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Ronny Westerman

· Federal Institute for Population Research

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Ronny Westerman is a registered researcher in their academic field.

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Parkinson's Disease Mechanisms and Treatments, Voice and Speech Disorders, Cerebral Palsy and Movement Disorders · 2018 · The Lancet Neurology

Global, regional, and national burden of Parkinson's disease, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

E. Ray Dorsey, Alexis Elbaz, Emma Nichols, Nooshin Abbasi, Foad Abd-Allah, Ahmed Abdelalim, José Carmelo Adsuar, Mustafa Geleto Ansha, Carol Brayne, Jee-Young Jasmine Choi, Daniel Collado‐Mateo, Nabila Dahodwala, Huyen Phuc, Dumessa Edessa, Matthias Endres, Seyed‐Mohammad Fereshtehnejad, Kyle J Foreman, Fortuné Gbètoho Gankpé, Rahul Gupta, Samer Hamidi, Graeme J. Hankey, Simon I Hay, Mohamed Hegazy, Desalegn Tsegaw Hibstu, Amir Kasaeian, Yousef Khader, Ibrahim Khalil, Young‐Ho Khang, Yun Jin Kim, Yoshihiro Kokubo, Giancarlo Logroscino, João Massano, Norlinah Mohamed Ibrahim, Mohammed A. Mohammed, Alireza Mohammadi, Maziar Moradi‐Lakeh, Mohsen Naghavi, Binh Thanh Nguyen, Yirga Legesse Nirayo, Felix Akpojene Ogbo, Mayowa Owolabi, David M. Pereira, Maarten J. Postma, Mostafa Qorbani, Muhammad Aziz Rahman, Kedir Teji Roba, Hosein Safari, Saeid Safiri, Maheswar Satpathy, Monika Sawhney, Azadeh Shafieesabet, Mekonnen Sisay Shiferaw, Mari Smith, Cassandra Szoeke, Rafael Tabarés‐Seisdedos, Nu Thi Truong, Kingsley Nnanna Ukwaja, Narayanaswamy Venketasubramanian, Santos Villafaina, Kidu gidey weldegwergs, Ronny Westerman, Tissa Wijeratne, Andrea Sylvia Winkler, Bach Tran Xuan, Naohiro Yonemoto, Valery L. Feigin, Theo Vos, Christopher J L Murray

BACKGROUND: Neurological disorders are now the leading source of disability globally, and ageing is increasing the burden of neurodegenerative disorders, including Parkinson's disease. We aimed to determine the global burden of Parkinson's disease between 1990 and 2016 to identify trends and to enable appropriate public health, medical, and scientific responses. METHODS: Through a systematic analysis of epidemiological studies, we estimated global, regional, and country-specific prevalence and years of life lived with disability for Parkinson's disease from 1990 to 2016. We estimated the proportion of mild, moderate, and severe Parkinson's disease on the basis of studies that used the Hoehn and Yahr scale and assigned disability weights to each level. We jointly modelled prevalence and excess mortality risk in a natural history model to derive estimates of deaths due to Parkinson's disease. Death counts were multiplied by values from the Global Burden of Disease study's standard life expectancy to compute years of life lost. Disability-adjusted life-years (DALYs) were computed as the sum of years lived with disability and years of life lost. We also analysed results based on the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, 6·1 million (95% uncertainty interval [UI] 5·0-7·3) individuals had Parkinson's disease globally, compared with 2·5 million (2·0-3·0) in 1990. This increase was not solely due to increasing numbers of older people, because age-standardised prevalence rates increased by 21·7% (95% UI 18·1-25·3) over the same period (compared with an increase of 74·3%, 95% UI 69·2-79·6, for crude prevalence rates). Parkinson's disease caused 3·2 million (95% UI 2·6-4·0) DALYs and 211 296 deaths (95% UI 167 771-265 160) in 2016. The male-to-female ratios of age-standardised prevalence rates were similar in 2016 (1·40, 95% UI 1·36-1·43) and 1990 (1·37, 1·34-1·40). From 1990 to 2016, age-standardised prevalence, DALY rates, and death rates increased for all global burden of disease regions except for southern Latin America, eastern Europe, and Oceania. In addition, age-standardised DALY rates generally increased across the Socio-demographic Index. INTERPRETATION: Over the past generation, the global burden of Parkinson's disease has more than doubled as a result of increasing numbers of older people, with potential contributions from longer disease duration and environmental factors. Demographic and potentially other factors are poised to increase the future burden of Parkinson's disease substantially. FUNDING: Bill & Melinda Gates Foundation.

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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, Multiple and Secondary Primary Cancers, Frailty in Older Adults · 2016 · JAMA Oncology

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015

Christina Fitzmaurice, Christine A. Allen, Ryan M Barber, Lars Barregård, Zulfiqar A Bhutta, Hermann Brenner, Daniel Dicker, Odgerel Chimed‐Ochir, Rakhi Dandona, Lalit Dandona, Tom Fleming, Mohammad H. Forouzanfar, Jamie Hancock, Roderick J. Hay, Rachel Hunter‐Merrill, Chantal Huynh, Hung Chak Ho, Catherine O. Johnson, Jost B Jonas, Jagdish Khubchandani, G Anil Kumar, Michael Kutz, Qing Lan, Heidi J. Larson, Xiaofeng Liang, Stephen S Lim, Alan D Lopez, Michael F MacIntyre, Laurie B. Marczak, Neal Marquez, Ali H. Mokdad, Christine Pinho, Farshad Pourmalek, Joshua A. Salomon, Juan Sanabria, Logan Sandar, Benn Sartorius, Stephen M. Schwartz, Katya Anne Shackelford, Kenji Shibuya, Jeffrey D Stanaway, Caitlyn Steiner, Jiandong Sun, Ken Takahashi, Stein Emil Vollset, Theo Vos, Joseph A. Wagner, Haidong Wang, Ronny Westerman, Hajo Zeeb, Leo Zoeckler, Foad Abd-Allah, Muktar Beshir Ahmed, Samer Alabed, Noore Alam, Saleh Fahed Aldhahri, Girma Alem, Mulubirhan Assefa Alemayohu, Raghib Ali, Rajaa Al‐Raddadi, Azmeraw T. Amare, Yaw Ampem Amoako, Al Artaman, Hamid Asayesh, Niguse Tadele Atnafu, Ashish Awasthi, Huda Ba Saleem, Aleksandra Barać, Neeraj Bedi, Isabela M. Benseñor, Adugnaw Berhane, Eduardo Bernabé, Balem Demtsu Betsu, Agnès Binagwaho, Dube Jara Boneya, Ismael Campos‐Nonato, Carlos A Castañeda-Orjuela, Ferrán Catalá-López, Peggy Pei-Chia Chiang, Chioma Chibueze, Abdulaal Chitheer, Jee-Young Jasmine Choi, Benjamin Cowie, Solomon Abrha Damtew, José das Neves, Suhojit Dey, Samath Dhamminda Dharmaratne, Preet K. Dhillon, Eric L. Ding, Tim Driscoll, Donatus U. Ekwueme, Aman Yesuf Endries, Maryam S. Farvid, Farshad Farzadfar, João Carlos Fernandes, Florian Fischer, Tsegaye Tewelde G/hiwot, Alemseged Aregay Gebru, Sameer Vali Gopalani, Alemayehu Hailu

IMPORTANCE: Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. EVIDENCE REVIEW: Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results. FINDINGS: In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globally was prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancer was the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancer was breast cancer (2.4 million cases). Breast cancer was also the leading cause of cancer deaths and DALYs for women (523 000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in 174 of 195 countries or territories. Age-standardized death rates (ASDRs) for all cancers combined decreased within that timeframe in 140 of 195 countries or territories. Countries with an increase in the ASDR due to all cancers were largely located on the African continent. Of all cancers, deaths between 2005 and 2015 decreased significantly for Hodgkin lymphoma (-6.1% [95% uncertainty interval (UI), -10.6% to -1.3%]). The number of deaths also decreased for esophageal cancer, stomach cancer, and chronic myeloid leukemia, although these results were not statistically significant. CONCLUSION AND RELEVANCE: As part of the epidemiological transition, cancer incidence is expected to increase in the future, further straining limited health care resources. Appropriate allocation of resources for cancer prevention, early diagnosis, and curative and palliative care requires detailed knowledge of the local burden of cancer. The GBD 2015 study results demonstrate that progress is possible in the war against cancer. However, the major findings also highlight an unmet need for cancer prevention efforts, including tobacco control, vaccination, and the promotion of physical activity and a healthy diet.

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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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