Socio-demographic Index Countries Research Articles

Estimates of over-time trends in incidence and mortality of testicular cancer from 1990 to 2030.

BackgroundThis study aims to explore and project the temporal trends in incidence and mortality of testicular cancer. Moreover, it can provide theoretical guidance for the rational allocation of health resources.MethodsThis study analyzed existing data on testicular cancer morbidity and mortality from 1990 to 2016 and predicted time-varying trends of age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) from 2017 to 2030 in different ages, regions and sociodemographic index (SDI) quintile sub-groups.ResultGlobally, numbers of testicular cancer cases in 2016 [66,833; 95% uncertainty interval (UI), 64,487–69,736] are 1.8 times larger than in 1990 (37,231; 95% UI, 36,116–38,515). The testicular cancer-related death cases increased slightly from 8,394 (95% UI, 7,980–8,904) in 1990 to 8,651 (95% UI, 8,292–9,027) in 2016. In aspect of ASIR, the data showed an up-trend from 0.74 (95% UI, 0.72–0.77) in 1990 to 0.88 (95% UI, 0.85–0.92) in 2016. The ASDR of testicular cancer declined from 0.18 (95% UI, 0.17–0.19) in 1990 to 0.12 (95% UI, 0.11–0.12) in 2016. From 2017 to 2030, predictions of trends in testicular cancer indicate that the ASIRs of most SDI countries are rising, but the ASDRs trends in testicular cancer will decrease.ConclusionsBy analyzing the available and reliable data in different ages, regions and SDI, this study shows a significant upward trend in incidence and a slow upward trend in mortality of testicular cancer from 1990 to 2016, and simultaneously, predicts the increase of ASIR and the downward trend of ASDR in 2017–2030.

Estimates of over-time trends in incidence and mortality of prostate cancer from 1990 to 2030.

BackgroundThis research aims to identify the current and future trends in the incidence and death rate of prostate cancer and to provide the necessary data support for making relevant health decisions.MethodsThis study used the collected data and methodologies to describe the incidence and mortality trends of prostate cancer from 1990 to 2016. Based on the data, this paper projected the future trends in prostate cancer incidence and death rate.ResultsIn 2016, prostate cancer cases [1,435,742; 95% uncertainty interval (UI), 1,293,395–1,618,655] were nearly 2.5-fold the number in 1990 (579,457; 95% UI, 521,564–616,107). Deaths increased by 2.0-fold from 191,687 (95% UI, 168,885–209,254) in 1990 to 380,916 (95% UI, 320,808–412,868) in 2016. The global age-standardized incidence rate (ASIR) increased from 17.75 (95% UI, 18.91–15.95) in 1990 to 22.12 (95% UI, 19.92–24.91) in 2016, changing 24.62%. The global change of age-standardized death rate (ASDR) has declined slightly, but in some regions it shows a trend of growth. By sociodemographic index (SDI) sub-types, prostate cancer will frequently occur in high SDI countries from 1990 to 2030. Simultaneously, the highest mortality will present in low SDI countries.ConclusionsThrough projecting and analyzing incidence and mortality rate of prostate cancer, from 1990 to 2030, by different ages, regions and SDI sub-types, this result may reveal the relationship between prostate cancer and financial development. At the same time, the result also showed a sufficiently heavy burden of prostate cancer, but the burden varies greatly in each region. The burden is a challenge and will require attention for all levels of society. The current study is beneficial to formulate more specific and efficient policies.

Trends in health and disability in Botswana. An analysis of the global burden of disease study

Purpose Globally, years of life lost are declining, while years lived with disability are increasing. In high socio-demographic index countries, this trend has been attributed to an overall ageing population and rehabilitation services have begun to adjust to this change. In low- and middle-income countries, this trend is less well understood. Hence, the WHO’s ‘Rehabilitation 2030 Call for Action’ and ‘Rehabilitation in Health Systems Guide’ call for better assessment of the situation. In order to understand trends and causes in middle income countries such as Botswana, we examine the change over time in causes and number of years lived with disability and years of life lost. Methods We conducted a secondary analysis of the Global Burden of Disease 2017 data, exploring the change over time in Disability Adjusted Life Years per 100 000 people over the period 1990–2016. The descriptive analysis focuses on the contribution of years lived with disability towards the burden of disease within Botswana compared with the world, sub-Saharan Africa, and high-income countries. Results Our results show that Botswana’s top causes of years of life lost are HIV and other sexually transmitted infections, cardiovascular diseases, maternal and neonatal disorders, respiratory infections and tuberculosis, and neoplasms. Years lived with disability have increased over time, which is driven by mental disorders, HIV and other sexually transmitted infections, musculoskeletal disorders, neurological disorders, and skin and subcutaneous diseases. Conclusions Botswana needs better data to prepare its emerging health systems to accommodate the increased need for disability support and rehabilitation services caused by communicable and non-communicable diseases. Implications for Rehabilitation Botswana has an increase in disability prevalence over time that requires the development of disability and rehabilitation services. The greatest contributors towards disability adjusted life years in Botswana are currently mental disorders (13.7%), HIV and other sexual transmitted diseases, (13.0%), musculoskeletal disorders (9.9%), neurological disorders (8.0%), and sense organ diseases (6.2%). This requires strengthen of services such as mental health interventions, physiotherapy, optometry and audiology as well as linkages from major disease clusters such as HIV to rehabilitation services.

Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study

BackgroundAs global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated...

Recent updates on worldwide gout epidemiology.

To provide recent statistics on worldwide gout epidemiology. Current and prediction data on gout epidemiology were retrieved from the Global Health Data Exchange (GHDx) registry and from the World Health Organization (WHO) database on projected mortality. Overall, 7.44 million cases of gout have been estimated around the world in 2017 (incidence, 0.097%), with a prevalence of 41.22 million cases (0.54%), and causing 1.28 million DALYs (0.051% of all DALYs). Gout incidence, prevalence, and health loss considerably increased during the last 25years and are all higher in men than in women. The burden of gout increases linearly with aging, until the age of 64years, and is correlated with socio-demographic index (SDI), with incident risk of gout > 3-fold higher in high than in low SDI regions. Projections suggest that gout mortality may increase by 55% in 2060. The epidemiologic burden of gout remains high around the world, especially in men and in high SDI countries, with a trend that is unlikely to reverse soon.Key Points• A significant association can be found between gout and socioeconomic status.• Projections suggest that gout mortality may increase by 55% in 2060.• The epidemiologic burden of gout remains high around the world.

Global, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990-2017: results from a global burden of disease study, 2017.

To provide comprehensive estimates of the global, regional, and national burden of infertility from 1990 to 2017, using findings from a 2017 study on the global burden of disease (GBD), we assessed the burden of infertility in 195 countries and territories from 1990 to 2017. DisMod-MR 2.1 is a Bayesian meta-regression method that estimates non-fatal outcomes using sparse and heterogeneous epidemiological data. Globally, the age-standardized prevalence rate of infertility increased by 0.370% per year for females and 0.291% per year for males from 1990 to 2017. Additionally, age-standardized disability-adjusted life-years (DALYs) of infertility increased by 0.396% per year for females and 0.293% per year for males during the observational period. An increasing trend to these burden estimates was observed throughout the all socio-demographic index (SDI) countries. Interestingly, we found that high SDI countries had the lowest level of prevalence and DALYs in both genders. However, the largest increasing trend was observed in high-SDI countries for females. By contrast, low-SDI countries had the largest increasing trend in males. Negative associations were observed between these burden estimates and the SDI level. The global disease burden of infertility has been increasing throughout the period from 1990 to 2017.

Worldwide epidemiology of carbon monoxide poisoning.

This article presents updated information on the worldwide burden of carbon monoxide (CO) poisoning. The worldwide epidemiologic data were obtained from the Global Health Data Exchange registry, a large database of health-related data maintained by the Institute for Health Metrics and Evaluation. The worldwide cumulative incidence and mortality of CO poisoning are currently estimated at 137 cases and 4.6 deaths per million, respectively. The worldwide incidence has remained stable during the last 25 years, while both mortality and percentage of patients who died have declined by 36% and 40%, respectively. The incidence of CO poisoning does not differ between sexes, whilst mortality is double in men. The incidence shows two apparent peaks, between 0-14 years and 20-39 years. The percentage of patients who died constantly increases in parallel with aging, peaking in patients aged 80 years or older. The number of CO poisoning grows in parallel with the socio-demographic index (SDI), though more detailed analyses would be needed to confirm our findings. Mortality displays a similar trend, being approximately 2.1- and 3.6-fold higher in middle and middle-to-high than in low-to-middle SDI countries. In conclusion, while these data suggest that the worldwide burden of CO poisoning remains stable, and the number of fatal outcomes and percentage of patients who die have both consistently declined during the last 25 years, the unreliability of the primary data sources in many countries with respect to accurate diagnosis of CO poisoning means that caution is required, and that field studies, particularly in poorer countries, are required.

Measuring the potential impact of physical inactivity on worldwide epidemiology of colorectal and breast cancers

Background: Solid evidence has been published in support of a strong association between physical inactivity and enhanced risk of colorectal and breast cancers. This article aims to objectively assess the worldwide epidemiology of physical inactivity-related burden of colorectal and breast cancers. Methods: An electronic search was performed in the Global Health Data Exchange (GHDx) registry, a large database of health-related data, using the keywords “low physical activity” in the category “risk”, combined with “colon and rectum cancer” AND “breast cancer” in the category “cause”. The output of the electronic search was downloaded in comma-separated values (CSV), imported into an Excel file and analyzed. Results: The contribution of physical inactivity on the current burden of disability-adjusted life years (DALYs) and mortality is estimated at 3.44% and 3.64% for colorectal cancer, and at 1.43% and 1.54% for breast cancer, respectively. The impact of physical inactivity on the epidemiologic burden of colorectal cancer is constantly higher in women than in men, whilst it also increases in parallel with the socio-demographic index (SDI) in both types of cancer. The effect of physical inactivity on DALYs and deaths caused by these two malignancies remains substantially stable up to the age of 50 years, but then linearly increases, peaking in the elderly. In multivariable analysis, physical inactivity-related DALYs and deaths for colorectal cancer were independently associated with female sex, older age and higher SDI. Physical inactivity-related DALYs and deaths for breast cancer were also independently predicted by older age and higher SDI. Conclusions: The contribution of physical inactivity to the current burden of colorectal and breast cancer seems higher in the elderly, in people living in middle-to-high SDI countries, and in the female sex as regards colorectal cancer.

Global patterns and trends in the breast cancer incidence and mortality according to sociodemographic indices: an observational study based on the global burden of diseases

ObjectivesDisparities in the global burden of breast cancer have been identified. We aimed to investigate recent patterns and trends in the breast cancer incidence and associated mortality. We also assessed...

Measuring population ageing: an analysis of the Global Burden of Disease Study 2017

SummaryBackgroundTraditional metrics for population health ageing tend not to differentiate between extending life expectancy and adding healthy years. A population ageing metric that reflects both longevity and health status, incorporates a comprehensive range of diseases, and allows for comparisons across countries and time is required to understand the progression of ageing and to inform policies.MethodsUsing the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, we developed a metric that reflects age-related morbidity and mortality at the population level. First, we identified a set of age-related diseases, defined as diseases with incidence rates among the adult population increasing quadratically with age, and measured their age-related burden, defined as the sum of disability-adjusted life-years (DALYs) of these diseases among adults. Second, we estimated age-standardised age-related health burden across 195 countries between 1990 and 2017. Using global average 65-year-olds as the reference population, we calculated the equivalent age in terms of age-related disease burden for all countries. Third, we analysed how the changes in age-related burden during the study period relate to different factors with a decomposition analysis. Finally, we describe how countries with similar levels of overall age-related burden experience different onsets of ageing. We represent the uncertainty of our estimates by calculating uncertainty intervals (UI) from 1000 draw-level estimates for each disease, country, year, and age.Findings92 diseases were identified as age related, accounting for 51·3% (95% UI 48·5–53·9) of all global burden among adults in 2017. Across the Socio-demographic Index (SDI), the rate of age-related burden ranged from 137·8 DALYs (128·9–148·3) per 1000 adults in high SDI countries to 265·9 DALYs (251·0–280·1) in low SDI countries. The equivalent age to average 65-year-olds globally spanned from 76·1 years (75·6–76·7) in Japan to 45·6 years (42·6–48·2) in Papua New Guinea. Age-standardised age-related disease rates have decreased over time across all SDI levels and regions between 1990 and 2017, mainly due to decreases in age-related case fatality and disease severity. Even among countries with similar age-standardised death rates, large differences in the onset and patterns of accumulating age-related burden exist.InterpretationThe new metric facilitates the shift from thinking not just about chronological age but the health status and disease severity of ageing populations. Our findings could provide inputs into policymaking by identifying key drivers of variation in the ageing burden and resources required for addressing the burden.FundingNational Institute on Aging of the National Institutes of Health.

Disease burden among people aged 70 years or older in countries with different developmental levels from 1990 to 2016

To examine differences in burden of disease among people aged ≥70 years old in countries with different developmental levels from 1990 to 2016. Methods: The sociodemographic index (SDI) of global burden of disease (GBD) was used to divide 195 countries into five developmental levels: high, high middle, middle, low middle and low. The results of the Global Burden of Diseases Study 2016 (GBD 2016) were extracted to examine disability-adjusted life years (DALY) and the health loss from the top 10 diseases and risk factors among the people aged ≥70 years old in countries with different SDIs. Results: Between 1990 and 2016, the age-standardized DALY rate among people aged ≥70 years old in countries with different SDIs all showed a downward trend. Different decreases in DALY rate in over-seventy old people were observed across countries with different SDI levels: -23.9% in high SDI, -21.3% in high-middle SDI, -23.4% in middle SDI, -18.8% in low-middle SDI and -16.3% in low SDI. In 1990, the age-standardized DALY rate among people aged ≥70 years old in low and low middle SDI countries was 1.67 and 1.49 times of that in high SDI countries; and the gaps rose to 1.83 and 1.59 times in 2016. The DALY rate of the aged people remained remarkably higher in low middle and low SDI countries in 2016, and the gap widened compared with that in 1990. The reduction of age-standardized DALY rate was mainly due to the decrease of years of life lost (YLL). In 2016, low SDI and low-middle SDI countries suffered much higher burden of disease from infectious diseases and chronic non-communicable diseases. Analysis of leading causes and risk factors of DALY showed significant disparities across different SDI countries; burden of disease caused by environmental pollution and adverse health conditions was much higher in the low SDI and lower-middle SDI countries than that in the other countries. Conclusion: During 1990-2016, the burden of disease in countries of all 5 SDI levels declined. But the reductions in the developing countries were less than those in the developed countries, widening health disparities for the elderly between low and high SDI countries. International organizations and individual governments should take measures to narrow health gaps among old adults across countries with different developmental levels.

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

SummaryBackgroundHow long one lives, how many years of life are spent in good and poor health, and how the population’s state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.MethodsWe used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.FindingsGlobally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1–33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8–15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9–6·7), from 57·0 years (54·6–59·1) in 1990 to 63·3 years (60·5–65·7) in 2017. The increase varied from 3·8 years (3·4–4·1) in high SDI countries to 10·5 years (9·8–11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4–1·7) in Saint Vincent and the Grenadines (62·4 years [59·9–64·7] in 1990 to 63·5 years [60·9–65·8] in 2017) to 23·7 years (21·9–25·6) in Eritrea (30·7 years [28·9–32·2] in 1990 to 54·4 years [51·5–57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6–2·3) in Algeria to 11·9 years (10·9–12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4–78·7]) and males (72·6 years [69·8–75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7–50·2] for females and 42·8 years [40·1–45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8–43·5) for communicable diseases and by 49·8% (47·9–51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8–43·0), although age-standardised DALY rates decreased by 18·1% (16·0–20·2).InterpretationWith increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.FundingBill & Melinda Gates Foundation.

Global and Regional Incidence, Mortality Trends and Predictions of Urologic Cancer, 1990-2026: A Systematic Analysis of the Global Burden of Disease Study 2016

Background: Urologic cancer, including prostate cancer, kidney cancer, bladder cancer, and testicular cancer, are substantially increasing with the growing and ageing population. This study analyzed trends in the incidence and mortality of these urologic cancers to provide evidence for policy makers to inform national policies for disease prevention and treatment and allocate resources appropriately. Methods: This study used the Global Burden of Disease Study data and methodologies to describe the incidence and mortality trends of urologic cancer from 1990 to 2016. Based on the data, we predicted the 10-year trends in urologic cancer incidence and death. Trends were analyzed over time, as well as by age, sex, and sociodemographic index (SDI). Findings: In 2016, 2282117 new urologic cancer cases occurred worldwide (95% uncertainty interval [UI], 2115350-2486237), nearly 2.2-fold the number in 1990 (1024819; 95% UI, 956085-1072322). Cumulative deaths increased by 1.9-fold from 380801 (95% UI, 353032-404060) in 1990 to 707566 (95% UI, 636888-749766) in 2016. UC incident cases are increased by 55%, while deaths increased by 86% between 1990 and 2016. From 1990 to 2026, kidney cancers in both sexes are projected to increase substantially in high SDI, middle SDI, low-middle SDI, and low SDI countries, while the trends in incidence rates will remain stable globally and in high-middle SDI countries. Globally, the trends in deaths due to kidney cancer will remain stable. Bladder cancer will have the greatest occurrence in high SDI countries, followed by high-middle SDI countries. Moreover, bladder cancer incidence rates may increase substantially in middle SDI countries, while the incidence rates will remain relatively stable in other SDI countries for both sexes. From 1990 to 2026, bladder cancer deaths will continue to increase in low SDI countries, while deaths in other SDI countries will continue to decrease 2026. Of note, from 1990 to 2016, the most common incident urologic cancer globally for men was prostate cancer. Globally, from 1990 to 2026, the trends in prostate cancer incident cases are increasing substantially. By SDI subtypes, prostate cancer will most frequently occur in high SDI countries over the next 10 years, followed by high-middle SDI countries, low SDI countries, middle SDI countries, and low-middle SDI countries. Simultaneously, the trends in prostate cancer deaths are expected to increase worldwide. The highest mortality rates will present in low SDI countries, followed by high SDI countries, high-middle SDI countries, and low-middle SDI countries. However, trends in prostate cancer deaths are expected to slightly decrease in middle SDI countries from 2016 to 2026.Testicular cancer will most frequently occur in high SDI countries and at a highly increased rate. From 1990 to 2026, testicular cancer incident cases are projected to rise in all SDI countries except for the low SDI and low-middle SDI countries, where they will remain stable. However, the trends in testicular cancer deaths decreased in the high-middle SDI countries in 2016, and are projected to increase from 2016 to 2026. Testicular cancer death rates in other SDI countries will decline from 1990 to 2026. Interpretations: The incidence of urologic cancer is highly variable among countries but has increased uniformly since 1990. The findings of increases in total deaths and accelerated population ageing call for specific focus from health policy makers to ensure that health care systems are equipped to meet peoples' needs. However, the incidence and mortality of urologic cancer are steadily increasing globally, resulting in further challenges in the allocation of limited health care resources. The current study provides comprehensive knowledge of the local burden of disease and assists with the appropriate allocation of resources for urologic cancer prevention, screening, and treatment. Funding Statement: The research was funded by the National Natural Science Foundation of China (NSFC, Grant No. 91746205, 71673199, and 71473175). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The present study complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016

The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories. Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

SummaryBackgroundA key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.MethodsDrawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.FindingsIn 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.InterpretationGBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.FundingBill & Melinda Gates Foundation.

Global Burden of Multiple Myeloma

Multiple myeloma (MM) is a plasma cell neoplasm with substantial morbidity and mortality. A comprehensive description of the global burden of MM is needed to help direct health policy, resource allocation, research, and patient care. To describe the burden of MM and the availability of effective therapies for 21 world regions and 195 countries and territories from 1990 to 2016. We report incidence, mortality, and disability-adjusted life-year (DALY) estimates from the Global Burden of Disease 2016 study. Data sources include vital registration system, cancer registry, drug availability, and survey data for stem cell transplant rates. We analyzed the contribution of aging, population growth, and changes in incidence rates to the overall change in incident cases from 1990 to 2016 globally, by sociodemographic index (SDI) and by region. We collected data on approval of lenalidomide and bortezomib worldwide. Multiple myeloma mortality; incidence; years lived with disabilities; years of life lost; and DALYs by age, sex, country, and year. Worldwide in 2016 there were 138 509 (95% uncertainty interval [UI], 121 000-155 480) incident cases of MM with an age-standardized incidence rate (ASIR) of 2.1 per 100 000 persons (95% UI, 1.8-2.3). Incident cases from 1990 to 2016 increased by 126% globally and by 106% to 192% for all SDI quintiles. The 3 world regions with the highest ASIR of MM were Australasia, North America, and Western Europe. Multiple myeloma caused 2.1 million (95% UI, 1.9-2.3 million) DALYs globally in 2016. Stem cell transplantation is routinely available in higher-income countries but is lacking in sub-Saharan Africa and parts of the Middle East. In 2016, lenalidomide and bortezomib had been approved in 73 and 103 countries, respectively. Incidence of MM is highly variable among countries but has increased uniformly since 1990, with the largest increase in middle and low-middle SDI countries. Access to effective care is very limited in many countries of low socioeconomic development, particularly in sub-Saharan Africa. Global health policy priorities for MM are to improve diagnostic and treatment capacity in low and middle income countries and to ensure affordability of effective medications for every patient. Research priorities are to elucidate underlying etiological factors explaining the heterogeneity in myeloma incidence.