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Florian Fischer

· Bielefeld University

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Ophthalmology and Visual Impairment Studies, Tactile and Sensory Interactions, Retinopathy of Prematurity Studies · 2020 · The Lancet Global Health

Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study

Rupert Bourne, Jaimie D Steinmetz, Seth Flaxman, Paul Svitil Briant, Hugh R. Taylor, Serge Resnikoff, Robert J. Casson, Amir Abdoli, Eman Abu‐Gharbieh, Ashkan Afshin, Hamid Ahmadieh, Yonas Akalu, Alehegn Aderaw Alamneh, Wondu Alemayehu, Ahmed Samir Alfaar, Vahid Alipour, Etsay Woldu Anbesu, Sofia Androudi, Jalal Arabloo, Aries Arditi, Malke Asaad, Eleni Bagli, Atif Amin Baig, Till Bärnighausen, Maurízio Battaglia Parodi, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Ali Bijani, Mukharram M. Bikbov, Michele Bottone, Tasanee Braithwaite, Alain M. Bron, Zahid A Butt, Ching‐Yu Cheng, Dinh‐Toi Chu, Maria Vittoria Cicinelli, João Coelho, Baye Dagnew, Xiaochen Dai, Reza Dana, Lalit Dandona, Rakhi Dandona, Monte A. Del Monte, Jenny P Deva, Daniel Díaz, Shirin Djalalinia, Laura E. Dreer, Joshua R. Ehrlich, Leon B. Ellwein, Mohammad Hassan Emamian, Arthur Gustavo Fernandes, Florian Fischer, David S. Friedman, João M. Furtado, Abhay Gaidhane, Shilpa Gaidhane, Gus Gazzard, Berhe Gebremichael, Ronnie George, Ahmad Ghashghaee, Mahaveer Golechha, Samer Hamidi, Billy R. Hammond, M. Elizabeth Hartnett, Risky Kusuma Hartono, Simon I Hay, Golnaz Heidari, Hung Chak Ho, Chi Linh Hoang, Mowafa Househ, Segun Emmanuel Ibitoye, Irena Ilić, Milena Ilić, April Ingram, Seyed Sina Naghibi Irvani, Ravi Prakash Jha, Rim Kahloun, Himal Kandel, Ayele Semachew Kasa, John H. Kempen, Maryam Keramati, Moncef Khairallah, Ejaz Ahmad Khan, Rohit C Khanna, Mahalaqua Nazli Khatib, Judy E. Kim, Yun Jin Kim, Sezer Kısa, Adnan Kısa, Ai Koyanagi, Om Kurmi, Van Charles Lansingh, Janet L Leasher, Nicolas Leveziel, Hans Limburg, Marek Majdán, Navid Manafi, Kaweh Mansouri

Background To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990–2020, and forecasts for 2050. Methods We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and

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Ophthalmology and Visual Impairment Studies, Tactile and Sensory Interactions, Retinopathy of Prematurity Studies · 2020 · The Lancet Global Health

Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

Jaimie D Steinmetz, Rupert Bourne, Paul Svitil Briant, Seth Flaxman, Hugh R B Taylor, Jost B. Jonas, Amir Abdoli, Woldu Aberhe Abrha, Ahmed Abualhasan, Eman Girum Abu-Gharbieh, Tadele Girum Girum Adal, Ashkan Afshin, Hamid Ahmadieh, Wondu Alemayehu, Sayyed Amirpooya Alemzadeh, Ahmed Samir Alfaar, Vahid Alipour, Sofia Androudi, Jalal Arabloo, Aries Arditi, Brhane Berhe Aregawi, Alessandro Arrigo, Charlie Ashbaugh, Elham Ashrafi, Desta Debalkie Atnafu, Eleni Bagli, Atif Amin Baig, Till Bärnighausen, Maurízio Battaglia Parodi, Mahya Beheshti, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Ali Bijani, Mukharram M. Bikbov, Michele Bottone, Tasanee M Braithwaite, Alain M. Bron, Sharath Burugina Nagaraja, Zahid A Butt, Florentino Luciano Caetano dos Santos, Vera Lúcia Alves Carneiro, Robert J. Casson, Ching-Yu Jasmine Cheng, Jee-Young Jasmine Choi, Dinh‐Toi Chu, Maria Vittoria Cicinelli, João M G Coelho, Nathan Congdon, Rosa A A Couto, Elizabeth A. Cromwell, Saad M A Dahlawi, Xiaochen Dai, Reza Dana, Lalit Dandona, Rakhi Dandona, Monte A. Del Monte, Meseret Derbew Molla, Nikolaos Dervenis, Abebaw Alemayehu Desta, Jenny P Deva, Daniel Díaz, Shirin E Djalalinia, Joshua R. Ehrlich, Rajesh Elayedath, Hala Rashad Elhabashy, Leon B. Ellwein, Mohammad Hassan Emamian, Sharareh Eskandarieh, Farshad Farzadfar, Arthur Gustavo Fernandes, Florian Fischer, David S. Friedman, João M. Furtado, Shilpa Gaidhane, Gus Gazzard, Berhe Gebremichael, Ronnie George, Ahmad Ghashghaee, Syed Amir Gilani, Mahaveer Golechha, Samer Randall Hamidi, Billy R. Hammond, M. Elizabeth Hartnett, Risky Kusuma Hartono, Abdiwahab Hashi, Simon I Hay, Khezar Hayat, Golnaz Heidari, Hung Chak Ho, Ramesh Holla, Mowafa J Househ, John J. Huang, Segun Emmanuel Ibitoye, Irena Ilić, Milena Ilić, April Ingram, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam

BACKGROUND: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. METHODS: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from

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Global Cancer Incidence and Screening, Multiple and Secondary Primary Cancers, Cancer Risks and Factors · 2018 · JAMA Oncology

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

Christina Fitzmaurice, Tomi Akinyemiju, Faris Lami, Shazia Alam, Reza Alizadeh‐Navaei, Christine A. Allen, Ubai Alsharif, Nelson Alvis‐Guzmán, Erfan Amini, Benjamin O. Anderson, Olatunde Aremu, Al Artaman, Solomon Weldegebreal Asgedom, Reza Assadi, Tesfay Mehari Atey, Leticia Ávila‐Burgos, Ashish Awasthi, Huda Omer Ba Saleem, Aleksandra Barać, James R. Bennett, Isabela M. Benseñor, Nickhill Bhakta, Hermann Brenner, Lucero Cahuana-Hurtado, Carlos A Castañeda-Orjuela, Ferrán Catalá-López, Jee-Young J Choi, Devasahayam Jesudas Christopher, Sheng‐Chia Chung, María Paula Curado, Lalit Dandona, Rakhi Dandona, José das Neves, Subhojit Dey, Samath Dhamminda Dharmaratne, David Teye Doku, Tim Driscoll, Manisha Dubey, Hedyeh Ebrahimi, Dumessa Edessa, Ziad El‐Khatib, Aman Yesuf Endries, Florian Fischer, Lisa M Force, Kyle J Foreman, Solomon Weldemariam Gebrehiwot, Sameer Vali Gopalani, Giuseppe Grosso, Rahul Gupta, Bishal Gyawali, Randah R Hamadeh, Samer Hamidi, James Harvey, Hamid Yimam Hassen, Roderick J. Hay, Simon I Hay, Behzad Heibati, Molla Kahssay Hiluf, Nobuyuki Horita, Hung Chak Ho, Olayinka Stephen Ilesanmi, Kaire Innos, Farhad Islami, Mihajlo Jakovljević, Sarah Charlotte Johnson, Jost B Jonas, Amir Kasaeian, Tesfaye Kassa, Yousef Khader, Ejaz Ahmad Khan, Gulfaraz Khan, Young‐Ho Khang, Mohammad Hossein Khosravi, Jagdish Khubchandani, Jacek A Kopec, G Anil Kumar, Michael Kutz, Deepesh Lad, Alessandra Lafranconi, Qing Lan, Yirga Legesse, James Leigh, Shai Linn, Raimundas Lunevičius, Azeem Majeed, Reza Malekzadeh, Déborah Carvalho Malta, LG Mantovani, Brian J. McMahon, Toni Meier, Yohannes Adama Melaku, Mulugeta Melku, Peter Memiah, Walter Mendoza, Tuomo J Meretoja, Haftay Berhane Mezgebe, Ted R. Miller, Shafiu Mohammed, Ali H. Mokdad, Mahmood Moosazadeh

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

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Liver Disease Diagnosis and Treatment, Hepatitis B Virus Studies, Hepatocellular Carcinoma Treatment and Prognosis · 2017 · JAMA Oncology

The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level

Tomi Akinyemiju, Semaw Ferede Abera, Muktar Beshir Ahmed, Noore Alam, Mulubirhan Assefa Alemayohu, Christine A. Allen, Rajaa Al‐Raddadi, Nelson Alvis‐Guzmán, Yaw Ampem Amoako, Al Artaman, Tadesse Awoke Ayele, Aleksandra Barać, Isabela M. Benseñor, Adugnaw Berhane, Zulfiqar A Bhutta, Jacqueline Castillo-Rivas, Abdulaal Chitheer, Jee-Young Jasmine Choi, Benjamin Cowie, Lalit Dandona, Rakhi Dandona, Subhojit Dey, Daniel Dicker, Huyen Phuc, Donatus U. Ekwueme, Maysaa El Sayed Zaki, Florian Fischer, Thomas Fürst, Jamie Hancock, Simon I Hay, Peter J. Hotez, Sun Ha Jee, Amir Kasaeian, Yousef Khader, Young‐Ho Khang, G Anil Kumar, Michael Kutz, Heidi J. Larson, Alan D Lopez, Raimundas Lunevičius, Reza Malekzadeh, Colm McAlinden, Toni Meier, Walter Mendoza, Ali H. Mokdad, Maziar Moradi‐Lakeh, Gabriele Nagel, Quyen Le Nguyen, Grant Nguyen, Felix Akpojene Ogbo, George Patton, David M. Pereira, Farshad Pourmalek, Mostafa Qorbani, Amir Radfar, Gholamreza Roshandel, Joshua A. Salomon, Juan Sanabria, Benn Sartorius, Maheswar Satpathy, Monika Sawhney, Sadaf G Sepanlou, Katya Anne Shackelford, Hirbo Shore Roba, Jiandong Sun, Desalegn Tadese Mengistu, Roman Topór-Mądry, Bach Xuan Tran, Kingsley Nnanna Ukwaja, Vasily Vlassov, Stein Emil Vollset, Theo Vos, Tolassa Wakayo, Elisabete Weiderpass, Andrea Werdecker, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Zoubida Zaidi, Liguo Zhu, Christopher J L Murray, Mohsen Naghavi, Christina Fitzmaurice

Importance Liver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use. Objective To report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjusted life-years (DALYs) for 195 countries or territories from 1990 to 2015, and present global, regional, and national estimates on the burden of liver cancer attributable to HBV, HCV, alcohol, and an “other” group that encompasses residual causes. Design, Settings, and Participants Mortality was estimated using vital registration and cancer registry data in an ensemble modeling approach. Single-cause mortality estimates were adjusted for all-cause mortality. Incidence was derived from mortality estimates and the mortality-to-incidence ratio. Through a systematic literature review, data on the proportions of liver cancer due to HBV, HCV, alcohol, and other causes were identified. Years of life lost were calculated by multiplying each death by a standard life expectancy. Prevalence was estimated using mortality-to-incidence ratio as surrogate for survival. Total prevalence was divided into 4 sequelae that were multiplied by disability weights to derive years lived with disability (YLDs). DALYs were the sum of years of life lost and YLDs. Main Outcomes and Measures Liver cancer mortality, incidence, YLDs, years of life lost, DALYs by etiology, age, sex, country, and year. Results There were 854 000 incident cases of liver cancer and 810 000 deaths globally in 2015, contributing to 20 578 000 DALYs. Cases of incident liver cancer increased by 75% between 1990 and 2015, of which 47% can be explained by changing population age structures, 35% by population growth, and −8% to changing age-specific incidence rates. The male-to-female ratio for age-standardized liver cancer mortality was 2.8. Globally, HBV accounted for 265 000 liver cancer deaths (33%), alcohol for 245 000 (30%), HCV for 167 000 (21%), and other causes for 133 000 (16%) deaths, with substantial variation between countries in the underlying etiologies. Conclusions and Relevance Liver cancer is among the leading causes of cancer deaths in many countries. Causes of liver cancer differ widely among populations. Our results show that most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use. In line with the Sustainable Development Goals, the identification and elimination of risk factors for liver cancer will be required to achieve a sustained reduction in liver cancer burden. The GBD study can be used to guide these prevention efforts.

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Smoking Behavior and Cessation, Health disparities and outcomes, Health, Environment, Cognitive Aging · 2017 · The Lancet

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

Marissa B Reitsma, Nancy Fullman, Marie Ng, Joseph S Salama, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Semaw Ferede Abera, Biju Abraham, Gebre Yitayih Abyu, Akindele O. Adebiyi, Ziyad Al‐Aly, Alicia V Aleman, Raghib Ali, Ala’a Alkerwi, Peter Allebeck, Rajaa Al‐Raddadi, Azmeraw T. Amare, Alemayehu Amberbir, Walid Ammar, Stephen M. Amrock, Carl Abelardo T. Antonio, Hamid Asayesh, Niguse Tadela Atnafu, Peter Azzopardi, Amitava Banerjee, Aleksandra Barać, Tonatiuh Barrientos‐Gutiérrez, Ana Basto‐Abreu, Shahrzad Bazargan‐Hejazi, Neeraj Bedi, Brent Bell, Aminu K. Bello, Isabela M. Benseñor, Addisu Shunu Beyene, Neeraj Bhala, Stan Biryukov, Kaylin Bolt, Hermann Brenner, Zahid A Butt, Fiorella Cavalleri, Kelly Cercy, Honglei Chen, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Valentina Colistro, Mercedes Colomar, Leslie Cornaby, Xiaochen Dai, Solomon Abrha Damtew, Lalit Dandona, Rakhi Dandona, Emily Dansereau, Kairat Davletov, Anand Dayama, Tizta Tilahun Degfie, Amare Deribew, Samath Dhamminda Dharmaratne, Balem Dimtsu, Kerrie Doyle, Aman Yesuf Endries, Sergey Petrovich Ermakov, Kara Estep, Emerito Jose A Faraon, Farshad Farzadfar, Valery L. Feigin, Andrea B Feigl, Florian Fischer, Joseph Friedman, Tsegaye Tewelde G/hiwot, Seana Gall, Wayne Gao, Richard F Gillum, Audra L Gold, Sameer Vali Gopalani, Carolyn Gotay, Rahul Gupta, Rajeev Gupta, Vipin Gupta, Randah R Hamadeh, Graeme J. Hankey, Hilda L Harb, Simon I Hay, Masako Horino, Nobuyuki Horita, Hung Chak Ho, Abdullatif Husseini, Bogdan Vasile Ileanu, Farhad Islami, Guohong Jiang, Ying Jiang, Jost B. Jonas, Zubair Kabir, Ritul Kamal, Amir Kasaeian, Chandrasekharan Nair Kesavachandran, Yousef Khader, Ibrahim Khalil, Young‐Ho Khang, Sahil Khera

BACKGROUND: The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. METHODS: We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). FINDINGS: Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2-25·7) for men and 5·4% (5·1-5·7) for women, representing 28·4% (25·8-31·1) and 34·4% (29·4-38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7-7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. INTERPRETATION: The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years. FUNDING: Bill & Melinda Gates Foundation and Bloomberg Philanthropies.

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Blood Pressure and Hypertension Studies, Sodium Intake and Health, Cardiovascular Health and Risk Factors · 2017 · JAMA

Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

Mohammad H. Forouzanfar, Patrick Liu, Gregory A. Roth, Marie Ng, Stan Biryukov, Laurie B. Marczak, Lily Alexander, Kara Estep, Kalkidan Hassen Abate, Tomi Akinyemiju, Raghib Ali, Nelson Alvis‐Guzmán, Peter Azzopardi, Amitava Banerjee, Till Bärnighausen, Arindam Basu, Tolesa Bekele, Derrick Bennett, Sibhatu Biadgilign, Ferrán Catalá-López, Valery L. Feigin, João Carlos Fernandes, Florian Fischer, Alemseged Aregay Gebru, Philimon Gona, Rajeev Gupta, Graeme J. Hankey, Jost B. Jonas, Suzanne E. Judd, Young‐Ho Khang, Ardeshir Khosravi, Yun Jin Kim, Ruth W Kimokoti, Yoshihiro Kokubo, Dhaval Kolte, Alan D López, Paulo A. Lotufo, Reza Malekzadeh, Yohannes Adama Melaku, George A. Mensah, Awoke Misganaw, Ali H. Mokdad, Andrew Moran, Haseeb Nawaz, Bruce Neal, Frida Ngalesoni, Takayoshi Ohkubo, Farshad Pourmalek, Anwar Rafay, Rajesh Kumar, David Rojas‐Rueda, Uchechukwu K.A. Sampson, Itamar S Santos, Monika Sawhney, Aletta E. Schutte, Sadaf G Sepanlou, Girma Temam Shifa, Ivy Shiue, Bemnet Tedla, Amanda G. Thrift, Marcello Tonelli, Thomas Truelsen, Nikolaos Tsilimparis, Kingsley Nnanna Ukwaja, Olalekan A. Uthman, Tommi Vasankari, Narayanaswamy Venketasubramanian, Vasily Vlassov, Theo Vos, Ronny Westerman, Lijing L. Yan, Yuichiro Yano, Naohiro Yonemoto, Maysaa El Sayed Zaki, Christopher J L Murray

Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. Design: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. Main Outcomes and Measures: Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Results: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). For loss of DALYs associated with systolic blood pressure of 140 mm Hg or higher, the loss increased from 95.9 million (95% uncertainty interval [UI], 87.0-104.9 million) to 143.0 million (95% UI, 130.2-157.0 million) [corrected], and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. Conclusions and Relevance: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.

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