Abstract
Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.
Original language | English |
---|---|
Pages (from-to) | 231-266 |
Number of pages | 36 |
Journal | The Lancet |
Volume | 390 |
Issue number | 10091 |
DOIs | |
Publication status | Published - 15 Jul 2017 |
Fingerprint
Dive into the research topics of 'Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the global burden of disease study 2015'. Together they form a unique fingerprint.Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
}
Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the global burden of disease study 2015. / GBD 2015 Healthcare Access and Quality Collaborators ; Fernandes, João C.
In: The Lancet, Vol. 390, No. 10091, 15.07.2017, p. 231-266.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015
T2 - a novel analysis from the global burden of disease study 2015
AU - GBD 2015 Healthcare Access and Quality Collaborators
AU - Barber, Ryan M.
AU - Fullman, Nancy
AU - Sorensen, Reed J.D.
AU - Bollyky, Thomas
AU - McKee, Martin
AU - Nolte, Ellen
AU - Abajobir, Amanuel Alemu
AU - Abate, Kalkidan Hassen
AU - Abbafati, Cristiana
AU - Abbas, Kaja M.
AU - Abd-Allah, Foad
AU - Abdulle, Abdishakur M.
AU - Abdurahman, Ahmed Abdulahi
AU - Abera, Semaw Ferede
AU - Abraham, Biju
AU - Abreha, Girmatsion Fisseha
AU - Adane, Kelemework
AU - Adelekan, Ademola Lukman
AU - Adetifa, Ifedayo Morayo O.
AU - Afshin, Ashkan
AU - Agarwal, Arnav
AU - Agarwal, Sanjay Kumar
AU - Agarwal, Sunilkumar
AU - Agrawal, Anurag
AU - Ahmad Kiadaliri, Aliasghar
AU - Ahmadi, Alireza
AU - Ahmed, Kedir Yimam
AU - Ahmed, Muktar Beshir
AU - Akinyemi, Rufus Olusola
AU - Akinyemiju, Tomi F.
AU - Akseer, Nadia
AU - Al-Aly, Ziyad
AU - Alam, Khurshid
AU - Alam, Noore
AU - Alam, Sayed Saidul
AU - Alemu, Zewdie Aderaw
AU - Alene, Kefyalew Addis
AU - Alexander, Lily
AU - Ali, Raghib
AU - Ali, Syed Danish
AU - Alizadeh-Navaei, Reza
AU - Alkerwi, Ala'a
AU - Alla, François
AU - Allebeck, Peter
AU - Allen, Christine
AU - Al-Raddadi, Rajaa
AU - Alsharif, Ubai
AU - Altirkawi, Khalid A.
AU - Alvarez Martin, Elena
AU - Fernandes, João C.
N1 - Funding Information: Our analysis demonstrates that a policy-relevant summary measure of personal health-care access and quality can be derived from GBD. This novel measure supports the first-ever comparable assessment of personal health-care access and quality across 195 countries and territories, over time, and along the development spectrum. The HAQ Index considerably advances previous efforts to approximate personal health-care access and quality by systematically adjusting for cause of death certification biases and misclassification, risk-standardising death rates across geographies, and applying PCA to identify common dimensions of health-care access and quality associated with multiple conditions. Globally, most countries and territories recorded gains in personal health-care access and quality from 1990 to 2015, yet many still experienced levels that fell well below what has been achieved by geographies at a similar development status. Amid calls to improve monitoring of UHC and overall health-system performance, the HAQ Index provides a strong basis for benchmarking progress toward greater access and higher-quality personal health care alongside country-level gains in resources to achieve these aims. GBD 2015 Healthcare Access and Quality Collaborators Ryan M Barber, Nancy Fullman, Reed J D Sorensen, Thomas Bollyky, Martin McKee, Ellen Nolte, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Abdishakur M Abdulle, Ahmed Abdulahi Abdurahman, Semaw Ferede Abera, Biju Abraham, Girmatsion Fisseha Abreha, Kelemework Adane, Ademola Lukman Adelekan, Ifedayo Morayo O Adetifa, Ashkan Afshin, Arnav Agarwal, Sanjay Kumar Agarwal, Sunilkumar Agarwal, Anurag Agrawal, Aliasghar Ahmad Kiadaliri, Alireza Ahmadi, Kedir Yimam Ahmed, Muktar Beshir Ahmed, Rufus Olusola Akinyemi, Tomi F Akinyemiju, Nadia Akseer, Ziyad Al-Aly, Khurshid Alam, Noore Alam, Sayed Saidul Alam, Zewdie Aderaw Alemu, Kefyalew Addis Alene, Lily Alexander, Raghib Ali, Syed Danish Ali, Reza Alizadeh-Navaei, Ala'a Alkerwi, François Alla, Peter Allebeck, Christine Allen, Rajaa Al-Raddadi, Ubai Alsharif, Khalid A Altirkawi, Elena Alvarez Martin, Nelson Alvis-Guzman, Azmeraw T Amare, Erfan Amini, Walid Ammar, Joshu Amo-Adjei, Yaw Ampem Amoako, Benjamin O Anderson, Sofia Androudi, Hossein Ansari, Mustafa Geleto Ansha, Carl Abelardo T Antonio, Johan Ärnlöv, Al Artaman, Hamid Asayesh, Reza Assadi, Ayalew Astatkie, Tesfay Mehari Atey, Suleman Atique, Niguse Tadele Atnafu, Sachin R Atre, Leticia Avila-Burgos, Euripide Frinel G Arthur Avokpaho, Beatriz Paulina Ayala Quintanilla, Ashish Awasthi, Nebiyu Negussu Ayele, Peter Azzopardi, Huda Omer Ba Saleem, Till Bärnighausen, Umar Bacha, Alaa Badawi, Amitava Banerjee, Aleksandra Barac, Miguel A Barboza, Suzanne L Barker-Collo, Lope H Barrero, Sanjay Basu, Bernhard T Baune, Kaleab Baye, Yibeltal Tebekaw Bayou, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Ettore Beghi, Yannick Béjot, Aminu K Bello, Derrick A Bennett, Isabela M Bensenor, Adugnaw Berhane, Eduardo Bernabé, Oscar Alberto Bernal, Addisu Shunu Beyene, Tariku Jibat Beyene, Zulfiqar A Bhutta, Sibhatu Biadgilign, Boris Bikbov, Sait Mentes Birlik, Charles Birungi, Stan Biryukov, Donal Bisanzio, Habtamu Mellie Bizuayehu, Dipan Bose, Michael Brainin, Michael Brauer, Alexandra Brazinova, Nicholas J K Breitborde, Hermann Brenner, Zahid A Butt, Rosario Cárdenas, Lucero Cahuana-Hurtado, Ismael Ricardo Campos-Nonato, Josip Car, Juan Jesus Carrero, Daniel Casey, Valeria Caso, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Ferrán Catalá-López, Pedro Cecilio, Kelly Cercy, Fiona J Charlson, Alan Z Chen, Adrienne Chew, Mirriam Chibalabala, Chioma Ezinne Chibueze, Vesper Hichilombwe Chisumpa, Abdulaal A Chitheer, Rajiv Chowdhury, Hanne Christensen, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Massimo Cirillo, Megan S Coggeshall, Leslie Trumbull Cooper, Monica Cortinovis, John A Crump, Koustuv Dalal, Hadi Danawi, Lalit Dandona, Rakhi Dandona, Paul I Dargan, Jose das Neves, Gail Davey, Dragos V Davitoiu, Kairat Davletov, Diego De Leo, Liana C Del Gobbo, Borja del Pozo-Cruz, Robert P Dellavalle, Kebede Deribe, Amare Deribew, Don C Des Jarlais, Subhojit Dey, Samath D Dharmaratne, Daniel Dicker, Eric L Ding, Klara Dokova, E Ray Dorsey, Kerrie E Doyle, Manisha Dubey, Rebecca Ehrenkranz, Christian Lycke Ellingsen, Iqbal Elyazar, Ahmadali Enayati, Sergey Petrovich Ermakov, Babak Eshrati, Alireza Esteghamati, Kara Estep, Thomas Fürst, Imad D A Faghmous, Fanuel Belayneh Bekele Fanuel, Emerito Jose Aquino Faraon, Talha A Farid, Carla Sofia e Sa Farinha, Andre Faro, Maryam S Farvid, Farshad Farzadfar, Valery L Feigin, Andrea B Feigl, Seyed-Mohammad Fereshtehnejad, Jefferson G Fernandes, João C Fernandes, Tesfaye Regassa Feyissa, Florian Fischer, Christina Fitzmaurice, Thomas D Fleming, Nataliya Foigt, Kyle J Foreman, Mohammad H Forouzanfar, Richard C Franklin, Joseph Frostad, Tsegaye Tewelde G/hiwot, Emmanuela Gakidou, Ketevan Gambashidze, Amiran Gamkrelidze, Wayne Gao, Alberto L Garcia-Basteiro, Teshome Gebre, Amanuel Tesfay Gebremedhin, Mengistu Welday Gebremichael, Alemseged Aregay Gebru, Amha Admasie Gelaye, Johanna M Geleijnse, Ricard Genova-Maleras, Katherine B Gibney, Ababi Zergaw Giref, Melkamu Dedefo Gishu, Giorgia Giussani, William W Godwin, Audra Gold, Ellen M Goldberg, Philimon N Gona, Amador Goodridge, Sameer Vali Gopalani, Atsushi Goto, Nicholas Graetz, Felix Greaves, Max Griswold, Peter Imre Guban, Harish Chander Gugnani, Prakash C Gupta, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Vipin Gupta, Tesfa Dejenie Habtewold, Nima Hafezi-Nejad, Demewoz Haile, Alemayehu Desalegne Hailu, Gessessew Bugssa Hailu, Alex Hakuzimana, Randah Ribhi Hamadeh, Mitiku Teshome Hambisa, Samer Hamidi, Mouhanad Hammami, Graeme J Hankey, Yuantao Hao, Hilda L Harb, Habtamu Abera Hareri, Josep Maria Haro, Mohammad Sadegh Hassanvand, Rasmus Havmoeller, Roderick J Hay, Simon I Hay, Delia Hendrie, Ileana Beatriz Heredia-Pi, Hans W Hoek, Masako Horino, Nobuyuki Horita, H Dean Hosgood, Aung Soe Htet, Guoqing Hu, Hsiang Huang, John J Huang, Bethany M Huntley, Chantal Huynh, Kim Moesgaard Iburg, Bogdan Vasile Ileanu, Kaire Innos, Asnake Ararsa Irenso, Nader Jahanmehr, Mihajlo B Jakovljevic, Peter James, Spencer Lewis James, Mehdi Javanbakht, Sudha P Jayaraman, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Vivekanand Jha, Denny John, Catherine Johnson, Sarah C Johnson, Jost B Jonas, Knud Juel, Zubair Kabir, Yogeshwar Kalkonde, Ritul Kamal, Haidong Kan, Andre Karch, Corine Kakizi Karema, Seyed M Karimi, Amir Kasaeian, Nicholas J Kassebaum, Anshul Kastor, Srinivasa Vittal Katikireddi, Konstantin Kazanjan, Peter Njenga Keiyoro, Laura Kemmer, Andrew Haddon Kemp, Andre Pascal Kengne, Amene Abebe Kerbo, Maia Kereselidze, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Ibrahim Khalil, Abdur Rahman Khan, Ejaz Ahmad Khan, Gulfaraz Khan, Young-Ho Khang, Abdullah Tawfih Abdullah Khoja, Irma Khonelidze, Jagdish Khubchandani, Getiye Dejenu Kibret, Daniel Kim, Pauline Kim, Yun Jin Kim, Ruth W Kimokoti, Yohannes Kinfu, Niranjan Kissoon, Miia Kivipelto, Yoshihiro Kokubo, Anneli Kolk, Dhaval Kolte, Jacek A Kopec, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Michael Kravchenko, Sanjay Krishnaswami, Kristopher J Krohn, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Ernst J Kuipers, Veena S Kulkarni, G Anil Kumar, Fekede Asefa Kumsa, Michael Kutz, Hmwe H Kyu, Anton Carl Jonas Lager, Aparna Lal, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Qing Lan, Sinead M Langan, Van C Lansingh, Heidi J Larson, Anders Larsson, Dennis Odai Laryea, Asma Abdul Latif, Alicia Elena Beatriz Lawrynowicz, Janet L Leasher, James Leigh, Mall Leinsalu, Cheru Tesema Leshargie, Janni Leung, Ricky Leung, Miriam Levi, Xiaofeng Liang, Stephen S Lim, Margaret Lind, Shai Linn, Steven E Lipshultz, Patrick Liu, Yang Liu, Loon-Tzian Lo, Giancarlo Logroscino, Alan D Lopez, Scott A Lorch, Paulo A Lotufo, Rafael Lozano, Raimundas Lunevicius, Ronan A Lyons, Erlyn Rachelle King Macarayan, Mark T Mackay, Hassan Magdy Abd El Razek, Mohammed Magdy Abd El Razek, Mahdi Mahdavi, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Lorenzo G Mantovani, Tsegahun Manyazewal, Chabila C Mapoma, Wagner Marcenes, Guy B Marks, Neal Marquez, Jose Martinez-Raga, Melvin Barrientos Marzan, João Massano, Manu Raj Mathur, Pallab K Maulik, Mohsen Mazidi, Colm McAlinden, John J McGrath, Claire McNellan, Peter A Meaney, Alem Mehari, Man Mohan Mehndiratta, Toni Meier, Alemayehu B Mekonnen, Kidanu Gebremariam Meles, Ziad A Memish, Melkamu Merid Mengesha, Desalegn Tadese Mengiste, Mubarek Abera Mengistie, Bereket Gebremichael Menota, George A Mensah, Seid Tiku Mereta, Atte Meretoja, Tuomo J Meretoja, Haftay Berhane Mezgebe, Renata Micha, Anoushka Millear, Edward J Mills, Shawn Minnig, Mojde Mirarefin, Erkin M Mirrakhimov, Charles N Mock, Karzan Abdulmuhsin Mohammad, Shafiu Mohammed, Sanjay K Mohanty, Ali H Mokdad, Glen Liddell D Mola, Mariam Molokhia, Lorenzo Monasta, Marcella Montico, Maziar Moradi-Lakeh, Paula Moraga, Lidia Morawska, Rintaro Mori, Mark Moses, Ulrich O Mueller, Srinivas Murthy, Kamarul Imran Musa, Jean B Nachega, Chie Nagata, Gabriele Nagel, Mohsen Naghavi, Aliya Naheed, Luigi Naldi, Vinay Nangia, Bruno Ramos Nascimento, Ionut Negoi, Sudan Prasad Neupane, Charles R Newton, Marie Ng, Frida Namnyak Ngalesoni, Josephine Wanjiku Ngunjiri, Grant Nguyen, Dina Nur Anggraini Ningrum, Sandra Nolte, Marika Nomura, Ole F Norheim, Bo Norrving, Jean Jacques N Noubiap, Carla Makhlouf Obermeyer, Felix Akpojene Ogbo, In-Hwan Oh, Anselm Okoro, Olanrewaju Oladimeji, Andrew Toyin Olagunju, Pedro R Olivares, Helen E Olsen, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, John Nelson Opio, Eyal Oren, Alberto Ortiz, Richard H Osborne, Majdi Osman, Mayowa O Owolabi, Mahesh PA, Amanda W Pain, Smita Pakhale, Elizabeth Palomares Castillo, Adrian Pana, Christina Papachristou, Mahboubeh Parsaeian, Tejas Patel, George C Patton, Deepak Paudel, Vinod K Paul, Neil Pearce, David M Pereira, Rogelio Perez-Padilla, Fernando Perez-Ruiz, Norberto Perico, Konrad Pesudovs, Max Petzold, Michael Robert Phillips, David M Pigott, Julian David Pillay, Christine Pinho, Suzanne Polinder, Constance D Pond, V Prakash, Manorama Purwar, Mostafa Qorbani, D Alex Quistberg, Amir Radfar, Anwar Rafay, Kazem Rahimi, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Rajesh Kumar Rai, Usha Ram, Saleem M Rana, Zane Rankin, Paturi Vishnupriya Rao, Puja C Rao, Salman Rawaf, Maria Albertina Santiago Rego, Marissa Reitsma, Giuseppe Remuzzi, Andre M N N Renzaho, Serge Resnikoff, Satar Rezaei, Mohammad Sadegh Rezai, Antonio L Ribeiro, Hirbo Shore Roba, Mohammad Bagher Rokni, Luca Ronfani, Gholamreza Roshandel, Gregory A Roth, Dietrich Rothenbacher, Nawal K Roy, Perminder S Sachdev, Ben Benasco Sackey, Mohammad Yahya Saeedi, Saeid Safiri, Rajesh Sagar, Mohammad Ali Sahraian, Muhammad Muhammad Saleh, Joshua A Salomon, Abdallah M Samy, Juan Ramon Sanabria, Maria Dolores Sanchez-Niño, Logan Sandar, Itamar S Santos, João Vasco Santos, Milena M Santric Milicevic, Rodrigo Sarmiento-Suarez, Benn Sartorius, Maheswar Satpathy, Miloje Savic, Monika Sawhney, Mete I Saylan, Ben Schöttker, Aletta E Schutte, David C Schwebel, Soraya Seedat, Abdulbasit Musa Seid, Canaan Negash Seifu, Sadaf G Sepanlou, Berrin Serdar, Edson E Servan-Mori, Tesfaye Setegn, Katya Anne Shackelford, Amira Shaheen, Saeid Shahraz, Masood Ali Shaikh, Marina Shakh-Nazarova, Mansour Shamsipour, Sheikh Mohammed Shariful Islam, Jayendra Sharma, Rajesh Sharma, Jun She, Sara Sheikhbahaei, Jiabin Shen, Peilin Shi, Mika Shigematsu, Min-Jeong Shin, Rahman Shiri, Haitham Shoman, Mark G Shrime, Ephrem Lejore Sibamo Sibamo, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Dayane Gabriele Alves Silveira, Shireen Sindi, Abhishek Singh, Jasvinder A Singh, Om Prakash Singh, Prashant Kumar Singh, Virendra Singh, Abiy Hiruye Sinke, Aklilu Endalamaw Sinshaw, Vegard Skirbekk, Karen Sliwa, Alison Smith, Eugene Sobngwi, Samir Soneji, Joan B Soriano, Tatiane Cristina Moraes Sousa, Luciano A Sposato, Chandrashekhar T Sreeramareddy, Vasiliki Stathopoulou, Nicholas Steel, Caitlyn Steiner, Sabine Steinke, Mark Andrew Stokes, Saverio Stranges, Mark Strong, Konstantinos Stroumpoulis, Lela Sturua, Muawiyyah Babale Sufiyan, Rizwan Abdulkader Suliankatchi, Jiandong Sun, Patrick Sur, Soumya Swaminathan, Bryan L Sykes, Rafael Tabarés-Seisdedos, Karen M Tabb, Getachew Redae Taffere, Roberto Tchio Talongwa, Musharaf Tarajia, Mohammad Tavakkoli, Nuno Taveira, Stephanie Teeple, Teketo Kassaw Tegegne, Arash Tehrani-Banihashemi, Tesfalidet Tekelab, Dejen Yemane Tekle, Girma Temam Shifa, Abdullah Sulieman Terkawi, Azeb Gebresilassie Tesema, JS Thakur, Alan J Thomson, Taavi Tillmann, Tenaw Yimer Tiruye, Ruoyan Tobe-Gai, Marcello Tonelli, Roman Topor-Madry, Miguel Tortajada, Christopher Troeger, Thomas Truelsen, Abera Kenay Tura, Uche S Uchendu, Kingsley N Ukwaja, Eduardo A Undurraga, Chigozie Jesse Uneke, Olalekan A Uthman, Job F M van Boven, Rita Van Dingenen, Santosh Varughese, Tommi Vasankari, Narayanaswamy Venketasubramanian, Francesco S Violante, Sergey K Vladimirov, Vasiliy Victorovich Vlassov, Stein Emil Vollset, Theo Vos, Joseph A Wagner, Tolassa Wakayo, Stephen G Waller, Judd L Walson, Haidong Wang, Yuan-Pang Wang, David A Watkins, Elisabete Weiderpass, Robert G Weintraub, Chi-Pang Wen, Andrea Werdecker, Joshua Wesana, Ronny Westerman, Harvey A Whiteford, James D Wilkinson, Charles Shey Wiysonge, Belete Getahun Woldeyes, Charles D A Wolfe, Sungho Won, Abdulhalik Workicho, Shimelash Bitew Workie, Mamo Wubshet, Denis Xavier, Gelin Xu, Ajit Kumar Yadav, Mohsen Yaghoubi, Bereket Yakob, Lijing L Yan, Yuichiro Yano, Mehdi Yaseri, Hassen Hamid Yimam, Paul Yip, Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Z Younis, Chuanhua Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Carlos Zambrana-Torrelio, Tomas Zapata, Zerihun Menlkalew Zenebe, Sanjay Zodpey, Leo Zoeckler, Liesl Joanna Zuhlke, Christopher J L Murray. Affiliations Institute for Health Metrics and Evaluation (R M Barber BS, N Fullman MPH, R J D Sorensen MPH, A Afshin MD, L Alexander BA, C Allen BA, S Biryukov BS, Prof M Brauer ScD, D Casey BA, K Cercy BS, F J Charlson PhD, A Z Chen BS, A Chew ND, M S Coggeshall BA, Prof L Dandona MD, R Dandona PhD, D Dicker BS, R Ehrenkranz MPH, K Estep MPA, C Fitzmaurice MD, T D Fleming BS, K J Foreman PhD, J Frostad MPH, Prof E Gakidou PhD, W W Godwin BS, A Gold MSc, E M Goldberg BS, N Graetz MPH, M Griswold MS, Prof S I Hay DSc, B M Huntley BA, C Huynh BA, C Johnson PhD, S C Johnson MSc, N J Kassebaum MD, L Kemmer PhD, I Khalil MD, P Kim BA, K J Krohn BA, M Kutz BS, H H Kyu PhD, H J Larson PhD, Prof S Lim PhD, M Lind MPHc, P Liu BA, N Marquez BA, C McNellan BA, A Millear BA, S Minnig MSc, M Mirarefin MPH, Prof A H Mokdad PhD, M Moradi-Lakeh MD, M Moses MHS, Prof M Naghavi PhD, M Ng PhD, G Nguyen MPH, H E Olsen MA, A W Pain MPH, D M Pigott DPhil, C Pinho BA, Z Rankin BS, P C Rao MPH, M Reitsma BS, G A Roth MD, L Sandar BS, K A Shackelford BA, A Smith BA, C Steiner MPH, P Sur BA, S Teeple BA, C Troeger MPH, Prof S E Vollset DrPH, Prof T Vos PhD, J A Wagner BS, H Wang PhD, Prof H A Whiteford PhD, L Zoeckler BA, Prof C J L Murray DPhil), Division of Hematology, Department of Medicine (C Fitzmaurice MD), Harborview Injury Prevention and Research Center (C N Mock PhD, D A Quistberg PhD), Department of Anesthesiology & Pain Medicine, (D A Quistberg PhD), University of Washington, Seattle, WA, USA (Prof B O Anderson MD, J Leung PhD, J L Walson MD, D A Watkins MD); Council on Foreign Relations, Washington DC, Washington DC, USA (T Bollyky JD); European Observatory on Health Systems and Policies (E Nolte PhD), Department of Infectious Disease Epidemiology (H J Larson PhD), London School of Hygiene & Tropical Medicine, London, UK (Prof M McKee DSc, I M O Adetifa PhD, I D A Faghmous MPH, S M Langan PhD, Prof N Pearce PhD); School of Public Health (A A Abajobir MPH, F J Charlson PhD, J Leung PhD, Prof H A Whiteford PhD), School of Dentistry (Prof R Lalloo PhD), University of Queensland, Brisbane, QLD, Australia (Prof J J McGrath MD); College of Health Sciences, Department of Epidemiology, ICT and e-Learning Coordinator (M B Ahmed MPH), Jimma University, Jimma, Ethiopia (K H Abate MS, T T Ghiwot MPH, A T Gebremedhin MPH, M A Mengistie MS, S T Mereta PhD, T Wakayo MS, A Workicho MPH); La Sapienza, University of Rome, Rome, Italy (C Abbafati PhD); Virginia Tech, Blacksburg, VA, USA (Prof K M Abbas PhD); Department of Neurology, Cairo University, Cairo, Egypt (Prof F Abd-Allah MD); New York University Abu Dhabi, Abu Dhabi, United Arab Emirates (A M Abdulle PhD); Uro-Oncology Research Center (E Amini MD), Endocrinology and Metabolism Population Sciences Institute Research Institute (E Amini MD, Prof A Esteghamati MD, S Sheikhbahaei MD, N Hafezi-Nejad MD, A Kasaeian PhD), Non-Communicable Diseases Research Center (F Farzadfar MD, M Parsaeian PhD), Department of Epidemiology and Biostatistics, School of Public Health (M Parsaeian PhD), Center for Air Pollution Research (M S Hassanvand PhD), Institute for Environmental Research (M Shamsipour PhD), Hematology-Oncology and Stem Cell Transplantation Research Center (A Kasaeian PhD), Digestive Diseases Research Institute (Prof R Malekzadeh MD, G Roshandel PhD, S G Sepanlou PhD), Sina Trauma and Surgery Research Center (Prof V Rahimi-Movaghar MD), MS Research Center, Neuroscience Institute (M A Sahraian MD), Tehran University of Medical Sciences, Tehran, Iran (A A Abdurahman PhD, Prof M B Rokni PhD); School of Public Health (S F Abera MSc, G F Abreha MPH, K G Meles MPH, G R Taffere PhD), College of Health Sciences (D T Mengiste MS), Department of Medical Microbiology and Immunology (K Adane MS), Mekelle University, Mekelle, Ethiopia (T M Atey MS, M W Gebremichael MS, A A Gebru MPH, G B Hailu MSc, H B Mezgebe MS, D Y Tekle MS, A G Tesema MPH, Z M Zenebe MS); Food Security and Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany (S F Abera MSc); NMSM Governement College Kalpetta, Kerala, India (Prof B Abraham MPhil); Public Health Promotion Alliance, Osogbo, Nigeria (A L Adelekan MPH); University of Ibadan, Ibadan, Nigeria (A L Adelekan MPH, R O Akinyemi PhD); KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya (I M O Adetifa PhD, A Deribew PhD); Dalla Lana School of Public Health (N Akseer MSc), Department of Nutritional Sciences, Faculty of Medicine (A Badawi PhD), University of Toronto, Toronto, ON, Canada (A Agarwal BHSc); McMaster University, Hamilton, ON, Canada (A Agarwal BHSc); All India Institute of Medical Sciences, New Delhi, India (Prof S K Agarwal, V K Paul MD, R Sagar MD, M Satpathy PhD); National Institute of Occupational Health (ICMR), Ahmedabad, India (S Agarwal PhD); CSIR - Institute of Genomics and Integrative Biology, Delhi, India (A Agrawal PhD); Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA (A Agrawal PhD); Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit (A Ahmad Kiadaliri PhD), Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden (Prof B Norrving PhD); School of Public Health (S Rezaei PhD), Kermanshah University of Medical Sciences, Kermanshah, Iran (A Ahmadi PhD); Debre Markos University, Debre Markos, Ethiopia (K Y Ahmed MPH, Z A Alemu MPH, G D Kibret MPH, C T Leshargie MPH, T K Tegegne MPH, T Y Tiruye MPH); Newcastle University, Newcastle upon Tyne, UK (R O Akinyemi PhD); Department of Epidemiology (T F Akinyemiju PhD), University of Alabama at Birmingham, Birmingham, AL, USA (D C Schwebel PhD); Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada (N Akseer, Z A Bhutta PhD); Washington University in Saint Louis, St. Louis, MO, USA (Z Al-Aly MD); Murdoch Childrens Research Institute (K Alam PhD), University of Melbourne, Melbourne, VIC, Australia (K Alam PhD); The University of Sydney, Sydney, NSW, Australia (K Alam PhD); Department of Health, Queensland, Brisbane, QLD, Australia (N Alam MAppEpid); International Centre for Diarrhoeal Disease Research (ICDDR), Bangladesh, Dhaka, Bangladesh (S S Alam MSc, A Naheed PhD, S M Shariful Islam PhD); Department of Epidemiology and Biostatistics, Institute of Public Health (K A Alene MPH), University of Gondar, Gondar, Ethiopia (A B Mekonnen MS); Nuffield Department of Medicine (D Bisanzio PhD, A Deribew PhD), Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery (Prof S I Hay DSc), University of Oxford, Oxford, UK (R Ali FRCP, D A Bennett PhD, Prof V Jha DM, K Rahimi DM); University of London, London, UK (S D Ali BA); SIR management consultants, Oxford, UK (S D Ali BA); Institute and Faculty of Actuaries, Oxford, UK (S D Ali BA); Gastrointestinal Cancer Research Center (R Alizadeh-Navaei PhD), Mazandaran University of Medical Sciences, Sari, Iran (M S Rezai MD); Luxembourg Institute of Health (LIH), Strassen, Luxembourg (A Alkerwi PhD, S Stranges PhD); School of Public Health, University of Lorraine, Nancy, France (Prof F Alla PhD); Department of Public Health Sciences (P Allebeck PhD), Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society (Prof J Ärnlöv PhD), Department of Clinical Science, Intervention and Technology (Prof J J Carrero PhD), Department of Neurobiology, Care Sciences and Society (NVS) (S Fereshtehnejad PhD), Aging Research Center (Prof M Kivipelto PhD), Department of Medical Epidemiology and Biostatistics (E Weiderpass PhD), Karolinska Institutet, Stockholm, Sweden (R Havmoeller PhD, S Sindi PhD); Ministry of Health, Jeddah, Saudi Arabia (R Al-Raddadi PhD); Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology (S Nolte PhD), Charité University Medicine Berlin, Berlin, Germany (U Alsharif MPH, C Papachristou PhD); King Saud University, Riyadh, Saudi Arabia (K A Altirkawi MD); Spanish Observatory on Drugs, Government Delegation for the National Plan on Drugs, Ministry of Health, Social Policy and Equality, Madrid, Spain (E Alvarez Martin PhD); Universidad de Cartagena, Cartagena de Indias, Colombia (Prof N Alvis-Guzman PhD); School of Medicine (A T Amare MPH, Prof B T Baune PhD), University of Adelaide, Adealaide, SA, Australia (A T Olagunju MS, L G Ciobanu MS); College of Medicine and Health Sciences (A T Amare MPH), Bahir Dar University, Bahir Dar, Ethiopia (T Setegn MPH); Ministry of Public Health, Beirut, Lebanon (W Ammar PhD, H L Harb MPH); African Population and Health Research Center, Nairobi, Kenya (J Amo-Adjei PhD); University of Cape Coast, Cape Coast, Ghana (J Amo-Adjei PhD); Department of Medicine (Y A Amoako FWACP), Komfo Anokye Teaching Hospital, Kumasi, Ghana (D O Laryea MD); University of Thessaly, Larissa, Greece (Prof S Androudi MD); Health Promotion Research Center, Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran (H Ansari PhD); West Hararghe Zonal Health Department, Chiro, Ethiopia (M G Ansha MPH); Department of Health Policy and Administration, College of Public Health (C A T Antonio MD), College of Public Health (E J A Faraon MD), University of the Philippines Manila, Manila, Philippines; School of Health and Social Studies, Dalarna University, Falun, Sweden (Prof J Ärnlöv PhD); University of Manitoba, Winnipeg, MB, Canada (A Artaman PhD); Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran (H Asayesh PhD); Mashhad University of Medical Sciences, Mashhad, Iran (R Assadi PhD); Hawassa University, Hawassa, Ethiopia (A Astatkie PhD, F B B Fanuel MPH); Graduate Institute of Biomedical Informatics (S Atique MS), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan (D N A Ningrum MPH); Mizan Tepi University, Mizan Teferi, Ethiopia (N T Atnafu MS, H H Yimam MPH); PMA 2020, Mizan Teferi, Ethiopia (N T Atnafu MS); Clinical Trials Unit, BJ Medical College - Johns Hopkins University, Pune, India (S R Atre PhD); National Institute of Public Health, Cuernavaca, Mexico (L Avila-Burgos PhD); Institut de Recherche Clinique du Bénin (IRCB), Cotonou, Benin (E F G A Avokpaho MPH); Laboratoire d'Etudes et de Recherche-Action en Santé (LERAS Afrique), Parakou, Benin (E F G A Avokpaho MPH); The Judith Lumley Centre for Mother, Infant and Family Health Research, La Trobe University, Melbourne, VIC, Australia (B P Ayala Quintanilla PhD); Peruvian National Institute of Health, Lima, Peru (B P Ayala Quintanilla PhD); Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (A Awasthi PhD); Ministry of Health, Addis Ababa, Ethiopia (N N Ayele MPH); Department of Paediatrics (P Azzopardi MEpi), Murdoch Childrens Research Institute (K Alam PhD, P Azzopardi MEpi, R G Weintraub MBBS, Prof G C Patton MD), Department of Paediatrics (P Azzopardi MEpi), Melbourne School of Population and Global Health (Prof A D Lopez PhD), Department of Medicine (A Meretoja PhD), University of Melbourne, Melbourne, VIC, Australia (K Alam PhD); Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia (P Azzopardi MEpi); Centre for International Health, Burnet Institute, Melbourne, VIC, Australia (P Azzopardi MEpi); Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen (Prof H O Ba Saleem PhD); Department of Global Health and Population (Prof T Bärnighausen MD, A B Feigl ScD, J A Salomon PhD), Department of Epidemiology (P James ScD), Department of Nutrition (M S Farvid PhD), Harvard T.H. Chan School of Public Health, (I R Campos-Nonato PhD, E L Ding ScD), Harvard Medical School, Harvard University, Boston, MA, USA (M Osman MD, M G Shrime MD); Africa Health Research Institute, Mtubatuba, South Africa (Prof T Bärnighausen MD); Institute of Public Health, Heidelberg University, Heidelberg, Germany (Prof T Bärnighausen MD, S Mohammed PhD); School of Health Sciences, University of Management and Technology, Lahore, Pakistan (U Bacha PhD); Public Health Agency of Canada, Toronto, ON, Canada (A Badawi PhD); Farr Institute of Health Informatics Research (A Banerjee DPhil), Institute of Epidemiology & Health (T Tillmann MSc), University College London, London, UK (C Birungi MS); Faculty of Medicine (A Barac PhD), Institute of Social Medicine (M M Santric Milicevic PhD), Centre School of Public Health and Health Management, Faculty of Medicine (M M Santric Milicevic PhD), University of Belgrade, Belgrade, Serbia; Hospital Dr. Rafael A. Calderón Guardia, CCSS, San Jose, Costa Rica (M A Barboza MD); Universidad de Costa Rica, San Pedro, Costa Rica (M A Barboza MD); School of Psychology (S L Barker-Collo PhD), University of Auckland, Auckland, New Zealand (B del Pozo-Cruz PhD); Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogota, Colombia (L H Barrero ScD); Stanford University, Stanford, CA, USA (S Basu PhD, L C Del Gobbo PhD); School of Public Health (K Deribe MPH, A D Hailu MPH), Addis Ababa University, Addis Ababa, Ethiopia (K Baye PhD, T J Beyene MS, A Z Giref PhD, D Haile MPH, H A Hareri MS, B G Menota MS, G Temam Shifa MPH, B G Woldeyes MPH); Jhpiego-Ethiopia, Addis Ababa, Ethiopia (Y T Bayou PhD); College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA (Prof S Bazargan-Hejazi PhD); David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA (Prof S Bazargan-Hejazi PhD); College of Public Health and Tropical Medicine, Jazan, Saudi Arabia (N Bedi MD); IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (E Beghi MD, G Giussani BiolD); University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France (Prof Y Béjot PhD); University of Alberta, Edmonton, AB, Canada (A K Bello PhD); Internal Medicine Department (Prof I S Santos PhD), University of Sao Paulo, Sao Paulo, Brazil (I M Bensenor PhD, Prof P A Lotufo DrPH); College of Health Sciences (A Berhane PhD), Debre Berhan University, Debre Berhan, Ethiopia (T D Habtewold MS); Division of Health and Social Care Research (Prof C D Wolfe MD), King's College London, London, UK (E Bernabé PhD, Prof R J Hay DM, M Molokhia PhD); University Andes, Bogota, Colombia (O A Bernal PhD); College of Health and Medical Sciences (A S Beyene MPH, M T Hambisa MPH, M M Mengesha MPH, H S Roba MPH, A M Seid MS), Haramaya University, Dire Dawa, Ethiopia (M D Gishu MS, A A Irenso MPH, F A Kumsa MPH, A K Tura MPH); Division of Human Nutrition (J M Geleijnse PhD), Wageningen University, Wageningen, Netherlands (T J Beyene MS); Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan (Z A Bhutta PhD); Independent Public Health Consultants, Addis Ababa, Ethiopia (S Biadgilign MPH); IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy (B Bikbov MD, M Cortinovis Biotech D, Prof G Remuzzi MD); GBS-CIDP International Foundation, Menemen, Turkey (S M Birlik BS); Debre Markos University, Debre Markos town, Ethiopia (H M Bizuayehu MPH); World Bank, Washington DC, DC, USA (D Bose PhD); Danube-University Krems, Krems, Austria (Prof M Brainin PhD); University of British Columbia, Vancouver, BC, Canada (Prof M Brauer ScD, Prof N Kissoon MD, J A Kopec PhD, S Murthy MD); Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Trnava, Slovakia (A Brazinova PhD); International Neurotrauma Research Organization, Vienna, Austria (A Brazinova PhD); College of Medicine (J Shen PhD), Ohio State University, Columbus, OH, USA (Prof N J K Breitborde PhD); Division of Clinical Epidemiology and Ageing Research (B Schöttker MPH), German Cancer Research Center, Heidelberg, Germany (Prof H Brenner MD); Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan (Z A Butt PhD); Metropolitan Autonomous University, Mexico City, Mexico (R Cárdenas ScD); National Institute of Public Health, Cuernavaca, Mexico (L Cahuana-Hurtado PhD, I R Campos-Nonato PhD, I B Heredia-Pi PhD, R Lozano MD, Prof E E Servan-Mori MSc); Nanyang Technological University, Singapore, Singapore (J Car PhD); Stroke Unit, University of Perugia, Perugia, Italy (V Caso MD); Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia (C A Castañeda-Orjuela MSc); Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogota, Colombia (C A Castañeda-Orjuela MSc); Caja Costarricense de Seguro Social, San Jose, Costa Rica (Prof J Castillo Rivas MPH); Universidad de Costa Rica, San Pedro, Montes de Oca, Costa Rica (Prof J Castillo Rivas MPH); Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain (F Catalá-López PhD); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada (F Catalá-López PhD); Independent Collaborator, Porto, Portugal (P Cecilio MS); Queensland Centre for Mental Health Research, Brisbane, QLD, Australia (F J Charlson PhD, Prof H A Whiteford PhD); Crowd Watch Africa, Lusaka, Zambia (M Chibalabala BS); National Center for Child Health and Development, Setagaya ku, Japan (C E Chibueze PhD); University of Zambia, Lusaka, Zambia (V H Chisumpa MPhil, C C Mapoma PhD); University of Witwatersrand, Johannesburg, South Africa (V H Chisumpa MPhil); Ministry of Health, Baghdad, Iraq (A A Chitheer FETP); Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (R Chowdhury PhD); Bispebjerg University Hospital, Copenhagen, Denmark (Prof H Christensen DMSCi); Christian Medical College, Vellore, India (Prof D J Christopher MD, Prof S Varughese DM); School of Medicine (A T Amare MPH, Prof B T Baune PhD); University of Salerno, Baronissi, Italy (Prof M Cirillo MD); Mayo Clinic, Jacksonville, FL, USA (L T Cooper MD); Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (Prof J A Crump MD); Centre for Injury Prevention and Safety Promotion, School of Health and Medical Sciences, Orebro University, Orebro, Sweden (Prof K Dalal PhD); Walden University, Minneapolis, MN, USA (H Danawi PhD); Centre for Control of Chronic Conditions (P Jeemon PhD), Public Health Foundation of India, New Delhi, India (Prof L Dandona MD, R Dandona PhD); Guy's and St. Thomas' NHS Foundation Trust, London, UK (P I Dargan FRCP); i3S - Instituto de Investigação e Inovação em Saúde (J das Neves PhD), INEB - Instituto de Engenharia Biomédica (J das Neves PhD), Faculty of Medicine, University of Porto, Porto, Portugal (J Massano MD, J V Santos BHlthSc); Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton, UK (Prof G Davey MD); University of Medicine and Pharmacy Bucharest, Bucharest, Romania (D V Davitoiu PhD); Republican Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan (K Davletov PhD); School of Public Health, Kazakh National Medical University, Almaty, Kazakhstan (K Davletov PhD); Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); University of Colorado School of Medicine and the Colorado School of Public Health, Aurora, CO, USA (R P Dellavalle MD); Brighton and Sussex Medical School, Brighton, UK (K Deribe MPH); Mount Sinai Beth Israel, New York, NY, USA (Prof D C Des Jarlais PhD); Icahn School of Medicine at Mount Sinai, New York City, NY, USA (Prof D C Des Jarlais PhD); Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India (S Dey PhD, Prof S Zodpey PhD); Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka (S D Dharmaratne MD); Department of Social Medicine, Faculty of Public Health, Medical University - Varna, Varna, Bulgaria (K Dokova PhD); University of Rochester Medical Center, Rochester, NY, USA (E R Dorsey MD); RMIT University, Bundoora, VIC, Australia (Prof K E Doyle PhD); Australian National University, Canberra, ACT, Australia (Prof K E Doyle PhD); International Institute for Population Sciences, Mumbai, India (M Dubey MPhil, A Kastor MPhil, S K Mohanty MD, M H U Rahman MPhil, Prof U Ram PhD, A Singh PhD, A K Yadav MPhil); Center for Disease Burden (Prof S E Vollset), Norwegian Institute of Public Health, Oslo, Norway (C L Ellingsen MD, M Savic PhD, Prof V Skirbekk PhD); Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia (I Elyazar PhD); School of Public Health and Health Sciences Research Center, Sari, Iran (Prof A Enayati PhD); The Institute of Social and Economic Studies of Population, Russian Academy of Sciences, Moscow, Russia (Prof S P Ermakov DSc); Federal Research Institute for Health Organization and Informatics, Ministry of Health of the Russian Federation, Moscow, Russia (Prof S P Ermakov DSc); Ministry of Health and Medical Education, Tehran, Iran (B Eshrati PhD); Arak University of Medical Sciences, Arak, Iran (B Eshrati PhD); Department of Infectious Disease Epidemiology (T Fürst PhD), Imperial College London, London, UK (K J Foreman PhD, F Greaves PhD, Prof A Majeed MD, Prof S Rawaf MD); Department of Epidemiology and Public Health (T Fürst PhD), Swiss Tropical and Public Health Institute, Basel, Switzerland (C K Karema MSc); University of Basel, Basel, Switzerland (T Fürst PhD); Wolaita Sodo University, Wolaita Sodo, Ethiopia (F B B Fanuel MPH, A A Kerbo MPH, C N Seifu MS, E L S Sibamo MPH); Department of Health, Manila, Philippines (E J A Faraon MD); University of Louisville, Louisville, KY, USA (T A Farid MD, A R Khan MD); DGS Directorate General of Health, Lisboa, Portugal (C S E S Farinha MSc); Universidade Aberta, Lisboa, Portugal (C S E S Farinha MSc); Federal University of Sergipe, Aracaju, Brazil (Prof A Faro PhD); Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA (M S Farvid PhD); National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand (V L Feigin PhD); Institute of Education and Sciences, German Hospital Oswaldo Cruz, Sao Paulo, Brazil (Prof J G Fernandes PhD); CBQF - Center for Biotechnology and Fine Chemistry - Associate Laboratory, Faculty of Biotechnology, Catholic University of Portugal, Porto, Portugal (J C Fernandes PhD); Wollega University, Nekemte, Ethiopia (T R Feyissa MPH, T Tekelab MS); School of Public Health, Bielefeld University, Bielefeld, Germany (F Fischer PhD); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (C Fitzmaurice MD); Institute of Gerontology, Academy of Medical Science, Kyiv, Ukraine (N Foigt PhD); Seattle Genetics, Seattle, WA, USA (M H Forouzanfar PhD); James Cook University, Townsville, QLD, Australia (R C Franklin PhD); National Center for Disease Control and Public Health, Tbilisi, Georgia (K Gambashidze MS, K Kazanjan MS, M Kereselidze PhD, I Khonelidze MPA, M Shakh-Nazarova MS, L Sturua PhD); National Center for Disease Control & Public Health, Tbilisi, Georgia (A Gamkrelidze PhD); Health Policy (Prof C Wen PhD), National Health Research Institute, Taipei, Taiwan (W Gao PhD); Manhiça Health Research Center, Manhiça, Mozambique (A L Garcia-Basteiro MSc); Barcelona Institute for Global Health, Barcelona, Spain (A L Garcia-Basteiro MSc); The Task Force for Global Health, Decatur, GA, USA (T Gebre PhD); Ludwig Maximilians University, Munich, Germany (A T Gebremedhin MPH); Kilte Awlaelo Health and Demographic Surveillance System, Mekelle, Ethiopia (A A Gebru MPH, G B Hailu MSc); Wolaita Sodo University, Sodo, Ethiopia (A A Gelaye MPH); Directorate General for Public Health, Regional Health Council, Madrid, Spain (R Genova-Maleras MS); National School of Public Health, Madrid, Spain (R Genova-Maleras MS); The Peter Doherty Institute for Infection and Immunity, University of Melbourne & The Royal Melbourne Hospital, Melbourne, VIC, Australia (K B Gibney FRACP); Kersa Health and Demographic Surveillance System, Harar, Ethiopia (M D Gishu MS); University of Massachusetts Boston, Boston, MA, USA (Prof P N Gona PhD); Instituto de Investigaciones Cientificas y Servicios de Alta Tecnologia - INDICASAT-AIP, Cuidad del Saber, Panama (A Goodridge PhD); Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Federated States of Micronesia (S V Gopalani MPH); Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan (A Goto PhD); Public Health England, London, UK (F Greaves PhD, Prof N Steel PhD); Stockholm County Council Surveillance and Analysis Centre for Epidemiology and Community Medicine, Solna, Sweden (P I Guban MSc); Departments of Microbiology and Epidemiology & Biostatistics, Saint James School of Medicine, The Quarter, Anguilla (Prof H C Gugnani PhD); Healis - Sekhsaria Institute for Public Health, Navi Mumbai, India (P C Gupta DSc); West Virginia Bureau for Public Health, Charleston, WV, USA (R Gupta MD); Eternal Heart Care Centre and Research Institute, Jaipur, India (R Gupta PhD); Montefiore Medical Center, Bronx, NY, USA (T Gupta MD); Department of Anthropology, University of Delhi, Delhi, India (V Gupta PhD); Department of Psychiatry, University Medical Center Groningen (Prof H W Hoek MD), University of Groningen, Groningen, Netherlands (T D Habtewold MS, A K Tura MPH, J F M van Boven PhD); Department of Global Public Health and Primary Care (Prof S E Vollset), University of Bergen, Bergen, Norway (A D Hailu MPH, Prof O F Norheim PhD); Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa (Prof K Sliwa PhD), University of Cape Town, Cape Town, South Africa (A Hakuzimana MPH, A P Kengne PhD, J J N Noubiap MD, D A Watkins MD); Euclid University, Banjul, The Gambia (A Hakuzimana MPH); Arabian Gulf University, Manama, Bahrain (Prof R R Hamadeh DPhil); Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates (S Hamidi DrPH); Wayne County Department of Health and Human Services, Detroit, MI, USA (M Hammami MD); School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia (Prof G J Hankey MD); Harry Perkins Institute of Medical Research, Nedlands, WA, Australia (Prof G J Hankey MD); Western Australian Neuroscience Research Institute, Nedlands, WA, Australia (Prof G J Hankey MD); School of Public Health, Sun Yat-sen University, Guangzhou, China (Prof Y Hao PhD); College of Health and Medical Science (A S Beyene MPH), Haramaya University, Harar, Ethiopia (T A Hassen MS, F A Kumsa MPH, A A Irenso MPH); International Foundation for Dermatology, London, UK (Prof R J Hay DM); Centre for Population Health Research, Curtin University, Bentley, WA, Australia (D Hendrie MA); Department of Epidemiology, Mailman School of Public Health (Prof H W Hoek MD), Columbia University, New York, NY, USA (Prof V Skirbekk PhD); Department of Health and Human Services, Nevada Division of Public and Behavioral Health, Carson City, NV, USA (M Horino MPH); Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (N Horita MD); Albert Einstein College of Medicine, Bronx, NY, USA (Prof H D Hosgood PhD); International Relations Division, Ministry of Health, Nay Pyi Taw, Myanmar (A S Htet MPhil); University of Oslo, Oslo, Norway (A S Htet MPhil, S P Neupane PhD); Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China (G Hu PhD); Cambridge Health Alliance, Cambridge, MA, USA (H Huang MD); Yale University, New Haven, CT, USA (J J Huang MD, E R K Macarayan PhD); Aarhus University, Aarhus, Denmark (K M Iburg PhD); Bucharest University of Economic Studies, Bucharest, Romania (B V Ileanu PhD, A Pana MPH); National Institute for Health Development, Tallinn, Estonia (K Innos PhD, M Leinsalu PhD); School of Public Health (N Jahanmehr PhD), Ophthalmic Research Center (M Yaseri PhD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia (Prof M B Jakovljevic PhD); Denver Health/University of Colorado, Denver, CO, USA (S L James MD); University of Aberdeen, Aberdeen, UK (M Javanbakht PhD); Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA (S P Jayaraman MD); Postgraduate Institute of Medicine, Colombo 07, Sri Lanka (A U Jayatilleke PhD); Institute of Violence and Injury Prevention, Colombo 08, Sri Lanka (A U Jayatilleke PhD); Centre for Chronic Disease Control, New Delhi, India (P Jeemon PhD); Centre for Control of Chronic Conditions (P Jeemon PhD), Public Health Foundation of India, Guragon, India (G A Kumar PhD); George Institute for Global Health, New Delhi, India (Prof V Jha DM); International Center for Research on Women, New Delhi, India (D John MPH); Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany (Prof J B Jonas MD); The National Institute of Public Health, Copenhagen, Denmark (Prof K Juel PhD); University College Cork, Cork, Ireland (Z Kabir PhD); Society for Education, Action and Research in Community Health, Gadchiroli, India (Y Kalkonde MD); CSIR - Indian Institute of Toxicology Research, Lucknow, India (R Kamal MSc, C N Kesavachandran PhD); Department of Pulmonary Medicine, Zhongshan Hospital (J She MD), Fudan University, Shanghai, China (H Kan MD); Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany (A Karch MD); Hannover-Braunschweig Site, German Center for Infection Research, Braunschweig, Germany (A Karch MD); Quality and Equity Health Care, Kigali, Rwanda (C K Karema MSc); University of Washington Tacoma, Tacoma, WA, USA (S M Karimi PhD); Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, Seattle, WA, USA (N J Kassebaum MD); University of Glasgow, Glasgow, UK (S V Katikireddi PhD); Institute of Tropical and Infectious Diseases, Nairobi, Kenya (P N Keiyoro PhD); School of Continuing and Distance Education, Nairobi, Kenya (P N Keiyoro PhD); Farr Institute (Prof R A Lyons MD), Swansea University, Swansea, UK (Prof A H Kemp PhD); Woolcock Institute of Medical Research (G B Marks PhD), University of Sydney, Camperdown, NSW, Australia (Prof A H Kemp PhD); South African Medical Research Council, Cape Town, South Africa (A P Kengne PhD); Jordan University of Science and Technology, Irbid, Jordan (Prof Y S Khader ScD); Health Services Academy, Islamabad, Pakistan (E A Khan MD); Department of Microbiology and Immunology, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates (G Khan PhD); College of Medicine (Prof Y Khang MD), Graduate School of Public Health (Prof S Won PhD), Seoul National University, Seoul, South Korea; Mohammed Ibn Saudi University, Riyadh, Saudi Arabia (A T A Khoja MD); Ball State University, Muncie, IN, USA (J Khubchandani PhD); Department of Health Sciences, Northeastern University, Boston, MA, USA (Prof D Kim DrPH); Southern University College, Skudai, Malaysia (Y J Kim PhD); Simmons College, Boston, MA, USA (R W Kimokoti MD); Centre for Research & Action in Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia (Y Kinfu PhD); Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan (Y Kokubo PhD); Department of Pediatrics, Faculty of Medicine, University of Tartu, Tartu, Estonia (A Kolk PhD); Division of Cardiology, Brown University, Providence, RI, USA (D Kolte MD); Center for Community Empowerment, Health Policy and Humanities, NIHRD, Jakarta, Indonesia (S Kosen MD); Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India (Prof P A Koul MD); Research and Development Unit, Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain (Prof J M Haro PhD, A Koyanagi MD); Research Center of Neurology, Moscow, Russia (M Kravchenko PhD); Oregon Health and Science University, Portland, OR, USA (S Krishnaswami MD); Department of Demography and Public Health Research Institute (Prof B Kuate Defo PhD), Department of Social and Preventive Medicine, School of Public Health (Prof B Kuate Defo PhD), University of Montreal, Montreal, QC, Canada; Institute of Public Health, Hacettepe University, Ankara, Turkey (B Kucuk Bicer PhD); Department of Public Health (S Polinder PhD), Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (Prof E J Kuipers PhD); Arkansas State University, State University, AR, USA (V S Kulkarni PhD); Centre for Epidemiology and Community Medicine, Stockholm County Council, Solna, Sweden (A C J Lager PhD); National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia (A Lal PhD); Centre for Control of Chronic Conditions (P Jeemon PhD), Public Health Foundation of India, Gurgaon, India (D K Lal MD, M R Mathur PhD); Finnish Institute of Occupational Health, Work Organizations, Work Disability Program, Department of Public Health, Faculty of Medicine (T Lallukka PhD, R Shiri PhD), University of Helsinki, Helsinki, Finland (T J Meretoja PhD); National Cancer Institute, Rockville, MD, USA (Q Lan PhD); Help Me See, Inc, New York, NY, USA (V C Lansingh PhD); Instituo Mexicano de Oftalmologia, Queretaro, Mexico (V C Lansingh PhD); Department of Medical Sciences, Uppsala University, Uppsala, Sweden (Prof A Larsson PhD); Department of Zoology, Lahore College for Women University, Lahore, Pakistan (A A Latif PhD); Instituto Nacional de Epidemiología Dr. Juan H. Jara, Mar del Plata, Argentina (A E B Lawrynowicz MPH); College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA (J L Leasher OD); Woolcock Institute of Medical Research (G B Marks PhD), University of Sydney, Sydney, NSW, Australia (J Leigh PhD, A B Mekonnen MS); Stockholm Centre for Health and Social Change, Södertörn University, Stockholm, Sweden (M Leinsalu PhD); State University of New York, Albany, Rensselaer, NY, USA (R Leung PhD); Tuscany Regional Centre for Occupational Injuries and Diseases, Florence, Italy (M Levi PhD); Chinese Center for Disease Control and Prevention, Beijing, China (Prof X Liang MD); University of Haifa, Haifa, Israel (Prof S Linn MD); School of Medicine, Wayne State University, Detroit, MI, USA (Prof S E Lipshultz MD, Prof J D Wilkinson MD); Children's Hospital of Michigan, Detroit, MI, USA (Prof S E Lipshultz MD, Prof J D Wilkinson MD); Emory University, Atlanta, GA, USA (Prof Y Liu PhD, Prof M R Phillips MD); UnionHealth Associates, LLC, St. Louis, MO, USA (L Lo MD); Alton Mental Health Center, Alton, IL, USA (L Lo MD); University of Bari, Bari, Italy (Prof G Logroscino PhD); Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA (S A Lorch MD); Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK (Prof R Lunevicius PhD); School of Medicine, University of Liverpool, Liverpool, UK (Prof R Lunevicius PhD); Royal Children's Hospital, Melbourne, VIC, Australia (M T Mackay MBBS, R G Weintraub MBBS); Mansoura Faculty of Medicine, Mansoura, Egypt (H Magdy Abd El Razek MBBCH); Aswan University Hospital, Aswan Faculty of Medicine, Aswan, Egypt (M Magdy Abd El Razek MBBCh); Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands (M Mahdavi PhD); Social Security Organization Research Institute, Tehran, Iran (M Mahdavi PhD); Faculdade de Medicna (Prof M A S Rego PhD), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Prof D C Malta PhD); University of Milano Bicocca, Monza, Italy (Prof L G Mantovani DSc); Ethiopian Public Health Association, Addis Ababa, Ethiopia (T Manyazewal PhD); Division of Population and Patient Health, King's College London Dental Institute, London, UK (Prof W Marcenes PhD); Hospital Universitario Doctor Peset, Valencia, Spain (J Martinez-Raga PhD); CEU Cardinal Herrera University, Moncada, Spain (J Martinez-Raga PhD); University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines (M B Marzan MSc); Hospital Pedro Hispano/ULS Matosinhos, Matosinhos, Portugal (J Massano MD); George Institute for Global Health India, New Delhi, India (P K Maulik PhD); Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China (M Mazidi PhD); University Hospitals Bristol NHS Foundation Trust, Bristol, UK (C McAlinden PhD); Public Health Wales, Swansea, UK (C McAlinden PhD); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (P A Meaney MD); Children's Hospital of Philadelphia, Philadelphia, PA, USA (P A Meaney MD); College of Medicine, Howard University, Washington, DC, USA (A Mehari MD); Janakpuri Superspecialty Hospital, New Delhi, India (Prof M M Mehndiratta DM); Martin Luther University Halle-Wittenberg, Halle (Saale), Germany (T Meier PhD); Saudi Ministry of Health, Riyadh, Saudi Arabia (Prof Z A Memish MD); College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Prof Z A Memish MD); Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA (G A Mensah MD); Department of Neurology (A Meretoja PhD), Comprehensive Cancer Center, Breast Surgery Unit (T J Meretoja PhD), Helsinki University Hospital, Helsinki, Finland; Friedman School of Nutrition Science and Policy (R Micha PhD), Tufts University, Boston, MA, USA (P Shi PhD); University of Ottawa, Ottawa, ON, Canada (E J Mills PhD); Hunger Action Los Angeles, Los Angeles, CA, USA (M Mirarefin MPH); Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan (Prof E M Mirrakhimov PhD); National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan (Prof E M Mirrakhimov PhD); University of Salahaddin, Erbil, Iraq (K A Mohammad PhD); Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria (S Mohammed PhD); Reproductive Health and ObGyn School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea (Prof G L D Mola DPH); Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy (L Monasta DSc, M Montico MSc, L Ronfani PhD); Department of Community Medicine, Gastrointestinal and Liver Disease Research Center (GILDRC), Preventative Medicine and Public Health Research Center (M Moradi-Lakeh MD), Preventive Medicine and Public Health Research Center (A Tehrani-Banihashemi PhD), Iran University of Medical Sciences, Tehran, Iran; International Laboratory for Air Quality and Health (L Morawska PhD), School of Public Health and Social Work (J Sun PhD), Queensland University of Technology, Brisbane, QLD, Australia (P Moraga PhD); National Center for Child Health and Development, Setagaya, Japan (R Mori PhD); Competence Center Mortality-Follow-Up of the German National Cohort (A Werdecker PhD), Federal Institute for Population Research, Wiesbaden, Germany (Prof U O Mueller PhD, R Westerman PhD); School of Medical Sciences, University of Science Malaysia, Kubang Kerian, Malaysia (K I Musa MD); Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA (Prof J B Nachega PhD); Stellenbosch University, Cape Town, South Africa (Prof J B Nachega PhD, Prof S Seedat PhD, Prof C S Wiysonge PhD); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (Prof J B Nachega PhD); National Center for Child Health and Development, Setagaya-ku, Japan (C Nagata PhD); Institute of Epidemiology and Medical Biometry (Prof D Rothenbacher MD), Ulm University, Ulm, Germany (Prof G Nagel PhD); Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy (Prof L Naldi MD); Suraj Eye Institute, Nagpur, India (V Nangia MD); Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Prof B R Nascimento PhD, Prof A L Ribeiro MD); Hospital Universitário Ciências Médicas, Belo Horizonte, Brazil (Prof B R Nascimento PhD); Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania (I Negoi PhD); KEMRI Wellcome Trust, Kilifi, Kenya (Prof C R Newton MD); Ministry of Health and Social Welfare, Dar es Salaam, Tanzania (F N Ngalesoni MSc); University of Nairobi, Nairobi, Kenya (J W Ngunjiri PhD); Department of Public Health, Semarang State University, Semarang City, Indonesia (D N A Ningrum MPH); Population Health Strategic Research Centre, School of Health and Social Development (S Nolte PhD), Deakin University, Burwood, VIC, Australia (Prof M A Stokes PhD); National Institute of Public Health, Saitama, Japan (M Nomura PhD); Medical Diagnostic Centre, Yaounde, Cameroon (J J N Noubiap MD); Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon (Prof C M Obermeyer DSc); Centre for Health Research (F A Ogbo MPH), Western Sydney University, Penrith, NSW, Australia (Prof A M N Renzaho PhD); Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea (Prof I Oh PhD); Society for Family Health, Abuja, Nigeria (A Okoro MPH); Human Sciences Research Council (HSRC), South Africa and University of KwaZulu-Natal, Durban, South Africa (O Oladimeji MS); Universidad Autonoma de Chile, Talca, Chile (Prof P R Olivares PhD); Center for Healthy Start Initiative, Lagos, Nigeria (B O Olusanya PhD, J O Olusanya MBA); Lira District Local Government, Lira Municipal Council, Uganda (J N Opio MPH); University of Arizona, Tucson, AZ, USA (Prof E Oren PhD); IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain (Prof A Ortiz PhD); Population Health Strategic Research Centre, School of Health and Social Development (S Nolte PhD), Deakin University, Geelong, VIC, Australia (Prof R H Osborne PhD); YBank, Cambridge, MA, USA (M Osman MD); Department of Medicine, Ibadan, Nigeria (M O Owolabi Dr Med); Blossom Specialist Medical Center, Ibadan, Nigeria (M O Owolabi Dr Med); JSS Medical College, JSS University, Mysore, India (Prof M PA DNB); The Ottawa Hospital Research Institute, Ottawa, ON, Canada (S Pakhale MD); Ministry of Health, Mexico City, Mexico (E Palomares Castillo PhD); Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico (E Palomares Castillo PhD); Mount Sinai Health System, New York, NY, USA (T Patel MD); UK Department for International Development, Lalitpur, Nepal (D Paudel PhD); REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal (Prof D M Pereira PhD); National Institute of Respiratory Diseases, Mexico City, Mexico (Prof R Perez-Padilla MD); Hopsital Universitario Cruces, OSI EE-Cruces, Baracaldo, Spain (F Perez-Ruiz PhD); Biocruces Health Research Institute, Baracaldo, Spain (F Perez-Ruiz PhD); Flinders University, Adelaide, SA, Australia (Prof K Pesudovs PhD); Health Metrics Unit, University of Gothenburg, Gothenburg, Sweden (Prof M Petzold PhD); University of the Witwatersrand, Johannesburg, South Africa (Prof M Petzold PhD); Shanghai Jiao Tong University School of Medicine, Shanghai, China (Prof M R Phillips MD); Durban University of Technology, Durban, South Africa (J D Pillay PhD); University of Newcastle, Callaghan, NSW, Australia (Prof C D Pond PhD); Charotar University of Science and Technology, Anand, India (Prof V Prakash MPT); Intergrowth 21st Study Research Centre, Nagpur, India (Prof M Purwar MD); Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran (M Qorbani PhD); A T Still University, Kirksville, MO, USA (A Radfar MD); Contech International Health Consultants, Lahore, Pakistan (A Rafay MS, Prof S M Rana PhD); Contech School of Public Health, Lahore, Pakistan (A Rafay MS, Prof S M Rana PhD); Research and Evaluation Division, BRAC, Dhaka, Bangladesh (M Rahman PhD); Society for Health and Demographic Surveillance, Suri, India (R K Rai MPH); Diabetes Research Society, Hyderabad, India (Prof P V Rao MD); Diabetes Research Center, Hyderabad, India (Prof P V Rao MD); Azienda Socio-Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy (Prof G Remuzzi MD); Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy (Prof G Remuzzi MD); Brien Holden Vision Institute (Prof S Resnikoff MD), School of Optometry and Vision Science (Prof S Resnikoff MD), University of New South Wales, Randwick, NSW, Australia (Prof P S Sachdev MD); Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran (G Roshandel PhD); Holmusk, Singapore, Singapore (N K Roy MS); Duke-NUS Medical School, Singapore, Singapore (N K Roy MS); Prince of Wales Hospital, Randwick, NSW, Australia (Prof P S Sachdev MD); World Health Organization, Accra, Ghana (B B Sackey MS); Ministry of Health, Riyadh, Saudi Arabia (M Y Saeedi PhD); Managerial Epidemiology Research Center, Maragheh University of Medical Sciences, Maragheh, Iran (S Safiri PhD); Development Research and Projects Center, Abuja, Nigeria (M M Saleh MPH); Ain Shams University, Cairo, Egypt (A M Samy PhD); J Edwards School of Medicine, Marshall Univeristy, Huntington, WV, USA (J R Sanabria MD); Case Western Reserve University, Cleveland, OH, USA (J R Sanabria MD); IIS-Fundacion Jimenez Diaz, Madrid, Spain (M D Sanchez-Niño PhD); Universidad Ciencias Aplicadas y Ambientales, Bogotá, Colombia (R Sarmiento-Suarez MPH); Public Health Medicine, School of Nursing and Public Health (Prof B Sartorius PhD), Discipline of Public Health Medicine, School of Nursing and Public Health (B Yakob PhD), University of KwaZulu-Natal, Durban, South Africa; UKZN Gastrointestinal Cancer Research Centre, South African Medical Research Council (SAMRC), Cape Town, South Africa (Prof B Sartorius PhD); Marshall University, Huntington, WV, USA (M Sawhney PhD); Bayer Turkey, Istanbul, Turkey (M I Saylan PhD); Institute of Health Care and Social Sciences, FOM University, Essen, Germany (B Schöttker MPH); Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa (Prof A E Schutte PhD); South African Medical Research Council, Potchefstroom, South Africa (Prof A E Schutte PhD); University of Colorado, Aurora, CO, USA (B Serdar PhD); Department of Public Health, An-Najah University, Nablus, Palestine (A Shaheen PhD); Tufts Medical Center, Boston, MA, USA (Prof S Shahraz PhD); Independent Consultant, Karachi, Pakistan (M A Shaikh MD); Ministry of Health, Thimphu, Bhutan (J Sharma MPH); Indian Institute of Technology Ropar, Rupnagar, India (R Sharma MA); Research Institute at Nationwide Children's Hospital, Columbus, OH, USA (J Shen PhD); National Institute of Infectious Diseases, Tokyo, Japan (M Shigematsu PhD); Sandia National Laboratories, Albuquerque, NM, USA (M Shigematsu PhD); Department of Public Health Science, Graduate School (Prof M Shin PhD), Department of Preventive Medicine, College of Medicine (S Yoon PhD), Korea University, Seoul, South Korea; Imperial College London, UK (H Shoman MPH); Reykjavik University, Reykjavik, Iceland (I D Sigfusdottir PhD); Federal University of Santa Catarina, Florianopolis, Brazil (D A S Silva PhD); Brasília University, Brasília, Brazil (D G A Silveira MD); University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA (J A Singh MD); Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India (O P Singh PhD); Institute for Human Development, New Delhi, India (P K Singh PhD); Asthma Bhawan, Jaipur, India (V Singh MD); Ethiopian Medical Association, Addis Ababa, Ethiopia (A H Sinke MD); University of Gondar, Ethiopia, Gondar, Ethiopia (A E Sinshaw MS); University of Yaoundé, Yaoundé, Cameroon (Prof E Sobngwi PhD); Yaoundé Central Hospital, Yaoundé, Cameroon (Prof E Sobngwi PhD); Dartmouth College, Hanover, NH, USA (S Soneji PhD); Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain (Prof J B Soriano PhD); National School of Public Health/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (Prof T C M Sousa MPH); Department of Clinical Neurological Sciences, Western University, London, ON, Canada (L A Sposato MD); Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia (C T Sreeramareddy MD); Attikon University Hospital, Athens, Greece (V Stathopoulou PhD); University of East Anglia, Norwich, UK (Prof N Steel PhD); Department of Dermatology, University Hospital Muenster, Muenster, Germany (S Steinke DrMed); School of Health and Related Research, University of Sheffield, Sheffield, UK (M Strong PhD); Alexandra General Hospital of Athens, Athens, Greece (K Stroumpoulis PhD); Centre Hospitalier Public du Cotentin, Cherbourg, France (K Stroumpoulis PhD); Ahmadu Bello University, Zaria, Zaria, Nigeria (M B Sufiyan MBA); Ministry of Health, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia (R A Suliankatchi MD); University of Southern Queensland, Institute for Resilient Regions, Springfield, QLD, Australia (J Sun PhD); Indian Council of Medical Research, Chennai, India (S Swaminathan MD); Departments of Criminology, Law & Society, Sociology, and Public Health, University of California, Irvine, Irvine, CA, USA (Prof B L Sykes PhD); Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain (Prof R Tabarés-Seisdedos PhD); School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, USA (K M Tabb PhD); Ministry of Health, MINSANTE, Yaounde, Cameroon (R T Talongwa MD); Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama (M Tarajia MD); New York Medical Center, Valhalla, NY, USA (M Tavakkoli MD); Instituto Superior de Ciências da Saúde Egas Moniz, Almada, Portugal (Prof N Taveira PhD); Faulty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal (Prof N Taveira PhD); University of Newcastle, Newcastle, New South Wales, Australia (T Tekelab MS); Arba Minch University, Arba Minch, Ethiopia (G Temam Shifa MPH); Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA (A S Terkawi MD); Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia (A S Terkawi MD); Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA (A S Terkawi MD); School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India (Prof J Thakur MD); Adaptive Knowledge Management, Victoria, BC, Canada (A J Thomson PhD); National Center for Child Health and Development, Tokyo, Japan (R Tobe-Gai PhD); University of Calgary, Calgary, AB, Canada (Prof M Tonelli MD); Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland (R Topor-Madry PhD); Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland (R Topor-Madry PhD); Hospital Universitario Dr. Peset, Valencia, Spain (M Tortajada PhD); Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (T Truelsen DMSc); Department of Veterans Affairs, Washington DC, DC, USA (U S Uchendu MD); Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria (K N Ukwaja MD); Brandeis University, Waltham, MA, USA (E A Undurraga PhD); Ebonyi State University, Abakaliki, Nigeria (C J Uneke PhD); Warwick Medical School, University of Warwick, Coventry, UK (O A Uthman PhD); Joint Research Centre, European Commission, Ispra, Italy (R Van Dingenen PhD); UKK Institute for Health Promotion Research, Tampere, Finland (Prof T Vasankari PhD); Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore (N Venketasubramanian FRCP); University of Bologna, Bologna, Italy (Prof F S Violante MD); Federal Research Institute for Health Organization and Informatics, Moscow, Russia (S K Vladimirov PhD); National Research University Higher School of Economics, Moscow, Russia (Prof V V Vlassov MD); Uniformed Services University of Health Sciences, Bethesda, MD, USA (Prof S G Waller MD); Natural History Museum, London, UK (J L Walson MD); University of Sao Paulo Medical School, Sao Paulo, Brazil (Y Wang PhD); Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway (E Weiderpass PhD); Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway (E Weiderpass PhD); Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland (E Weiderpass PhD); Ghent University, Gent, Belgium (J Wesana MPH); Mountains of the Moon University, Fort Portal, Uganda (J Wesana MPH); German National Cohort Consortium, Heidelberg, Germany (R Westerman PhD); South African Medical Research Council, Cochrane South Africa, Cape Town, South Africa (Prof C S Wiysonge PhD); National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust and King's College London, London, UK (Prof C D Wolfe MD); Ghent University, Ghent, Belgium (A Workicho MPH); Wolaita Sodo University, Wolaita Sodo, Ethiopia (S B Workie MPH); St Paul's Hospital Millenium Medical College, Addis Ababa, Ethiopia (M Wubshet Terefe PhD); Addis Continental Institute of Public Health, Addis Ababa, Ethiopia (M Wubshet Terefe PhD); St. John's Medical College and Research Institute, Bangalore, India (Prof D Xavier MD); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China (Prof G Xu PhD); University of Saskatchewan, Saskatoon, SK, Canada (M Yaghoubi MA); Global Health Research Center, Duke Kunshan University, Kunshan, China (Prof L L Yan PhD); Department of Preventive Medicine, Northwestern University, Chicago, IL, USA (Y Yano MD); Uro-Oncology Research Center (E Amini MD), Endocrinology and Metabolism Population Sciences Institute (Prof A Esteghamati MD, S Sheikhbahaei MD), Non-Communicable Diseases Research Center (F Farzadfar MD, M Parsaeian PhD), Endocrinology and Metabolism Research Center (N Hafezi-Nejad MD), Center for Air Pollution Research, Institute for Environmental Research (M S Hassanvand PhD), Hematology-Oncology and Stem Cell Transplantation Research Center (A Kasaeian PhD), Digestive Diseases Research Institute (Prof R Malekzadeh MD, G Roshandel PhD, S G Sepanlou PhD), Sina Trauma and Surgery Research Center (Prof V Rahimi-Movaghar MD), MS Research Center, Neuroscience Institute (M A Sahraian MD), Institute for Environmental Research (M Shamsipour PhD), Tehran University of Medical Sciences, Terhan, Iran (M Yaseri PhD); Social Work and Social Administration Department (Prof P Yip PhD), The Hong Kong Jockey Club Centre for Suicide Research and Prevention (Prof P Yip PhD), University of Hong Kong, Hong Kong, China; Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan (N Yonemoto MPH); Jackson State University, Jackson, MS, USA (Prof M Z Younis DrPH); Department of Epidemiology and Biostatistics, School of Public Health (Prof C Yu PhD), Global Health Institute (Prof C Yu PhD), Wuhan University, Wuhan, China; University Hospital, Setif, Algeria (Prof Z Zaidi PhD); Faculty of Medicine, Mansoura University, Mansoura, Egypt (Prof M E Zaki PhD); EcoHealth Alliance, New York, NY, USA (C Zambrana-Torrelio MSc); Instituto de Ecologia-Bolivia, La Paz, Bolivia (C Zambrana-Torrelio MSc); World Health Organization, Windhoek, Namibia (T Zapata MD); and Red Cross War Memorial Children's Hospital, Cape Town, South Africa (L J Zuhlke PhD). Contributors CJLM and NF prepared the first draft of the report. RMB conducted risk-standardisation analyses, computed indices, and led sensitivity analyses. RJDS developed methods for the frontier analysis. CJLM conceived of this study and provided overall guidance, with key inputs from TB, MM, and EN. CJLM and NF finalised the manuscript based on reviewer feedback. All other authors provided data or developed models, reviewed results, initiated modelling infrastructure, or reviewed and contributed to this manuscript. Declaration of interests HEO was supported by the National Science Foundation Graduate Research Fellowship Program. MDS-N was supported by Miguel Servet contract MS14/00133 (ISCIII, Spanish Government). ALR receives an unrestricted scholarship from CNPq, the Brazilian Research Agency. MOO is supported by the National Institute of Health ( grant number U54 HG007479 ). JdN was supported in his contribution to this work by a Fellowship from Fundação para a Ciência e a Tecnologia, Portugal (SFRH/BPD/92934/2013). Imperial College London is grateful for support from the NW London National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care. JMcG is supported by the National Health and Medical Research Council John Cade Fellowship in Mental Health Research (APP1056929) and the Danish National Research Foundation Niels Bohr Professorship. LLY is partly supported by the National Natural Sciences Foundation of China (grant numbers 71233001 and 71490732). AB received institutional support from the Ministry of Education, Science and Technological Development (project number III45005). AES is funded by the Medical Research Council of South Africa, and the South African Research Chair Initiative by the Department of Science and Technology. KD is funded by the Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine (grant number 201900). This research was supported by the NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. SI is supported by a Postdoctoral Research Fellowship funded by The George Institute for Global Health. CW's research was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The research was funded by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. DB is supported by Bill & Melinda Gates Foundation (grant numbers OPP1068048 and OPP1106023). TL is supported by the Academy of Finland (grant numbers 287488 and 294096). UM was funded by the German National Cohort BMBF (grant number 0IER1301/22). RB acknowledged funding from the Brien Holden Vision Institute. All other authors declare no competing interests. Acknowledgments We thank the countless individuals who have contributed to the Global Burden of Disease Study 2015 in various capacities. Publisher Copyright: Copyright © The Author(s). Published by Elsevier Ltd. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2017/7/15
Y1 - 2017/7/15
N2 - Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.
AB - Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.
UR - http://www.scopus.com/inward/record.url?scp=85019850160&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(17)30818-8
DO - 10.1016/S0140-6736(17)30818-8
M3 - Article
C2 - 28528753
AN - SCOPUS:85019850160
VL - 390
SP - 231
EP - 266
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 10091
ER -