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Jost B. Jonas

· University of Salerno

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Retinal and Optic Conditions, Global Maternal and Child Health, Travel-related health issues · 2021 · The Lancet Global Health

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

Matthew J. Burton, Jacqueline Ramke, Ana Patrícia Marques, Rupert Bourne, Nathan Congdon, Iain Jones, Brandon A M Ah Tong, Simon Arunga, Damodar Bachani, Covadonga Bascarán, Andrew Bastawrous, Karl Blanchet, Tasanee Braithwaite, John Buchán, John Cairns, Anasaini Cama, Margarida Chagunda, Chimgee Chuluunkhuu, Andrew Cooper, Jessica Crofts-Lawrence, William H. Dean, Alastair K. Denniston, Joshua R. Ehrlich, Paul M. Emerson, Jennifer Evans, Kevin D. Frick, David S. Friedman, João M. Furtado, Michael Gichangi, Stephen Gichuhi, Suzanne Gilbert, Reeta Gurung, Esmael Habtamu, Peter W. H. Holland, Jost B. Jonas, Pearse A. Keane, Lisa Keay, Rohit Khanna, Peng T. Khaw, Hannah Kuper, Fatima Kyari, Van Charles Lansingh, Islay Mactaggart, Milka Mafwiri, Wanjiku Mathenge, Ian McCormick, Priya Morjaria, Lizette Mowatt, Debbie Muirhead, G. V. S. Murthy, Nyawira Mwangi, Daksha Patel, Tünde Pető, Babar Qureshi, Solange Rios Salomão, Virginia Sarah, Bernadetha Shilio, Anthony W. Solomon, Bonnielin K. Swenor, Hugh R. Taylor, Ningli Wang, Aubrey Webson, Sheila K. West, Tien Yin Wong, Richard Wormald, Sumrana Yasmin, Mayinuer Yusufu, Juan Carlos Silva, Serge Resnikoff, Thulasiraj Ravilla, Clare Gilbert, Allen Foster, Hannah Faal

There is extensive evidence showing that improving eye health contributes directly and indirectly to achieving many Sustainable Development Goals, including reducing poverty and improving work productivity, general and mental health, and education and equity. Improving eye health is a practical and cost-effective way of unlocking human potential. Eye health needs to be reframed as an enabling, cross-cutting issue within the sustainable development framework.

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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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Cardiovascular Health and Risk Factors, Diabetes, Cardiovascular Risks, and Lipoproteins, Cardiac Health and Mental Health · 2017 · Journal of the American College of Cardiology

Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

Gregory A. Roth, Catherine O. Johnson, Amanuel Alemu Abajobir, Foad Abd-Allah, Semaw Ferede Abera, Gebre Yitayih Abyu, Muktar Beshir Ahmed, Baran Aksut, Shazia Alam, Khurshid Alam, François Alla, Nelson Alvis‐Guzmán, Stephen M. Amrock, Hossein Ansari, Johan Ärnlöv, Hamid Asayesh, Tesfay Mehari Atey, Leticia Ávila‐Burgos, Ashish Awasthi, Amitava Banerjee, Aleksandra Barać, Till Bärnighausen, Lars Barregård, Neeraj Bedi, Ezra B. Ketema, Derrick Bennett, Gebremedhin Berhe, Zulfiqar A Bhutta, Shimelash Bitew Workie, Jonathan R. Carapetis, Juan Jesús Carrero, Déborah Carvalho Malta, Carlos A Castañeda-Orjuela, Jacqueline Castillo-Rivas, Ferrán Catalá-López, Jee-Young Choi, Hanne Christensen, Massimo Círillo, Leslie T. Cooper, Michael H Criqui, David K Cundiff, Albertino Damasceno, Lalit Dandona, Rakhi Dandona, Kairat Davletov, Samath Dhamminda Dharmaratne, Prabhakaran Dorairaj, Manisha Dubey, Rebecca Ehrenkranz, Maysaa El Sayed Zaki, Emerito Jose A Faraon, Alireza Esteghamati, Talha Farid, Maryam S. Farvid, Valery L. Feigin, Eric L. Ding, Gerry Fowkes, Tsegaye Gebrehiwot, Richard F Gillum, Audra L Gold, Philimon Gona, Rajeev Gupta, Tesfa Dejenie Habtewold, Nima Hafezi‐Nejad, Tesfayé Hailu, Gessessew Bugssa Hailu, Graeme J. Hankey, Hamid Yimam Hassen, Kalkidan Hassen Abate, Rasmus Havmoeller, Simon I Hay, Masako Horino, Peter J. Hotez, Kathryn H. Jacobsen, Spencer L James, Mehdi Javanbakht, Panniyammakal Jeemon, Denny John, Jost B. Jonas, Yogeshwar Kalkonde, Chanté Karimkhani, Amir Kasaeian, Yousef Khader, Abdur Rahman Khan, Young‐Ho Khang, Sahil Khera, Abdullah T Khoja, Jagdish Khubchandani, Daniel Kim, Dhaval Kolte, Soewarta Kosen, Kristopher J Krohn, G Anil Kumar, Gene F. Kwan, Dharmesh Kumar Lal, Anders Larsson, Shai Linn, Alan D Lopez, Paulo A. Lotufo, Hassan Magdy Abd El Razek

BACKGROUND: The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world. OBJECTIVES: The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden. METHODS: CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. RESULTS: In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75. CONCLUSIONS: CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

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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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Global Cancer Incidence and Screening, Cancer Risks and Factors, Multiple and Secondary Primary Cancers · 2015 · JAMA Oncology

The Global Burden of Cancer 2013

Christina Fitzmaurice, Daniel Dicker, Amanda Pain, Hannah Hamavid, Maziar Moradi‐Lakeh, Michael F MacIntyre, Christine A. Allen, Gillian M Hansen, Rachel Woodbrook, Charles Wolfe, Randah R Hamadeh, Ami R. Moore, Andrea Werdecker, Bradford D. Gessner, Braden Te Ao, Brian J. McMahon, Chanté Karimkhani, Chuanhua Yu, Graham Cooke, David C. Schwebel, David O. Carpenter, David M. Pereira, Denis Nash, Dhruv S Kazi, Diego De Leo, Dietrich Plaß, Kingsley Nnanna Ukwaja, George D. Thurston, Kim Yun Jin, Edgar P. Simard, Edward J Mills, Eun‐Kee Park, Ferrán Catalá-López, Gabrielle deVeber, Carolyn Gotay, Gulfaraz Khan, Hung Chak Ho, Itamar S Santos, Janet L Leasher, Jasvinder A. Singh, James Leigh, Jost B. Jonas, Juan Sanabria, Justin Beardsley, Kathryn H. Jacobsen, Ken Takahashi, Richard C. Franklin, Luca Ronfani, Marcella Montico, Luigi Naldi, Marcello Tonelli, Johanna M. Geleijnse, Max Petzold, Mark G. Shrime, Mustafa Z Younis, Naohiro Yonemoto, Nicholas J. K. Breitborde, Paul Yip, Farshad Pourmalek, Paulo A. Lotufo, Alireza Esteghamati, Graeme J. Hankey, Raghib Ali, Raimundas Lunevičius, Reza Malekzadeh, Robert P Dellavalle, Robert Weintraub, Robyn Lucas, Roderick J. Hay, David Rojas‐Rueda, Ronny Westerman, Sadaf G Sepanlou, Sandra Nolte, Scott B. Patten, Scott Weichenthal, Semaw Ferede Abera, Seyed-Mohammad Fereshtehnejad, Ivy Shiue, Tim Driscoll, Tommi Vasankari, Ubai Alsharif, Vafa Rahimi‐Movaghar, Vasily Vlassov, Wagner Marcenes, Wubegzier Mekonnen, Yohannes Adama Melaku, Yuichiro Yano, Al Artaman, Ismael Campos‐Nonato, Jennifer H MacLachlan, Ulrich Müeller, Daniel Kim, Matias Trillini, Babak Eshrati, Hywel C Williams, Kenji Shibuya, Rakhi Dandona, Kinnari Murthy, Benjamin Cowie, Azmeraw T. Amare

IMPORTANCE: Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies. OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013. EVIDENCE REVIEW: The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs. FINDINGS: In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries. CONCLUSIONS AND RELEVANCE: Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

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