Levels Of Socio-demographic Index Research Articles

Assessment of Global Trends in the Diagnosis of Mesothelioma From 1990 to 2017

It is difficult for policy makers and clinicians to formulate targeted management strategies for mesothelioma because data on current epidemiological patterns worldwide are lacking. To evaluate the mesothelioma burden across the world and describe its epidemiological distribution over time and by sociodemographic index (SDI) level, geographic location, sex, and age. Annual case data and age-standardized rates of incidence, death, and disability-adjusted life-years associated with mesothelioma among different age groups were obtained from the Global Burden of Disease 2017 database. The estimated annual percentage changes in age-standardized rates were calculated to evaluate temporal trends in incidence and mortality. The study population comprised individuals from 21 regions in 195 countries and territories who were diagnosed with mesothelioma between 1990 and 2017. Data were collected from May 23, 2019, to January 18, 2020. Primary outcomes were incident cases, deaths, and their age-standardized rates and estimated annual percentage changes. Secondary outcomes were disability-adjusted life-years and relative temporal trends. Overall, 34 615 new cases (95% uncertainty interval [UI], 33 530-35 697 cases) of mesothelioma and 29 909 deaths (95% UI, 29 134-30 613 deaths) associated with mesothelioma were identified in 2017, and more than 70% of these cases and deaths were among male individuals. In 1990, the number of incident cases was 21 224 (95% UI, 17 503-25 450), and the number of deaths associated with mesothelioma was 17 406 (95% UI, 14 495-20 660). These numbers increased worldwide from 1990 to 2017, with more than 50% of cases recorded in regions with high SDI levels, whereas the age-standardized incidence rate (from 0.52 [95% UI, 0.43-0.62] in 1990 to 0.44 [95% UI, 0.42-0.45] in 2017) and the age-standardized death rate (from 0.44 [95% UI, 0.37-0.52] in 1990 to 0.38 [95% UI, 0.37-0.39] in 2017) decreased, with estimated annual percentage changes of -0.61 (95% CI, -0.67 to -0.54) for age-standardized incidence rate and -0.44 (95% CI, -0.52 to -0.37) for age-standardized death rate. The proportion of incident cases among those 70 years or older continued to increase (from 36.49% in 1990 to 44.67% in 2017), but the proportion of patients younger than 50 years decreased (from 16.74% in 1990 to 13.75% in 2017) over time. In addition, mesothelioma incident cases and age-standardized incidence rates began to decrease after 20 years of a complete ban on asbestos use. For example, in Italy, a complete ban on asbestos went into effect in 1992; incident cases increased from 1409 individuals (95% UI, 1013-1733 individuals) in 1990, peaked in 2015 after 23 years of the asbestos ban, then decreased from 1820 individuals (95% UI, 1699-1981 individuals) in 2015 to 1746 individuals (95% UI, 1555-1955 individuals) in 2017. This cross-sectional study found that incident cases of mesothelioma and deaths associated with mesothelioma continuously increased worldwide, especially in resource-limited regions with low SDI levels. Based on these findings, global governments and medical institutions may consider formulating optimal policies and strategies for the targeted prevention and management of mesothelioma.

Sociodemographic index and global trends in prostate cancer: 1990-2017.

Considered globally, prostate cancer is a disease of the aging male that increases in prevalence with exposure to screening and diagnostic testing, and which requires a population with the health and longevity to encounter it. The Global Burden of Disease (GBD) dataset is an aggregation of worldwide registries and health data systems that reports global and regional assessment of disease impact. Using the GBD database, 1171 worldwide registries and health registration systems from 1990 to 2016 were aggregated for prostate cancer disease codes and outcomes. Disease-Adjusted Life Years (DALYs) were calculated and segregated by sociodemographic index (SDI) quintile, and compared to other urologic diseases and tuberculosis (TB). Prostate cancer exerts a burden of disease that is vastly higher in the top quintile of SDI. The three lowest SDI quintiles represent the majority of global population but are currently less impacted by prostate cancer. Conversely, TB has its highest impact on the lowest SDI levels, although these rates are declining. As a global disease, prostate cancer predominantly affects high SDI men who enjoy a longer life expectancy in which to suffer from this disease and a greater exposure to screening and diagnosis. As lower SDI men are elevated in health and income, reallocation of DALYs will occur, and a greater burden of prostate cancer can be expected. These epidemiologic trends have great implications for the allocation of resources, as the population of men affected by prostate cancer outpaces urologic workforce growth.

Global, regional and national burden of lung cancer and its attributable risk factors in 204 countries and territories, 1990-2019.

To explore the lung cancer burden and related risk factors in groups of different sex, ages and levels of sociodemographic index (SDI) at global, regional and national levels. Using newly released GBD 2019 data, we explored the trends of lung cancer burden and its related risk factors in groups of different sex, ages and levels of SDI at global, regional and national levels. The Global Health Data Exchange query tool was used to obtain the data. While lung cancer has an overall stable age-standardized incidence rate (ASIR), the death rate (ASDR) and disability-adjusted life-years (DALYs) rate (with even a trend of decline), it is still the number one malignant tumor. The ASIR and ASDR grew slowly in women worldwide. In 2019, High-income North America, East Asia and Central Europe ranked top three in ASIR, ASDR and age-standardized DALY rate, with growth in East Asia the highest. These three indicators were not in a single linear relation with SDI at a national level, and a peak appeared when SDI was about 0.8. The top three attributable risk factors to DALYs were smoking, particulate matter pollution and occupational carcinogens. Given the high heterogeneity in lung cancer burden among different populations, decision-makers should understand local epidemiological characteristics of lung cancer in detail to formulate effective policies. Stricter tobacco control and improvement in lung cancer screening and treatment are imperative.

Changing epidemiology of calcific aortic valve disease: 30-year trends of incidence, prevalence, and deaths across 204 countries and territories.

Calcific aortic valve disease (CAVD) is associated with increased morbidity and mortality. We aimed to elucidate the 30-year epidemiology of CAVD globally. Global CAVD incidence, prevalence, and deaths increased 3.51-, 4.43-, and 1.38-fold from 1990 to 2019, respectively, without any decreasing trends, even after age standardization. In 2019, Slovenia had the highest age-standardized rate (ASR) of CAVD incidence (62.21/100,000 persons) and prevalence (1,080.06/100,000) whereas Cyprus had the highest ASR of deaths (8.20/100,000). Population aging was an important contributor to incidence. Compared with women, more men had CAVD and men had earlier peaks in disease prevalence. High systolic blood pressure, diet high in sodium, and lead exposure were the main risk factors for deaths owing to CAVD. The estimated annual percentage change, a measure to estimate the variation of ASR, was significantly associated with the ASR and sociodemographic index (SDI) in 2019 for incidence and prevalence across all 204 countries and territories (all p<0.0001). With increased lifespan and risk factors, the overall burden of CAVD is high and remains on the rise, with differences by sex, age, and SDI level. Our findings serve to sound the alarm for organizations, institutions, and resources whose primary purpose is to improve human health.

Global, regional, and national burden of aortic aneurysm, 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017.

This study aimed at evaluating the age, sex, and country-income patterns in aortic aneurysm disease burden, analysing trends in mortality and years of life lost (YLLs), as well as their causal drivers and risk factors, using the 2017 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2017). We described the temporal, global, and regional (195 countries) patterns of aortic aneurysm (thoracic and abdominal) mortality, YLLs, their drivers [sociodemographic index (SDI), healthcare access and quality index (HAQ index)] and risk factors using the GBD 1990-2017. Correlation and mixed multilevel modelling between aortic aneurysm mortality, YLLs, HAQ index and other variables were applied. From 1990 to 2017, a global declining trend in age-standardized aortic aneurysm mortality was found [2.88 deaths/100000 (95% uncertainty intervals, UI 2.79 to 3.03) in 1990 and 2.19 deaths/100000 (95% UI 2.09 to 2.28) in 2017]. Among high-income countries (HICs) a consistent declining Spearman's correlation between age-standardised aortic aneurysm mortality, SDI (HICs; 1990 rho: 0.57, P ≤ 0.001; 2017 rho: 0.41, P = 0.001) and HAQ index was observed (HICs; 1990 rho: 0.50, P <0.001; 2016 rho: 0.35, P = 0.006); in comparison with low- and middle-income countries where correlation trends were weak and mixed. At a global level, higher HAQ index was related with lower aortic aneurysm mortality and YLLs [mortality, coef: -0.05, 95% confidence interval (CI): -0.06, -0.04; YLLs, coef: -0.94, 95% CI: -1.17, -0.71]. Age-standardized aortic aneurysm mortality declined globally between 1990 and 2017. Globally, age-standardized aortic aneurysm mortality and YLLs were related to changes in SDI and HAQ index levels, while country-level income-related variations were also observed.

Age, Gender and Geographic Differences in Global Health Burden of Cirrhosis and Liver Cancer due to Nonalcoholic Steatohepatitis.

Objective: Recently, Nonalcoholic Steatohepatitis (NASH) has become a major contributor to cirrhosis and liver cancer. Therefore, the Global Burden of Disease (GBD) 2017 was used to comprehensively analyze the global, regional, and national burden of cirrhosis and liver cancer due to NASH between 1990 and 2017.Methods: Data for cirrhosis and liver cancer due to NASH were extracted from the GBD study 2017. Socio-demographic Index (SDI) in 2017 was cited as indicators of socioeconomic status. ARIMA model was established to forecast the future health burden. Kruskal-Wallis test and Pearson linear correlation were adopted to evaluate the gender disparity and association with socioeconomic level.Results: From 1990-2017, the global disability-adjusted life years (DALYs) numbers of liver cancer due to NASH increased from 0.71 million to 1.46 million. The age-standardized DALYs rates of liver cancer due to NASH were negatively associated with SDI levels (r=0.-409, p<0.001). Geographically, Australasia experienced the largest increase in the burden of liver cancer due to NASH, with the age-standardized DALYs rate increasing by 143.54%. The global prevalence number of liver cancer due to NASH peaked at 60-64 years in males and at 65-69 years in females. Globally, the burden was heavier in males compared with females. Male-female-ratio of age-standardized DALYs rates in liver cancer due to NASH were positively related to SDI (r=0.303, P=0.011).Conclusion: The global burden of NASH-associated liver cancer has increased significantly since 1990, with age, gender and geographic disparity. Public awareness of liver diseases due to NASH should be emphasized.

Global Incidence and Mortality Patterns of Pedestrian Road Traffic Injuries by Sociodemographic Index, with Forecasting: Findings from the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study.

(1) Background: Pedestrian injuries (PIs) represent a significant proportion of road traffic injuries. Our aim was to investigate the incidence and mortality of PIs in different age groups and sociodemographic index (SDI) categories between 1990 and 2017. (2) Method: Estimates of age-standardized incidence and mortality along with trends of PIs by SDI levels were obtained from the Global Burden of Disease from 1990 to 2017. We also forecasted the trends across all the SDI categories until 2040 using the Statistical Package for the Social Sciences (SPSS Statistics for Windows, version 23.0, Chicago, IL, USA) time series expert modeler. (3) Results: Globally, the incidence of PIs increased by 3.31% (−9.94 to 16.56) in 2017 compared to 1990. Men have higher incidence of PIs than women. Forecasted incidence was 132.02 (127.37 to 136.66) per 100,000 population in 2020, 101.52 (65.99 to 137.05) in 2030, and reduced further to 71.02 (10.62 to 152.65) by 2040. Globally across all SDI categories, there was a decreasing trend in mortality due to PIs with the global estimated percentage reduction of 37.12% (−45.19 to −29.04). (4) Conclusions: The results show that PIs are still a burden for all SDI categories despite some variation. Although incidence and mortality are expected to decrease globally, some SDI categories and specific vulnerable age groups may require particular attention. Further studies addressing incidence and mortality patterns in vulnerable SDI categories are needed.

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017

BackgroundThe epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given...

Trends in the prevalence and disability-adjusted life years of eating disorders from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Eating disorders have increasingly become a public health concern globally. This study aimed to reveal the burden of eating disorders at the global, regional and national levels using the Global Burden of Disease (GBD) Study 2017 data. We extracted the age-standardised rates (ASRs) of prevalence and disability-adjusted life years (DALYs) and their 95% uncertainty intervals (UIs) of eating disorders, including anorexia nervosa and bulimia nervosa, between 1990 and 2017 from the GBD 2017 data. The estimated annual percentage changes (EAPCs) were calculated to quantify the secular trends of the burden of eating disorders. The ASRs of prevalence and the DALYs of eating disorders continuously increased worldwide from 1990 to 2017 by an average of 0.65 (95% UI: 0.59-0.71) and 0.66 (95% UI: 0.60-0.72), respectively. The burden of eating disorders was higher in females than in males, but the increment in ASRs was greater in males than in females over time. In 2017, the highest burden of eating disorders was observed in the high sociodemographic index (SDI) regions, especially Australasia (ASR of prevalence = 807.13, 95% UI: 664.20-982.30; ASR of DALYs = 170.74, 95% UI: 113.43-244.14, per 100 000 population), Western Europe and high-income North America. However, the most significant increment of the burden of eating disorders was observed in East Asia (EAPC for prevalence = 2.23, 95% UI: 2.14-2.32; EAPC for DALYs = 2.22, 95% UI: 2.13-2.31), followed by South Asia. An increasing trend in the burden of eating disorders at the national level was observed among most countries or territories. The countries with the top three highest increasing trends were Equatorial Guinea, Bosnia and Herzegovina and China. Positive associations were found between the burden estimates and the SDI levels in almost all geographic regions during the observed 28-year period. We also found that the human development indexes in 2017 were positively correlated with the EAPCs of the ASRs of prevalence (ρ = 0.222, P = 0.002) and DALYs (ρ = 0.208, P = 0.003). The highest burden of eating disorders remains in the high-income western countries, but an increasing trend was observed globally and in all SDI-quintiles, especially in Asian regions that were highly populous. These results could help governments worldwide formulate suitable medical and health policies for the prevention and early intervention of eating disorders.

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.

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...

Burden of neurodegenerative diseases in the Eastern Mediterranean Region, 1990-2016: findings from the Global Burden of Disease Study 2016.

The Eastern Mediterranean Region (EMR) is experiencing a demographic shift towards rapid aging at a time of political unrest. We aimed to estimate the burden of neurodegenerative disorders and its relationship with sociodemographic index in the EMR countries from 1990 to 2016. Using data from the Global Burden of Disease Study 2016, we calculated country-specific trends for prevalence, mortality, disability-adjusted life-years (DALY), years of life lost and years lived with disability (YLD) for Alzheimer's disease/other dementias and Parkinson's disease in the EMR during 1990-2016. In the EMR, the age-standardized prevalence rate of Alzheimer's disease/other dementias and Parkinson's disease was estimated at 759.8/100000 (95% uncertainty intervals, 642.9-899.9) and 87.1/100000 (95% uncertainty intervals, 69.8-108.2) people in 2016, demonstrating 0.01% and 42.3% change from 1990, respectively. Neurodegenerative disorders contributed to 5.4% of total DALY and 4.6% of total YLD among the older EMR population (70years of age or older in 2016). Age-standardized DALY due to Parkinson's disease were strongly correlated with the sociodemographic index level (r=0.823, P<0.001). The YLD:DALY ratio of neurodegenerative diseases declined during this period in the low-income but not the high-income EMR countries. Our findings demonstrated an increasing trend in the burden of dementias and Parkinson's disease in most EMR countries between 1990 and 2016. With aging of the EMR populations, countries should target the modifiable risk factors of neurodegenerative diseases to control their increasing burden.

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 burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study

SummaryBackgroundAlthough a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016.MethodsWe analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate.FindingsGlobally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05–10·16) and the number of tuberculosis deaths was 1·21 million (1·16–1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01–1·89) and the number of tuberculosis deaths was 0·24 million (0·16–0·31). Globally, among HIV-negative individuals the age-standardised incidence of tuberculosis decreased annually at a slower rate (–1·3% [–1·5 to −1·2]) than mortality did (–4·5% [–5·0 to −4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was −4·0% (–4·5 to −3·7) and mortality was −8·9% (–9·5 to −8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality).InterpretationIf current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV.FundingBill & Melinda Gates Foundation.

Research round-up

In a proof of concept study, Domany and colleagues assessed 1 mg/kg oral ketamine for treatment-resistant depression. In this randomised trial, participants (n=41) received active treatment or placebo three times per week for 21 days. The decrease in depression symptoms compared with baseline was significant in the ketamine group at all time points assessed up to day 21 (p<0·05). In the placebo group, a significant decrease in symptom score was only apparent 40 mins after dosing. At day 21, the reduction in depression symptom score was lower in the ketamine group than in the placebo group (p<0·001), with six (27%) of 22 participants in the active treatment group achieving remission versus none in the placebo group (p<0·05). After first administration of study medication, six (40%) of 15 participants in the ketamine group and two (18%) of 11 participants in the placebo group had a transient increase in systolic blood pressure greater than 20 mmHg (p=0·23 for comparison). Efficacy and cost-effectiveness of therapist-guided internet cognitive behavioural therapy for paediatric anxiety disorders: a single-centre, single-blind, randomised controlled trialICBT is an efficacious and cost-effective treatment for paediatric anxiety disorders that should be considered for implementation in routine clinical care. Full-Text PDF Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990–2016India's proportional contribution to global suicide deaths is high and increasing. SDR in India is higher than expected for its Socio-Demographic Index level, especially for women, with substantial variations in the magnitude and men-to-women ratio between the states. India must develop a suicide prevention strategy that takes into account these variations in order to address this major public health problem. Full-Text PDF Open Access

Epidemiological Transition of Cancer: A Systematic Analysis From the Global Burden of Disease Study 2016

Background: The epidemiologic transition describes the transition from high mortality due to infectious diseases to high mortality from NCDs as societies move up the socioeconomic ladder. Since some cancers have infectious etiologies, it is unclear how socioeconomic development impacts cancer burden. This knowledge, however, is crucial to inform health policies, and resource allocations. Aim: We analyzed the cancer transition between 1990 and 2016 using the Global Burden of Disease (GBD) 2016 cancer estimates. Methods: We used the GBD 2016 cancer estimates from 1990 to 2016 as well as the sociodemographic index (SDI). The SDI is a composite indicator of development including fertility, education, and income with a higher SDI representing improved socioeconomic development. To describe the cancer transition, we analyzed how cancer incidence, and mortality changed depending on the SDI with special emphasis on the most common cancers at the global level (lung, colorectal, breast cancer) as well as on common cancers with infectious etiologies (stomach, liver, cervical cancer). Findings: Within and across world regions, age-standardized total cancer incidence (ASIR) either remained stable or increased with SDI except for the regions at the highest level of SDI where ASIR either plateaued or has peaked. For most regions age-standardized total cancer mortality (ASMR) decreased with increasing SDI. For lung cancer, ASIR and ASMR increased across regions with improvements in development but have remained stable or decreased within regions with increased SDI. Colorectal cancer ASIR increased within and across regions with improvements in SDI, whereas ASMR increased with higher SDI within the least developed regions but declined with improvements in SDI for more developed regions. Breast cancer ASIR increased within and across regions and ASMR decreased within most regions with improvements in SDI. However, breast cancer ASMR showed large heterogeneity within regions of the same SDI level. Of the cancers with infectious etiologies, stomach, and cervical cancer ASIR and ASMR decreased with higher SDI within and across regions. However, for liver cancer, ASIR and ASMR by SDI varied substantially within and across regions without a clear pattern. Conclusion: The epidemiologic transition theory explains trends in incidence and mortality for certain cancers (cervical, stomach). However, even though for many cancers there is a clear pattern of changes in incidence and mortality with regards to development level, this pattern rarely supports the epidemiologic transition theory of decreases in cancers due to infectious etiologies and increases in cancers that have mainly been attributed to a “western lifestyle”. What is evident is a “fourth phase” of the epidemiologic transition where, for many cancers that are amenable to treatment, cancer mortality decreases with improvements in development despite stable or increasing incidence.

Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990–2016

SummaryBackgroundA systematic understanding of suicide mortality trends over time at the subnational level for India's 1·3 billion people, 18% of the global population, is not readily available. Thus, we aimed to report time trends of suicide deaths, and the heterogeneity in its distribution between the states of India from 1990 to 2016.MethodsAs part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, we estimated suicide death rates (SDRs) for both sexes in each state of India from 1990 to 2016. We used various data sources for estimating cause-specific mortality in India. For suicide mortality in India before 2000, estimates were based largely on GBD covariates. For each state, we calculated the ratio of the observed SDR to the rate expected in geographies globally with similar GBD Socio-demographic Index in 2016 (ie, the observed-to-expected ratio); and assessed the age distribution of suicide deaths, and the men-to-women ratio of SDR over time. Finally, we assessed the probability for India and the states of reaching the Sustainable Development Goal (SDG) target of a one-third reduction in SDR from 2015 to 2030, using location-wise trends of the age-standardised SDR from 1990 to 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsThere were 230 314 (95% UI 194 058–250 260) suicide deaths in India in 2016. India's contribution to global suicide deaths increased from 25·3% in 1990 to 36·6% in 2016 among women, and from 18·7% to 24·3% among men. Age-standardised SDR among women in India reduced by 26·7% from 20·0 (95% UI 16·5–23·5) in 1990 to 14·7 (13·1–16·2) per 100 000 in 2016, but the age-standardised SDR among men was the same in 1990 (22·3 [95% UI 14·4–27·4] per 100 000) and 2016 (21·2 [14·6–23·6] per 100 000). SDR in women was 2·1 times higher in India than the global average in 2016, and the observed-to-expected ratio was 2·74, ranging from 0·45 to 4·54 between the states. SDR in men was 1·4 times higher in India than the global average in 2016, with an observed-to-expected ratio of 1·31, ranging from 0·40 to 2·42 between the states. There was a ten-fold variation between the states in the SDR for women and six-fold variation for men in 2016. The men-to-women ratio of SDR for India was 1·34 in 2016, ranging from 0·97 to 4·11 between the states. The highest age-specific SDRs among women in 2016 were for ages 15–29 years and 75 years or older, and among men for ages 75 years or older. Suicide was the leading cause of death in India in 2016 for those aged 15–39 years; 71·2% of the suicide deaths among women and 57·7% among men were in this age group. If the trends observed up to 2016 continue, the probability of India achieving the SDG SDR reduction target in 2030 is zero, and the majority of the states with 81·3% of India's population have less than 10% probability, three states have a probability of 10·3–15·0%, and six have a probability of 25·1–36·7%.InterpretationIndia's proportional contribution to global suicide deaths is high and increasing. SDR in India is higher than expected for its Socio-Demographic Index level, especially for women, with substantial variations in the magnitude and men-to-women ratio between the states. India must develop a suicide prevention strategy that takes into account these variations in order to address this major public health problem.FundingBill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Suicide in India: a complex public health tragedy in need of a plan

Suicide in India: a complex public health tragedy in need of a plan

Informing NCD control efforts in India on the eve of Ayushman Bharat

Informing NCD control efforts in India on the eve of Ayushman Bharat