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Till Bärnighausen

· Harvard University Press

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COVID-19 and healthcare impacts, Economic and Financial Impacts of Cancer, Global Cancer Incidence and Screening · 2021 · JAMA Oncology

Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019

Jonathan Kocarnik, Kelly Compton, Frances Dean, Weijia Fu, Brian Gaw, James Harvey, Hannah Henrikson, Dan Lu, Alyssa Pennini, Rixing Xu, Emad Ababneh, Mohsen Abbasi‐Kangevari, Hedayat Abbastabar, Sherief Abd‐Elsalam, Amir Abdoli, Aidin Abedi, Hassan Abidi, Hassan Abolhassani, Isaac Akinkunmi Adedeji, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Muhammad U. Afzal, Mohammad Aghaali, Bright Opoku Ahinkorah, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmadi, Sepideh Ahmadi, Tarik A. Rashid, Yusra Ahmed Salih, Gizachew Taddesse Akalu, Addis Aklilu, Tayyaba Akram, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Ziyad Al‐Aly, Saqib Ali, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Amir Almasi‐Hashiani, Nihad A. Almasri, Sadeq Ali Al‐Maweri, Sami Almustanyir, Nivaldo Alonso, Nelson Alvis‐Guzmán, Hubert Amu, Etsay Woldu Anbesu, Robert Ancuceanu, Fereshteh Ansari, Alireza Ansari‐Moghaddam, Maxwell Hubert Antwi, Davood Anvari, Anayochukwu Edward Anyasodor, Muhammad Aqeel, Jalal Arabloo, Morteza Arab‐Zozani, Olatunde Aremu, Hany Ariffin, Timur Aripov, Muhammad Arshad, Al Artaman, Judie Arulappan, Zatollah Asemi, Mohammad Asghari Jafarabadi, Tahira Ashraf, Prince Atorkey, Avinash Aujayeb, Marcel Ausloos, Atalel Fentahun Awedew, Beatriz Paulina Ayala Quintanilla, Temesgen Ayenew, Mohammed A. Azab, Sina Azadnajafabad, Amirhossein Azari Jafari, Ghasem Azarian, Ahmed Y. Azzam, Ashish Badiye, Saeed Bahadory, Atif Amin Baig, Jennifer L. Baker, Senthilkumar Balakrishnan, Maciej Banach, Till Bärnighausen, Francesco Barone‐Adesi, Fabio Barra, Amadou Barrow, Masoud Behzadifar, Uzma Belgaumi, Woldesellassie Bezabhe, Yihienew Mequanint Bezabih, Devidas S. Bhagat, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja

IMPORTANCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

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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, COVID-19 and healthcare impacts, Hematological disorders and diagnostics · 2019 · 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 2017

Christina Fitzmaurice, Degu Abate, Naghmeh Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Omar Abdel‐Rahman, Ahmed Abdelalim, Amir Abdoli, Ibrahim Abdollahpour, Abdishakur S. M. Abdulle, Nebiyu Dereje Abebe, Haftom Niguse Abraha, Laith J. Abu‐Raddad, Ahmed Abualhasan, Isaac Akinkunmi Adedeji, Shailesh M Advani, Mohsen Afarideh, Mahdi Afshari, Mohammad Aghaali, Dominic Agius, Sutapa Agrawal, Ayat Ahmadi, Elham Ahmadian, Ehsan Ahmadpour, Muktar Beshir Ahmed, Mohammad Esmaeil Akbari, Tomi Akinyemiju, Ziyad Al‐Aly, Assim M. AlAbdulKader, Fares Alahdab, Shazia Alam, Genet Melak Alamene, Birhan Alemnew, Kefyalew Addis Alene, Cyrus Alinia, Vahid Alipour, Syed Mohamed Aljunid, Fatemeh Allah Bakeshei, Majid A. Almadi, Amir Almasi‐Hashiani, Ubai Alsharif, Shirina Alsowaidi, Nelson Alvis‐Guzmán, Erfan Amini, Saeed Amini, Yaw Ampem Amoako, Zohreh Anbari, Nahla Anber, Cătălina Liliana Andrei, Mina Anjomshoa, Fereshteh Ansari, Ansariadi Ansariadi, Seth Christopher Yaw Appiah, Morteza Arab‐Zozani, Jalal Arabloo, Zohreh Arefi, Olatunde Aremu, Habtamu Abera Areri, Al Artaman, Hamid Asayesh, Ephrem Tsegay Asfaw, Alebachew Fasil Ashagre, Reza Assadi, Bahar Ataeinia, Hagos Tasew Atalay, Zerihun Ataro, Suleman Atique, Marcel Ausloos, Leticia Ávila‐Burgos, Euripide Avokpaho, Ashish Awasthi, Nefsu Awoke, Beatriz Paulina Ayala Quintanilla, Martin Amogre Ayanore, Henok Tadesse Ayele, Ebrahim Babaee, Umar Bacha, Alaa Badawi, Mojtaba Bagherzadeh, Eleni Bagli, Senthilkumar Balakrishnan, Abbas Balouchi, Till Bärnighausen, Robert J. Battista, Masoud Behzadifar, Meysam Behzadifar, Bayu Begashaw Bekele, Yared Belete Belay, Yaschilal Muche Belayneh, Kathleen Berfield, Adugnaw Berhane, Eduardo Bernabé, Mircea Beuran, Nickhill Bhakta, Krittika Bhattacharyya, Belete Biadgo, Ali Bijani, Muhammad Shahdaat Bin Sayeed, Charles Birungi, Catherine Bisignano

Importance Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). Conclusions and Relevance The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

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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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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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