by integrating the latest multi-source evidences. Methods: Groups of data from GLOBOCAN, series of Chinese Cancer Registry Annual Report (annual report), Cancer Incidence in Five Continents (CI5), Global Burden of Disease Project 2017 (GBD), China Death Cause Surveillance Datasets and China Health Statistical Yearbooks (yearbook) were used to extract the information. Data on incidence, mortality, disability-adjusted life year (DALY) and percentage distribution of sub-location of CRC were used to analyze the latest disease burden in China, and age-standardized rates by world standard population were mainly used. Joinpoint Trend Analysis Software 4.7.0.0 was applied for time trend analysis. Data related to the economic burden of CRC in China were gathered by literature review. Results: (1) Current status: according to the latest annual report, the incidence and mortality rates of CRC were 17.1 per 100 000 and 7.9 per 100 000, respectively among the covered registration sites in 2015. The incidence ratios of male to female and that of urban to rural were 1.5 and 1.4, with the mortality ratios were 1.6 and 1.4, respectively. Similar to data from the annual report, the mortality rate was reported as 6.9 per 100 000 in 2017 by the surveillance data sets. Data from the GBD project showed that, the DALYs caused by CRC in China in 2017 was 4.254 million person years (doubled compared with that of 1990), accounting for 22.4% of the global burden of CRC. (2) Time trends: according to the annual reports, from 2009 to 2015, the incidence rate and mortality rate of CRC in China decreased by 10.2% and 9.5%, respectively. The same trend was also observed in urban sites, but was opposite in rural areas (increased 20.0% in incidence and 15.2% in mortality). Results from the Joinpoint analysis showed that the averaged annual percentage change (AAPC) was estimated as -1.6% (P<0.05) in the national mortality rate. Similarly, in the incidence and mortality rates of urban sites appeared as AAPC=-1.5% and -1.4% (all P<0.05), but inversely in the incidence rate from the rural sites as AAPC=3.3% (P<0.05). The yearbook data showed a 9.8% increase in urban and 20.6% increase in rural on the mortality in 2017 when compared with 2004, but the Joinpoint analysis showed no statistical significance (P<0.05). (3) Distribution of sub-location of CRC: the annual report showed that among all the new CRC cases in China in 2015, colon, rectal and anal cancer accounted for 49.6%, 49.2% and 1.2%, respectively, while the proportions were 51.3%, 47.6% and 1.1%, respectively in 2009. The proportion of colon cancer was continuously higher in the urban (>52%) than that in the rural areas (<44%). The CI5 Ⅺ data showed that ascending and sigmoid colons were more commonly seen among all the colon cancers. (4) Economic burden: the average annual growth rate of the medical expenditure per CRC patient in China ranged from 6.9% to 9.2%, and the 1-year out-of-pocket expenditure of a newly diagnosed patient accounted for about 60% of their previous-year household income. Conclusions: In China, the overall disease burden of CRC might have been decreased slightly but generally remained stable in the last several years, however, the rising burden appeared in the rural areas should not be ignored. In consistent with findings from a previous review, men and people from the urban areas are considered the target populations for CRC. The finding of higher proportion of colon cancer in urban areas suggests the impact of development of socioeconomic and medical technologies on CRC development and detection. The economic burden of CRC continued to grow.

Increasing the Impact of Environmental Epidemiology in the Global Burden of Disease Project.

Increasing the Impact of Environmental Epidemiology in the Global Burden of Disease Project.

The French national Global Burden of Disease (GBD) evaluation project

Abstract As in many countries, there is an urgent need to prioritize the issues in public health care and prevention in France. The French GBD project aims to offer a unique set of combined morbidity and mortality estimates to inform health policy makers in France, at the national level. However, because of the variability in health status and risk factors across geographical areas, policy makers need comparable estimates at the regional and local levels to target specific populations and to implement actions to improve health. Besides, although the accuracy of the indicators provided by the GBD has not been evaluated in the French context, it would be likely improved by enhancing and enriching the French data used as input. The French national health data system is one of the largest healthcare claims database in Europe. Based on these data, the French National Health Insurance (Cnam) and Santé publique France (SpFrance), in collaboration with clinicians and researchers, have developed a set of algorithms to identify diseases based on health care reimbursements, which could improve GBD estimates. Cnam and SpFrance both contribute to the definition, prioritization and evaluation of health policies in France and have therefore decided to pool their strengths and mutualize their resources to build a common rationale and provide consistent French Burden of Diseases estimates. A collaboration with the Institute of Health Metrics and Evaluation (IHME) has also been initiated, to allow Cnam and SpFrance benefiting from IHME's infrastructure and expertise and together seek to improve the estimates of the indicators using comparable methods at local and national levels, and consistent with the overall Global Burden of Disease project. Finally, beyond the ongoing production of the GBD metrics, another objective is the knowledge transfer to Cnam and SpFrance as learning organizations. The project has started with a framework between the three parties and the expression of interest.

A comparison of health indicators and social determinants of health between Israel and the Occupied Palestinian Territories

ABSTRACT Despite the proximity and interconnections between Israel and the Occupied Palestinian Territories (oPt), great disparities persist in health status between these two regions. This disparity is seen in infant, child and maternal mortality, life expectancy, mortality rates for leading causes of death and measures of mental well-being. This paper compares health indicators between oPt and Israel and examines the social determinants of health that may be responsible for differences between them. Data on health indicators were obtained from publicly available publications or websites of the World Health Organization and The World Bank, as well as the database of the Global Burden of Disease Project of the Institute of Health Metrics and Evaluation. Data on the social determinants of health were obtained from publications and websites of the United Nations, the World Bank, the U.S. Central Intelligence Agency, Palestinian and Israeli government reports, reports from non-governmental organisations, peer-reviewed studies and news articles. The health disparities are due to a complex mix of factors involving economic conditions, food insecurity, environmental exposures, psychological trauma and stress, and access to health services, most of which can be related directly or indirectly to the Israeli military occupation of oPt.

COVID-19 outbreak and decreased hospitalisation of pregnant women in labour

COVID-19 outbreak and decreased hospitalisation of pregnant women in labour

Assessing the quality of public health in the Russian Federation and Israel: Main problems and solutions

Subject. The article addresses the public health in the Russian Federation and Israel. Objectives. The focus is on researching the state of public health in Russia and Israel, using the Global Burden of Disease (GBD) project methodology, identifying problem areas and searching for possible ways to improve the quality of health of the Russian population based on the experience of Israel. Methods. The study draws on the ideology of the GBD project, which is based on the Disability-Adjusted Life-Year (DALY) metric. Results. The paper reveals the main causes of DALY losses and important risk factors for cancer for Russia and Israel. The findings show that the total DALY losses for Russia exceed Israeli values. The same is true for cancer diseases. Conclusions. Activities in Israel aimed at improving the quality of public health, the effectiveness of which has been proven, can serve as practical recommendations for Russia. The method of analysis, using the ideology of the GBD project, can be used as a tool for quantitative and comparative assessment of the public health.

Energy and nutrient intakes in relation to National Nutrition Recommendations in a Norwegian population-based sample: the Tromsø Study 2015-16.

IntroductionAccording to the Global Burden of Disease project, unhealthy diet accounts for most of the disease burden in Norway. Current recommendations on nutrient intake in Norway reflect those published in the evidence-based Nordic Nutrition Recommendations from 2012 (NNR2012).AimTo study energy and nutrient intakes and compliance with the NNR2012 among women and men in a population-based study.MethodsA total of 15,146 participants (aged 40–99 years) completed a validated food frequency questionnaire (261 questions on food items, meals, and beverages) in the seventh survey of the Tromsø Study in 2015–16; 11,425 participants were eligible for the current analysis. Nutrient intake was estimated by a food and nutrient calculation system at the University of Oslo, Norway. We compared energy, macronutrient, and micronutrient intakes with the NNR2012.ResultsIn total, 85% of the women and men were not in compliance with the maximum recommended intake of saturated fat, and 40 and 77% of women and men, respectively, were not in compliance with the lowest recommended intake of fiber. More than 30% of women and 25% of men had a relatively high probability of inadequate intake of vitamin D, and more than 10% of the men had a relatively high probability of inadequate intake of vitamin B6 and vitamin C. More than 20% of women and men had a high probability of excessive intake of niacin, and almost 40% of women had a high probability of excessive intake of vitamin A.ConclusionAlthough most participants were in compliance with NNR2012, a large proportion of participants had higher intakes than maximum recommended for saturated fat, and lower than recommended for fiber and vitamin D.

Estimating the future burden of hip fractures in Norway. A NOREPOS study.

The incidence rate of hip fractures seems to be declining in many western countries. However, due to the ageing of the population, the number of fractures may still be on the rise. No papers so far have quantified the future burden of hip fractures in terms of both health loss (as measured in disability adjusted life years DALY) and costs. The purpose of this paper is to assess the future health and economic burden of hip fractures. We collected population projections from Statistics Norway up until the year 2040. The medium projection was used for the base case analysis. Fracture rates for 2008 were estimated based on information from the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) hip fracture database (NORHip), which includes information about all hip fractures in Norway. Future fracture rate was assumed to decline by 0.7% per year in the base case. We used the same assumptions as the global burden of disease project on years of remaining life and disability weights. Cost of hip fracture was based on the published literature. In sensitivity analyses, we assessed the impact of changing underlying assumptions on demographic change, development in hip fracture rate, assumed life expectancy and choice of disability weights. Assuming a medium population growth and a continued decline in fracture rate, our estimates indicate that health lost to hip fractures will approximately double, from 32,850 DALYs in 2020 to 60,555 in 2040. Over the same period, costs are estimated to increase by 65%. Sensitivity analyses indicate that estimates are highly sensitive to assumptions on both population growth, fracture rate development, disability weights and assumed life expectancy. The burden of hip fractures in terms of DALYs lost and cost incurred is likely to increase even if the fracture rate continues to decline.

Assessment of Prevention Research Measuring Leading Risk Factors and Causes of Mortality and Disability Supported by the US National Institutes of Health

No studies to date have examined support by the National Institutes of Health (NIH) for primary and secondary prevention research in humans and related methods research that measures the leading risk factors or causes of death or disability as outcomes or exposures. To characterize NIH support for such research. This serial cross-sectional study randomly sampled NIH grants and cooperative agreements funded during fiscal years 2012 through 2017. For awards with multiple subprojects, each was treated as a separate project. Study characteristics, outcomes, and exposures were coded from October 2015 through February 2019. Analyses weighted to reflect the sampling scheme were completed in March through June 2019. Using 2017 data from the Centers for Disease Control and Prevention and 2016 data from the Global Burden of Disease project, the leading risk factors and causes of death and disability in the United States were identified. The main outcome was the percentage of the NIH prevention research portfolio measuring a leading risk factor or cause of death or disability as an outcome or exposure. A total of 11 082 research projects were coded. Only 25.9% (95% CI, 24.0%-27.8%) of prevention research projects measured a leading cause of death as an outcome or exposure, although these leading causes were associated with 74.0% of US mortality. Only 34.0% (95% CI, 32.2%-35.9%) measured a leading risk factor for death, although these risk factors were associated with 57.3% of mortality. Only 31.4% (95% CI, 29.6%-33.3%) measured a leading risk factor for disability-adjusted life-years lost, although these risk factors were associated with 42.1% of disability-adjusted life-years lost. Relatively few projects included a randomized clinical trial (24.6%; 95% CI, 22.5%-26.9%) or involved more than 1 leading cause (3.3%; 95% CI, 2.6%-4.1%) or risk factor (8.8%; 95% CI, 7.9%-9.8%). In this cross-sectional study, the leading risk factors and causes of death and disability were underrepresented in the NIH prevention research portfolio relative to their burden. Because so much is already known about these risk factors and causes, and because randomized interventions play such a vital role in the development of clinical and public health guidelines, it appears that greater attention should be given to develop and test interventions that address these risk factors and causes, addressing multiple risk factors or causes when possible.

Environmental Burden of Childhood Disease in Europe.

Background: Environmental factors determine children’s health. Quantifying the health impacts related to environmental hazards for children is essential to prioritize interventions to improve health in Europe. Objective: This study aimed to assess the burden of childhood disease due to environmental risks across the European Union. Methods: We conducted an environmental burden of childhood disease assessment in the 28 countries of the EU (EU28) for seven environmental risk factors (particulate matter less than 10 micrometer of diameter (PM10) and less than 2.5 micrometer of diameter (PM2.5), ozone, secondhand smoke, dampness, lead, and formaldehyde). The primary outcome was disability-adjusted life years (DALYs), assessed from exposure data provided by the World Health Organization, Global Burden of Disease project, scientific literature, and epidemiological risk estimates. Results: The seven studied environmental risk factors for children in the EU28 were responsible for around 211,000 DALYs annually. Particulate matter (PM10 and PM2.5) was the main environmental risk factor, producing 59% of total DALYs (125,000 DALYs), followed by secondhand smoke with 20% of all DALYs (42,500 DALYs), ozone 11% (24,000 DALYs), dampness 6% (13,000 DALYs), lead 3% (6200 DALYs), and formaldehyde 0.2% (423 DALYs). Conclusions: Environmental exposures included in this study were estimated to produce 211,000 DALYs each year in children in the EU28, representing 2.6% of all DALYs in children. Among the included environmental risk factors, air pollution (particulate matter and ozone) was estimated to produce the highest burden of disease in children in Europe, half of which was due to the effects of PM10 on infant mortality. Effective policies to reduce environmental pollutants across Europe are needed.

Ambient PM2.5 Reduces Global and Regional Life Expectancy

Exposure to ambient fine particulate matter (PM2.5) air pollution is a major risk for premature death. Here, we systematically quantify the global impact of PM2.5 on life expectancy. Using data from the Global Burden of Disease project and actuarial standard life table methods, we estimate global and national decrements in life expectancy that can be attributed to ambient PM2.5 for 185 countries. In 2016, PM2.5 exposure reduced average global life expectancy at birth by ∼1 year with reductions of ∼1.2–1.9 years in polluted countries of Asia and Africa. If PM2.5 in all countries met the World Health Organization Air Quality Guideline (10 μg m–3), we estimate life expectancy could increase by a population-weighted median of 0.6 year (interquartile range of 0.2–1.0 year), a benefit of a magnitude similar to that of eradicating lung and breast cancer. Because background disease rates modulate the effect of air pollution on life expectancy, high age-specific rates of cardiovascular disease in many polluted low...