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Veröffentlichung Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980Ń2015: the Global Burden of Disease Study 2015(2016) Wang, Haidong; Wolock, Tim M.; Carter, Austin; Nguyen, Grant; Kyu, Hmwe Hmwe; Gakidou, Emmanuela; Hay, Simon I.; Mills, Edward J.; Trickey, Adam; Msemburl, William; Coates, Matthew M.; Mooney, Meghan D.; Fraser, Maya S.; Sligar, Amber; Salomon, Joshua; Larson, Heidi; Friedmann, Joseph; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbas, Kaja M.; Abd El Razek, Mohammed Magdy; Abd-Allah, Foad; Abdulle, Abdishakur M.; Abera, Semaw Ferede; Abubakar, Ibrahim; Abu-Raddad, Laith J.; Abu-Rmeileh, Niveen M. E.; Abyu, Gebre Yitayih; Adebiyi, Akindele Olupelumi; Adedeji, Isaac Akinkunmi; Adelekan, Ademola Lukman; Adofo, Koranteng; Adou, Arséne Kouablan; Ajala, Oluremi N.; Plaß, Dietrich; Akinyemiju, Tomi F.; Akseer, Nadia; Al Lami, Faris Hasan; Al-Aly, Ziyad; Alam, KhurshidBackground
Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015.
Methods
For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification.
Findings
Global HIV incidence reached its peak in 1997, at 3ı3 million new infections (95% uncertainty interval [UI] 3ı1-3ı4 million). Annual incidence has stayed relatively constant at about 2ı6 million per year (range 2ı5-2ı8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38ı8 million (95% UI 37ı6-40ı4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1ı8 million deaths (95% UI 1ı7-1ı9 million) in 2005, to 1ı2 million deaths (1ı1-1ı3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections.
Interpretation
Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030.
Funding
Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health.
Quelle: http://www.thelancet.comVeröffentlichung Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015(2016) Wang, Haidong; Naghavi, Mohsen; Allen, Christine; Barber, Ryan M.; Bhutta, Zulfiqar A.; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Zian; Coates, Matthew M.; Coggeshall, Megan; Dandona, Lalit; Dicker, Daniel J.; Erskine, Holly E.; Ferrari, Alize J.; Fitzmaurice, Christina; Foreman, Kyle J.; Forouzanfar, Mohammad H.; Fraser, Maya S.; Fullman, Nancy; Gething, Peter W.; Goldberg, Ellen M.; Graetz, Nicholas; Haagsma, Juanita A.; Hay, Simon I.; Huynh, Chantal; Johnson, Catherine O.; Kassebaum, Nicholas J.; Kinfu, Yohannes; Kulikoff, Xie Rachel; Kutz, Michael; Kyu, Hmwe H.; Larson, Heidi J.; Leung, Janni; Liang, Xiaofeng; Lim, Stephen S.; Lind, Margaret; Lozano, Rafael; Marquez, Neal; Mensah, George A.; Mikesell, Joe; Mokdad, Ali H.; Mooney, Meghan D.; Nguyen, Grant; Nsoesie, Elaine; Pigott, David M.; Pinho, Christine; Roth, Gregory A.; Salomon, Joshua A.; Sandar, Logan; Silpakit, Naris; Sligar, Amber; Sorensen, Reed J. D.; Stanaway, Jeffrey; Steiner, Caitlyn; Teeple, Stephanie; Thomas, Bernadette A.; Troeger, Christopher; VanderZanden, Amelia; Vollset, Stein Emil; Plaß, Dietrich; Wanga, Valentine; Whiteford, Harvey A.; Wolock, Timothy; Zoeckler, Leo; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abera, Semaw Ferede; Abreu, Daisy M. X.; Abu-Raddad, Laith J.; Abyu, Gebre Yitayih; Achoki, Tom; Adelekan, Ademola Lukman; Ademi, Zanfina; Adou, Arsène Kouablan; Adsuar, José C.; Afanvi, Kossivi AgbelenkoImproving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Quelle: www.sciencedirect.comVeröffentlichung Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015(2016) Kassebaum, Nicholas J.; Arora, Megha; Barber, Ryan M.; Bhutta, Zulfiqar A.; Brown, Jonathan P.; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Coates, Matthew M.; Coggeshall, Megan; Cornaby, Leslie; Dandona, Lalit; Dicker, Daniel J.; Erskine, Holly E.; Ferrari, Alize J.; Fitzmaurice, Christina; Foreman, Kyle J.; Forouzanfar, Mohammad H.; Fullman, Nancy; Gething, Peter W.; Goldberg, Ellen M.; Graetz, Nicholas; Haagsma, Juanita A.; Hay, Simon I.; Johnson, Catherine O.; Kemmer, Laura; Khalil, Ibrahim A.; Kinfu, Yohannes; Kutz, Michael J.; Kyu, Hmwe H.; Leung, Janni; Liang, Xiaofeng; Lim, Stephen S.; Lozano, Rafael; Mensah, George A.; Mikesell, Joe; Mokdad, Ali H.; Mooney, Meghan D.; Naghavi, Mohsen; Nguyen, Grant; Nsoesie, Elaine; Pigott, David M.; Pinho, Christine; Rankin, Zane; Reinig, Nikolas; Salomon, Joshua A.; Sandar, Logan; Smith, Alison M.; Sorensen, Reed J. D.; Stanaway, Jeffrey; Steiner, Caitlyn; Teeple, Stephanie; Troeger, Christopher; Truelsen, Thomas; VanderZanden, Amelia; Wagner, Joseph A.; Wanga, Valentine; Whiteford, Harvey A.; Zhou, Maigeng; Zoeckler, Leo; Abajobir, Amanuel Alemu; Plaß, Dietrich; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abraham, Biju; Abubakar, Ibrahim; Abu-Raddad, Laith J.; Abu-Rmeileh, Niveen M. E.; Achoki, Tom; Ackerman, Ilana N.; Adebiyi, Akindele Olupelumi; Adedeji, Isaac Akinkunmi; Adsuar, José C.; Afanvi, Kossivi Agbelenko; Afshin, Ashkan; Agardh, Emilie Elisabet; Agarwal, ArnavHealthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. www.sciencedirect.comVeröffentlichung Global, regional, and national age-sex-specific mortality and life expectancy, 1950 - 2017(2018) Dicker, Daniel J.; Nguyen, Grant; Abate, Degu; Plaß, DietrichBackground: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 187% (95% uncertainty interval 184â€Ì190) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 588% (582â€Ì593) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 481 years (465â€Ì496) to 705 years (701â€Ì708) for men and from 529 years (517â€Ì540) to 756 years (753â€Ì759) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 491 years (465â€Ì517) for men in the Central African Republic to 876 years (869â€Ì881) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 2160 deaths (1963â€Ì2381) per 1000 livebirths in 1950 to 389 deaths (356â€Ì4283) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 54 million (52â€Ì56) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license