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# Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.

Christopher J L Murray, Ryan M Barber, Kyle J Foreman, Ayse Abbasoglu Ozgoren, Semaw F Abera, Victor Aboyans, Jerry P Abraham, Ibrahim Abubakar, Laith J Abu-Raddad, Niveen M Abu-Rmeileh, et al.

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## To cite this version:

Christopher J L Murray, Ryan M Barber, Kyle J Foreman, Ayse Abbasoglu Ozgoren, Semaw F Abera, et al.. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.. The Lancet, 2015, 386 (10009), pp.2145-91. 10.1016/S0140-6736(15)61340-X. hal-01262808

HAL Id: hal-01262808

https://unilim.hal.science/hal-01262808

Submitted on 7 Jun 2024

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Distributed under a Creative Commons Attribution 4.0 International License
# Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.

Christopher J L Murray, Ryan M Barber, Kyle J Foreman, Ayse Abbasoglu Ozgoren, Semaw F Abera, Victor Aboyans, Jerry P Abraham, Ibrahim Abubakar, Laith J Abu-Raddad, Niveen M Abu-Rmeileh, et al.

► To cite this version:

Christopher J L Murray, Ryan M Barber, Kyle J Foreman, Ayse Abbasoglu Ozgoren, Semaw F Abera, et al.. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.. The Lancet, 2015, 386 (10009), pp.2145-91. 10.1016/S0140-6736(15)61340-X. hal-01262808

HAL Id: hal-01262808

https://unilim.hal.science/hal-01262808v1

Submitted on 7 Jun 2024

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

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Distributed under a Creative Commons Attribution 4.0 International License
Europe PMC Funders Group

Author Manuscript

Lancet. Author manuscript; available in PMC 2016 May 28.

Published in final edited form as:

Lancet. 2015 November 28; 386(10009): 2145–2191. doi:10.1016/S0140-6736(15)61340-X.

# Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition

GBD 2013 DALYs and HALE Collaborators*

## Summary

**Background**—The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.

**Methods**—We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.

**Findings**—Worldwide, from 1990 to 2013, life expectancy at birth rose by 6.2 years (95% UI 5.6–6.6), from 65.3 years (65.0–65.6) in 1990 to 71.5 years (71.0–71.9) in 2013, HALE at birth rose by 5.4 years (4.9–5.8), from 56.9 years (54.5–59.1) to 62.3 years (59.7–64.8), total DALYs

Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA, cjlm@uw.edu.

## Contributors

TV, ADL, JAS, and CJLM prepared the first draft. CJLM and TV finalised the draft based on comments from other authors and reviewer feedback. TV, ADL, JAS, and CJLM conceived of the study and provided overall guidance. RB and KF performed final statistical analyses. All other authors provided data, developed models, reviewed results, provided guidance on methodology, and reviewed the manuscript.

For the United Nations Development Programme Human Development Index see http://hdr.undp.org/en/content/human-development-index-hdi

See Online for appendix

<footnote>*Collaborators listed at the end of the Article</footnote>
Published in final edited form as:

Lancet. 2015 November 28; 386(10009): 2145-2191. doi:10.1016/S0140-6736(15)61340-X.

# Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition

GBD 2013 DALYs and HALE Collaborators*

## Summary

**Background**—The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.

**Methods**—We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.

**Findings**—Worldwide, from 1990 to 2013, life expectancy at birth rose by 6.2 years (95% UI 5.6–6.6), from 65.3 years (65.0–65.6) in 1990 to 71.5 years (71.0–71.9) in 2013, HALE at birth rose by 5.4 years (4.9–5.8), from 56.9 years (54.5–59.1) to 62.3 years (59.7–64.8), total DALYs

Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA, cjlm@uw.edu.

## Contributors

TV, ADL, JAS, and CJLM prepared the first draft. CJLM and TV finalised the draft based on comments from other authors and reviewer feedback. TV, ADL, JAS, and CJLM conceived of the study and provided overall guidance. RB and KF performed final statistical analyses. All other authors provided data, developed models, reviewed results, provided guidance on methodology, and reviewed the manuscript.

For the United Nations Development Programme Human Development Index see http://hdr.undp.org/en/content/human-development-index-hdi

See Online for appendix

<footnote>*Collaborators listed at the end of the Article</footnote>
fell by 3.6% (0.3–7.4), and age-standardised DALY rates per 100 000 people fell by 26.7% (24.6–29.1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.

**Interpretation**—Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Introduction

The Global Burden of Disease study 2013 (GBD 2013) seeks to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to allow comparisons of health loss to be made over time and across causes, age-sex groups, and geographies. The GBD 2013 data for disease and injury incidence and prevalence, years lived with disability (YLDs), causes of death, and years of life lost because of premature mortality (YLLs) for 188 countries provide an opportunity to assess the effect of recent changes in population health by examining summary measures of health loss attributed to specific causes, expressed in DALYs, and summary measures of average population health, expressed as HALE.¹,² These measures are crucial to track health progress, strengthen policy decisions, assess programme effects and results, and inform health service and research priorities. Such holistic measures of population health, encompassing both disability and mortality levels and patterns in populations, are also attracting interest as part of the discussion around the Sustainable Development Goals.³⁻⁵
fell by 3.6% (0.3–7.4), and age-standardised DALY rates per 100 000 people fell by 26.7% (24.6–29.1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.

**Interpretation**—Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Introduction

The Global Burden of Disease study 2013 (GBD 2013) seeks to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to allow comparisons of health loss to be made over time and across causes, age-sex groups, and geographies. The GBD 2013 data for disease and injury incidence and prevalence, years lived with disability (YLDs), causes of death, and years of life lost because of premature mortality (YLLs) for 188 countries provide an opportunity to assess the effect of recent changes in population health by examining summary measures of health loss attributed to specific causes, expressed in DALYs, and summary measures of average population health, expressed as HALE.¹,² These measures are crucial to track health progress, strengthen policy decisions, assess programme effects and results, and inform health service and research priorities. Such holistic measures of population health, encompassing both disability and mortality levels and patterns in populations, are also attracting interest as part of the discussion around the Sustainable Development Goals.³⁻⁵
A hallmark of the GBD approach is an emphasis on making national data easier to compare by taking into account the extensive variation that exists in national medical certification and cause of death coding practices and widely varying case definitions and measurement methods used to track the incidence and prevalence of diseases and injuries.¹,² The GBD not only provides detailed metrics for specific causes, but also generates summary measures, such as DALYs and HALE, which enable comparative assessments of broad epidemiological patterns across countries and different time periods. HALE is a useful summary of overall health for a country and DALYs allow assessment of both premature mortality and non-fatal outcomes by cause. These broad summary measures allow quantification of general trends, such as the epidemiological transition, while also making clear how countries and regions deviate from general patterns.⁶⁻⁹ The unfolding of the HIV epidemic and the rise of adult mortality, especially among men in Eastern Europe and Central Asia, have called into question the notion of a universal pattern of epidemiological change that occurs with sociodemographic development.²,¹⁰⁻¹³ However, the general notion of a shift from communicable to non-communicable causes of disease burden and injuries remains a powerful framework for global and regional health policy debates.⁹,¹⁴⁻¹⁸ The GBD provides an opportunity to quantify these patterns and explore the extent to which epidemiological change is driven by sociodemographic change, reduction of health risks, improvement of health management, or other local factors.

GBD 2013 results for deaths, YLLs, incidence, prevalence, and YLDs by cause for 1990 to 2013 for 188 countries have already been published.¹,² In this study we use these GBD 2013 results to calculate DALYs and HALE. These summary metrics are used to characterise broad patterns of lost healthy life and cross-country variations within these patterns. The GBD 2013 provides a complete re-analysis of each country's data from 1990 to 2013 and thus supersedes all previously published GBD analyses of DALYs and HALE.

# Methods

## Study design

GBD 2013 uses a hierarchy of causes that organises 306 diseases and injuries into four levels of classification, the rationale for which has been described previously.²,¹⁹ The first level distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level 2 has 21 mutually exclusive and collectively exhaustive categories, level 3 has 163 categories, and level 4 has 254 categories. The full cause list, including International Classification of Diseases tenth edition (ICD-10) codes, has been reported previously.¹,² Mortality rates and causes of death for each country–age–sex–year group have been estimated in accordance with some general principles: identification of all available data sources, evaluation of the quality and correction for known bias in each data source, consistent statistical estimation including uncertainty analysis, and cross-validation analysis to assess model performance. Details of data sources and estimation methods used to deal with missing data and multiple measurements for the same country–age–sex–year group have been described previously.² Disease and injury incidence and prevalence and computation of YLDs have been estimated in line with similar principles of identification and assessment of the quality of all available
A hallmark of the GBD approach is an emphasis on making national data easier to compare by taking into account the extensive variation that exists in national medical certification and cause of death coding practices and widely varying case definitions and measurement methods used to track the incidence and prevalence of diseases and injuries.¹,² The GBD not only provides detailed metrics for specific causes, but also generates summary measures, such as DALYs and HALE, which enable comparative assessments of broad epidemiological patterns across countries and different time periods. HALE is a useful summary of overall health for a country and DALYs allow assessment of both premature mortality and non-fatal outcomes by cause. These broad summary measures allow quantification of general trends, such as the epidemiological transition, while also making clear how countries and regions deviate from general patterns.⁶⁻⁹ The unfolding of the HIV epidemic and the rise of adult mortality, especially among men in Eastern Europe and Central Asia, have called into question the notion of a universal pattern of epidemiological change that occurs with sociodemographic development.²,¹⁰⁻¹³ However, the general notion of a shift from communicable to non-communicable causes of disease burden and injuries remains a powerful framework for global and regional health policy debates.⁹,¹⁴⁻¹⁸ The GBD provides an opportunity to quantify these patterns and explore the extent to which epidemiological change is driven by sociodemographic change, reduction of health risks, improvement of health management, or other local factors.

GBD 2013 results for deaths, YLLs, incidence, prevalence, and YLDs by cause for 1990 to 2013 for 188 countries have already been published.¹,² In this study we use these GBD 2013 results to calculate DALYs and HALE. These summary metrics are used to characterise broad patterns of lost healthy life and cross-country variations within these patterns. The GBD 2013 provides a complete re-analysis of each country's data from 1990 to 2013 and thus supersedes all previously published GBD analyses of DALYs and HALE.

# Methods

## Study design

GBD 2013 uses a hierarchy of causes that organises 306 diseases and injuries into four levels of classification, the rationale for which has been described previously.²,¹⁹ The first level distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level 2 has 21 mutually exclusive and collectively exhaustive categories, level 3 has 163 categories, and level 4 has 254 categories. The full cause list, including International Classification of Diseases tenth edition (ICD-10) codes, has been reported previously.¹,² Mortality rates and causes of death for each country–age–sex–year group have been estimated in accordance with some general principles: identification of all available data sources, evaluation of the quality and correction for known bias in each data source, consistent statistical estimation including uncertainty analysis, and cross-validation analysis to assess model performance. Details of data sources and estimation methods used to deal with missing data and multiple measurements for the same country–age–sex–year group have been described previously.² Disease and injury incidence and prevalence and computation of YLDs have been estimated in line with similar principles of identification and assessment of the quality of all available
sources for 2337 sequelae of the 301 diseases and injuries.¹ The discrepancy between the 306 diseases and injuries for which DALYs are calculated and the 301 diseases and injuries for which YLDs are calculated is attributable to five diseases that cause death but do not cause disability: sudden infant death syndrome, indirect maternal deaths, late maternal deaths, maternal deaths aggravated by HIV/AIDS, and aortic aneurysm. Various statistical estimation methods were used depending on the details of specific diseases, the most common approach being the application of a Bayesian metaregression model, DisMod-MR 2.0.²⁰ We used alternative methods when the basic susceptible, with disease, and dead states in DisMod-MR 2.0 were insufficient to capture the natural history of a sequela. We aggregated sequelae prevalence into YLDs first by estimating the distribution of comorbidities through microsimulation, and second by using disability weights derived from population-based surveys of the general public to assign disability weights to each sequela and combination of sequelae—details of both steps have been described previously.¹,²¹

We used the GBD 2013 results for YLLs² and YLDs¹ to calculate DALYs. To calculate HALE, we used YLDs per person and life tables.¹,² We applied decomposition of variance using hierarchical regression to DALY rates by cause.

## Years lived with disability

For each year for which YLDs have been estimated (1990, 1995, 2000, 2005, 2010, and 2013), we computed DALYs by adding YLLs and YLDs for each age-sex-country group. We assumed that uncertainty in YLLs is independent of uncertainty in YLDs. We did this by summing the first draw of the 1000 draws for YLLs and YLDs and then repeating for each subsequent draw. We calculated 95% uncertainty intervals (UIs) using the 25th and 975th ordered draw of the DALY uncertainty distribution.

## Healthy life expectancy

We calculated HALE in accordance with the methods outlined by Salomon and colleagues.⁸ In brief, we used Sullivan's method²² to incorporate information about average levels of health experienced at different ages into an abridged life table to produce estimates of life expectancy that are adjusted for reductions in functional health status relating to prevalent health conditions. Effectively, the cumulative years lived in an age group in the abridged life table (the life expectancy column) for each country-age-sex group is multiplied by the YLDs per person for that country-age-sex group. Calculation of HALE relies on three inputs from GBD 2013: life tables by sex, country, and year; estimates of the prevalence of 2337 sequelae by age, sex, country and year; and disability weights for 235 unique health states that collectively cover the range of functional health losses and symptoms associated with the 2337 sequelae. Wang and colleagues² have described data sources and methods to estimate mortality and life tables, and Vos and colleagues¹ have described these for the measurement of prevalence of sequelae and disability weights.¹ We combined information about prevalence and disability weights into measures of the overall rate of YLDs per person in each age-sex-country group. We make the strong assumption that uncertainty in YLDs per person is independent of uncertainty in age-specific death rates to calculate uncertainty distributions for HALE.
sources for 2337 sequelae of the 301 diseases and injuries.¹ The discrepancy between the 306 diseases and injuries for which DALYs are calculated and the 301 diseases and injuries for which YLDs are calculated is attributable to five diseases that cause death but do not cause disability: sudden infant death syndrome, indirect maternal deaths, late maternal deaths, maternal deaths aggravated by HIV/AIDS, and aortic aneurysm. Various statistical estimation methods were used depending on the details of specific diseases, the most common approach being the application of a Bayesian metaregression model, DisMod-MR 2.0.²⁰ We used alternative methods when the basic susceptible, with disease, and dead states in DisMod-MR 2.0 were insufficient to capture the natural history of a sequela. We aggregated sequelae prevalence into YLDs first by estimating the distribution of comorbidities through microsimulation, and second by using disability weights derived from population-based surveys of the general public to assign disability weights to each sequela and combination of sequelae—details of both steps have been described previously.¹,²¹

We used the GBD 2013 results for YLLs² and YLDs¹ to calculate DALYs. To calculate HALE, we used YLDs per person and life tables.¹,² We applied decomposition of variance using hierarchical regression to DALY rates by cause.

## Years lived with disability

For each year for which YLDs have been estimated (1990, 1995, 2000, 2005, 2010, and 2013), we computed DALYs by adding YLLs and YLDs for each age-sex-country group. We assumed that uncertainty in YLLs is independent of uncertainty in YLDs. We did this by summing the first draw of the 1000 draws for YLLs and YLDs and then repeating for each subsequent draw. We calculated 95% uncertainty intervals (UIs) using the 25th and 975th ordered draw of the DALY uncertainty distribution.

## Healthy life expectancy

We calculated HALE in accordance with the methods outlined by Salomon and colleagues.⁸ In brief, we used Sullivan's method²² to incorporate information about average levels of health experienced at different ages into an abridged life table to produce estimates of life expectancy that are adjusted for reductions in functional health status relating to prevalent health conditions. Effectively, the cumulative years lived in an age group in the abridged life table (the life expectancy column) for each country-age-sex group is multiplied by the YLDs per person for that country-age-sex group. Calculation of HALE relies on three inputs from GBD 2013: life tables by sex, country, and year; estimates of the prevalence of 2337 sequelae by age, sex, country and year; and disability weights for 235 unique health states that collectively cover the range of functional health losses and symptoms associated with the 2337 sequelae. Wang and colleagues² have described data sources and methods to estimate mortality and life tables, and Vos and colleagues¹ have described these for the measurement of prevalence of sequelae and disability weights.¹ We combined information about prevalence and disability weights into measures of the overall rate of YLDs per person in each age-sex-country group. We make the strong assumption that uncertainty in YLDs per person is independent of uncertainty in age-specific death rates to calculate uncertainty distributions for HALE.
Decomposition of variance and epidemiological transition

The epidemiological transition is an extension of the notion of the demographic transition.
In demographic transition, a characteristic evolution occurs in populations over time towards
reduced fertility rates, reduced mortality rates, and an older age distribution of the
population. The widely used concept of the epidemiological transition adds the idea that, in
addition to these changes, a characteristic change occurs in the contributing causes of death.
The epidemiological transition has been broadened to encompass the more general health
transition, including both morbidity and mortality. A single variable to characterise countries
over time in terms of their demographic and epidemiological status would be crucial to
describe the epidemiological transition. Some studies examine associations with income per
person, whereas others use variables such as mean age of the population.²³,²⁴ We aimed to
construct a single composite variable to represent both demographic status and
socioeconomic development to explore the patterns of the epidemiological transition. To
construct this sociodemographic status variable, we assessed variables indicative of
socioeconomic status and demographic change that were available for all 188 countries from
1990 to 2013. We did not include measures of income inequality, such as the Gini
coefficient, because these were not available for all countries for each year. We used
principal components analysis (PCA) of the log transformation of income per person (in
constant international dollars), average years of schooling of the population after age 15
years, the log of the total fertility rate, and the log of the mean age of the population. The
relationship between the PCA variables and DALY rates were highly non-linear, but became
linear with respect to the log DALY rates after log transformation of three of the four
sociodemographic status component variables. Before using PCA, we normalised each
variable to have a mean of zero and a standard deviation of 1.0. Only the first component of
the PCA had an eigenvalue greater than 1.0 and the weights were 0.471 for income per
person, -0.517 for total fertility rate, 0.495 for education per person, and 0.516 for mean
age.²⁵ As expected, the sign on the total fertility rate was negative, whereas the sign on the
other three components was positive. We also tested all possible combinations of the four
variables using the same PCA approach to confirm that the principal component of all four
was the most predictive of variation in DALY rates by cause. We used the predicted value of
the first component for each country-year in the subsequent ANOVA and predictions of the
epidemiological change with sociodemographic status.

We used hierarchical regression to decompose variance in log DALY rates into components
related to the sociodemographic status, intercountry variation, year, and fraction explained
by the interactions of the other variables. This approach estimates a simple model with
uncorrelated random effects for year, country, and sociodemographic status.²⁶ We divided
sociodemographic status into vigintiles (20 equal interval bins) to allow for non-linear
correlations between log DALY rates and sociodemographic status for a cause. We did tests
with up to 50 bins for the sociodemographic status variable with no change in qualitative
results. We divided the variance of each random effect by total variance to decompose
variance into different factors. We did this variance decomposition analysis for GBD level 2
and level 3 causes. We use these regressions to predict the pattern of DALYs by cause (and
through separate regressions for YLLs and YLDs) purely as a function of sociodemographic
status, holding all other random effects (year and country) at zero. Because there could be
Decomposition of variance and epidemiological transition

The epidemiological transition is an extension of the notion of the demographic transition.
In demographic transition, a characteristic evolution occurs in populations over time towards
reduced fertility rates, reduced mortality rates, and an older age distribution of the
population. The widely used concept of the epidemiological transition adds the idea that, in
addition to these changes, a characteristic change occurs in the contributing causes of death.
The epidemiological transition has been broadened to encompass the more general health
transition, including both morbidity and mortality. A single variable to characterise countries
over time in terms of their demographic and epidemiological status would be crucial to
describe the epidemiological transition. Some studies examine associations with income per
person, whereas others use variables such as mean age of the population.²³,²⁴ We aimed to
construct a single composite variable to represent both demographic status and
socioeconomic development to explore the patterns of the epidemiological transition. To
construct this sociodemographic status variable, we assessed variables indicative of
socioeconomic status and demographic change that were available for all 188 countries from
1990 to 2013. We did not include measures of income inequality, such as the Gini
coefficient, because these were not available for all countries for each year. We used
principal components analysis (PCA) of the log transformation of income per person (in
constant international dollars), average years of schooling of the population after age 15
years, the log of the total fertility rate, and the log of the mean age of the population. The
relationship between the PCA variables and DALY rates were highly non-linear, but became
linear with respect to the log DALY rates after log transformation of three of the four
sociodemographic status component variables. Before using PCA, we normalised each
variable to have a mean of zero and a standard deviation of 1.0. Only the first component of
the PCA had an eigenvalue greater than 1.0 and the weights were 0.471 for income per
person, -0.517 for total fertility rate, 0.495 for education per person, and 0.516 for mean
age.²⁵ As expected, the sign on the total fertility rate was negative, whereas the sign on the
other three components was positive. We also tested all possible combinations of the four
variables using the same PCA approach to confirm that the principal component of all four
was the most predictive of variation in DALY rates by cause. We used the predicted value of
the first component for each country-year in the subsequent ANOVA and predictions of the
epidemiological change with sociodemographic status.

We used hierarchical regression to decompose variance in log DALY rates into components
related to the sociodemographic status, intercountry variation, year, and fraction explained
by the interactions of the other variables. This approach estimates a simple model with
uncorrelated random effects for year, country, and sociodemographic status.²⁶ We divided
sociodemographic status into vigintiles (20 equal interval bins) to allow for non-linear
correlations between log DALY rates and sociodemographic status for a cause. We did tests
with up to 50 bins for the sociodemographic status variable with no change in qualitative
results. We divided the variance of each random effect by total variance to decompose
variance into different factors. We did this variance decomposition analysis for GBD level 2
and level 3 causes. We use these regressions to predict the pattern of DALYs by cause (and
through separate regressions for YLLs and YLDs) purely as a function of sociodemographic
status, holding all other random effects (year and country) at zero. Because there could be
lagged effects between sociodemographic status and DALY rate, we tested alternative models with sociodemographic status lagged from 1 to 10 years. Use of sociodemographic status from the same year as the DALY rates explained, on average, the highest proportion of the variance in DALY rates.

## Age standardisation

We selected the revised GBD 2013 world population standard for the age standardisation of rates. Details of the age standard, and its development, have been reported previously.²

## Role of the funding source

The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had access to the data in the study and final responsibility to submit the paper.

## Results

### Global

Global life expectancy at birth for both sexes combined increased from 65.3 years (95% UI 65.0–65.6) in 1990 to 71.5 years (71.0–71.9) in 2013, whereas during the same interval, HALE at birth for both sexes combined increased from 56.9 years (54.5–59.1) to 62.3 years (59.7–64.8). The survivorship curves shift up and to the right with increasing quintiles of country sociodemographic status (figure 1). In the three groups of countries, defined as the lowest, middle three, and highest quintiles of country sociodemographic status in 2013, individuals are distributed across ranges of disability weights, with the majority of the population in most age groups living in health states with disability weights in the range 0.0–0.1. The fraction of individuals in the life table in full health (ie, living with a disability weight of zero) is 16.3% in the lowest sociodemographic status quintile of countries. Even in the most advantageous sociodemographic quintile of countries, the time lived in full health constitutes only a small fraction (17.5%) of the overall life course. At the other end of the spectrum, the expectation of years lived with disability weights greater than 0.5 is 3.59 years in the lowest quintile and 6.60 years in the highest quintile of countries.

Figure 2 shows the need to understand global epidemiological change in terms of numbers, rates, and age-standardised rates. The number of DALYs caused by communicable, maternal, neonatal, and nutritional disorders has declined steadily from 1.19 billion (95% UI 1.15 billion to 1.24 billion) in 1990 to 769.3 million (725.5 million to 814.9 million) in 2013, whereas DALYs for non-communicable diseases (NCDs) have increased steadily, rising from 1.08 billion (0.97 billion to 1.20 billion) to 1.43 billion (1.26 billion to 1.61 billion) during the same period (figure 2A). The year of crossover, during which global DALYs for NCDs exceeded those for global communicable, maternal, neonatal, and nutritional causes, was 1994. DALYs due to injuries have remained relatively constant, decreasing slightly from 269.6 million (251.6 million to 286.7 million) to 247.6 million (231.3 million to 265.1 million). Figure 2B shows crude DALY rates per 100 000 people for these three broad cause groups, thereby removing the effect of global population growth during the period. The DALY rate for NCDs has remained fairly constant, while substantial
lagged effects between sociodemographic status and DALY rate, we tested alternative models with sociodemographic status lagged from 1 to 10 years. Use of sociodemographic status from the same year as the DALY rates explained, on average, the highest proportion of the variance in DALY rates.

## Age standardisation

We selected the revised GBD 2013 world population standard for the age standardisation of rates. Details of the age standard, and its development, have been reported previously.²

## Role of the funding source

The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had access to the data in the study and final responsibility to submit the paper.

## Results

### Global

Global life expectancy at birth for both sexes combined increased from 65.3 years (95% UI 65.0–65.6) in 1990 to 71.5 years (71.0–71.9) in 2013, whereas during the same interval, HALE at birth for both sexes combined increased from 56.9 years (54.5–59.1) to 62.3 years (59.7–64.8). The survivorship curves shift up and to the right with increasing quintiles of country sociodemographic status (figure 1). In the three groups of countries, defined as the lowest, middle three, and highest quintiles of country sociodemographic status in 2013, individuals are distributed across ranges of disability weights, with the majority of the population in most age groups living in health states with disability weights in the range 0.0–0.1. The fraction of individuals in the life table in full health (ie, living with a disability weight of zero) is 16.3% in the lowest sociodemographic status quintile of countries. Even in the most advantageous sociodemographic quintile of countries, the time lived in full health constitutes only a small fraction (17.5%) of the overall life course. At the other end of the spectrum, the expectation of years lived with disability weights greater than 0.5 is 3.59 years in the lowest quintile and 6.60 years in the highest quintile of countries.

Figure 2 shows the need to understand global epidemiological change in terms of numbers, rates, and age-standardised rates. The number of DALYs caused by communicable, maternal, neonatal, and nutritional disorders has declined steadily from 1.19 billion (95% UI 1.15 billion to 1.24 billion) in 1990 to 769.3 million (725.5 million to 814.9 million) in 2013, whereas DALYs for non-communicable diseases (NCDs) have increased steadily, rising from 1.08 billion (0.97 billion to 1.20 billion) to 1.43 billion (1.26 billion to 1.61 billion) during the same period (figure 2A). The year of crossover, during which global DALYs for NCDs exceeded those for global communicable, maternal, neonatal, and nutritional causes, was 1994. DALYs due to injuries have remained relatively constant, decreasing slightly from 269.6 million (251.6 million to 286.7 million) to 247.6 million (231.3 million to 265.1 million). Figure 2B shows crude DALY rates per 100 000 people for these three broad cause groups, thereby removing the effect of global population growth during the period. The DALY rate for NCDs has remained fairly constant, while substantial
declines have occurred in DALY rates for communicable, maternal, neonatal, and nutritional disorders (52.2%, 50.1–54.4) and injuries (32.0%, 27.0–35.9). The analysis of age-standardised DALY rates, shows that, after controlling for changes in population size and composition, NCD disease burden worldwide, has continued to decline, falling by 14.5% (11.6–17.3) between 1990 and 2013 (figure 3C). During the same period, worldwide age-standardised DALY rates fell by 42.4% (40.0–45.0) for communicable, maternal, neonatal, and nutritional disorders and 30.9% (26.1–34.7) for injuries.

We decomposed the changes in the number of DALYs into trends for two periods: 1990–2005 and 2005–2013 (figure 3).¹⁰ Between 1990 and 2005, the number of global DALYs changed only slightly, from 2.54 billion (95% UI 2.40 billion to 2.70 billion) to 2.51 billion (2.33 billion to 2.72 billion). Looking at disease-level details within this relative stagnation reveals important trends for specific diseases (figure 3A); the earlier period was characterised by decreases in the number of DALYs from diarrhoea, lower respiratory infections, measles, neonatal causes, tuberculosis, and tetanus, with smaller contributions from declines in congenital causes and some injuries. Conversely, large increases in disease burden were recorded for HIV/AIDS and malaria, with smaller increases for road injuries and a diverse range of NCDs, including ischaemic heart disease, diabetes, low back and neck pain, stroke, and depression, in addition to several types of cancer. From 2005 to 2013, total DALYs worldwide decreased from 2.51 billion (2.33 billion to 2.72 billion) to 2.45 billion (2.23 billion to 2.68 billion; figure 3B). Decreases were recorded for diarrhoea, malaria, HIV/AIDS, lower respiratory infections, measles, tuberculosis, and neonatal causes, and nearly all injuries. Increases were noted for a wide range of NCDs, especially low back and neck pain, ischaemic heart disease, diabetes, chronic obstructive pulmonary disease (COPD), depression, stroke, and sense organ disorders. Although they were not large contributors to the number of DALYs, notable increases were seen for dengue, food-borne trematodes, and leishmaniasis. Separate analyses of changes in age-standardised DALY rates for the period 2005–13 (data not shown) suggest that most of the increases shown in figure 3 are caused by ageing of the population and population growth.

We assessed changes in the age-standardised DALY rates of the leading GBD level 3 causes for 1990–2005 and 2005–2013 (figure 4; level 4 of the GBD cause hierarchy is reported in the appendix p 2). Between 1990 and 2005 huge reductions occurred in measles, meningitis, iron-deficiency anaemia, congenital anomalies, tuberculosis, drowning, protein-energy malnutrition, and some neonatal disorders, whereas disease burden from HIV/AIDS and malaria substantially increased (figure 4). From 2005 to 2013, age-standardised DALY rates for ischaemic heart disease, lower respiratory infections, and cerebrovascular disease have declined, although not sufficiently for these conditions to be replaced as the leading causes of disease burden worldwide. The ranks of low back and neck pain, road injuries and COPD have all increased since 2005. Age-standardised rates decreased significantly for 16 of the 25 leading causes of DALYs in 2013; for the remaining nine causes (Alzheimer’s disease, chronic kidney disease, congenital anomalies, depressive disorders, diabetes, low back and neck pain, migraine, neonatal sepsis, and skin diseases), age-standardised rates did not significantly change.
declines have occurred in DALY rates for communicable, maternal, neonatal, and nutritional disorders (52.2%, 50.1–54.4) and injuries (32.0%, 27.0–35.9). The analysis of age-standardised DALY rates, shows that, after controlling for changes in population size and composition, NCD disease burden worldwide, has continued to decline, falling by 14.5% (11.6–17.3) between 1990 and 2013 (figure 3C). During the same period, worldwide age-standardised DALY rates fell by 42.4% (40.0–45.0) for communicable, maternal, neonatal, and nutritional disorders and 30.9% (26.1–34.7) for injuries.

We decomposed the changes in the number of DALYs into trends for two periods: 1990–2005 and 2005–2013 (figure 3).¹⁰ Between 1990 and 2005, the number of global DALYs changed only slightly, from 2.54 billion (95% UI 2.40 billion to 2.70 billion) to 2.51 billion (2.33 billion to 2.72 billion). Looking at disease-level details within this relative stagnation reveals important trends for specific diseases (figure 3A); the earlier period was characterised by decreases in the number of DALYs from diarrhoea, lower respiratory infections, measles, neonatal causes, tuberculosis, and tetanus, with smaller contributions from declines in congenital causes and some injuries. Conversely, large increases in disease burden were recorded for HIV/AIDS and malaria, with smaller increases for road injuries and a diverse range of NCDs, including ischaemic heart disease, diabetes, low back and neck pain, stroke, and depression, in addition to several types of cancer. From 2005 to 2013, total DALYs worldwide decreased from 2.51 billion (2.33 billion to 2.72 billion) to 2.45 billion (2.23 billion to 2.68 billion; figure 3B). Decreases were recorded for diarrhoea, malaria, HIV/AIDS, lower respiratory infections, measles, tuberculosis, and neonatal causes, and nearly all injuries. Increases were noted for a wide range of NCDs, especially low back and neck pain, ischaemic heart disease, diabetes, chronic obstructive pulmonary disease (COPD), depression, stroke, and sense organ disorders. Although they were not large contributors to the number of DALYs, notable increases were seen for dengue, food-borne trematodes, and leishmaniasis. Separate analyses of changes in age-standardised DALY rates for the period 2005–13 (data not shown) suggest that most of the increases shown in figure 3 are caused by ageing of the population and population growth.

We assessed changes in the age-standardised DALY rates of the leading GBD level 3 causes for 1990–2005 and 2005–2013 (figure 4; level 4 of the GBD cause hierarchy is reported in the appendix p 2). Between 1990 and 2005 huge reductions occurred in measles, meningitis, iron-deficiency anaemia, congenital anomalies, tuberculosis, drowning, protein-energy malnutrition, and some neonatal disorders, whereas disease burden from HIV/AIDS and malaria substantially increased (figure 4). From 2005 to 2013, age-standardised DALY rates for ischaemic heart disease, lower respiratory infections, and cerebrovascular disease have declined, although not sufficiently for these conditions to be replaced as the leading causes of disease burden worldwide. The ranks of low back and neck pain, road injuries and COPD have all increased since 2005. Age-standardised rates decreased significantly for 16 of the 25 leading causes of DALYs in 2013; for the remaining nine causes (Alzheimer’s disease, chronic kidney disease, congenital anomalies, depressive disorders, diabetes, low back and neck pain, migraine, neonatal sepsis, and skin diseases), age-standardised rates did not significantly change.
Table 1 shows DALYs for each cause in 2005 and 2013 and changes in numbers and age-standardised rates of the DALYs (for the same information for 1990 to 2013 see appendix p 4).

Decomposition of epidemiological patterns

We decomposed the variance of DALY rates for GBD level 2 causes into contributions from sociodemographic status, year, country, and unexplained sources (residual; table 2). Sociodemographic status explained more than 50% of the variance for diarrhoea, lower respiratory infections and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable diseases; musculoskeletal disorders; and other NCDs. Furthermore, sociodemographic status explains between a fifth and a half of the variance for HIV/AIDS and tuberculosis; neurological disorders; mental and substance use disorders; transport injuries; and forces of nature, war, and legal intervention. Sociodemographic status explained little of the variance in the DALY rates for neglected tropical diseases and malaria, for which time-invariant country differences account for 84.98% of the variance. Notably, less than 10% of the variance in the burden of several level 2 causes could be related to sociodemographic status, including cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Year explained less than 7% of variance for all causes. By contrast, time invariant intercountry variation was an important component of the variance in DALY rates for all causes, ranging from a low of 11.29% for neonatal disorders to 91.23% for self-harm and interpersonal violence. Intercountry variation explains more than two-thirds of the total variance in DALY rates for HIV/AIDS and tuberculosis; neglected tropical diseases and malaria; neoplasms; cardiovascular diseases; chronic respiratory diseases; cirrhosis; digestive diseases; mental and substance use disorders; diabetes, urogenital, blood, and endocrine disorders; unintentional injuries; and self-harm and interpersonal violence. Notably, together, sociodemographic status and country account for more than 90% of the variance for 17 of 21 GBD level 2 causes; indeed, the lowest fraction of variance accounted for by these three factors is 80.2% for forces of nature, war, and legal intervention.

Figure 5 shows the predicted global composition of YLLs and YLDs for level 2 causes at different levels of sociodemographic status, controlling for year and country. YLLs from diarrhoea, lower respiratory infections, and other common infections, and neonatal disorders fall substantially as sociodemographic status increases. Other YLLs that fall noticeably with rising sociodemographic status include YLLs from maternal causes, nutritional deficiencies, other non-communicable causes (including congenital causes), and unintentional injuries. YLLs from cardiovascular diseases at first increase slightly with increasing sociodemographic status, but then decrease at the highest levels of country sociodemographic status. Some important causes of global YLLs are not strongly related to sociodemographic status because they are largely country-specific, such as neglected tropical diseases and malaria, neoplasms, and intentional injuries. By contrast, overall YLDs decline slightly at first, but then increase substantially, showing the opposite trend to YLLs. The large increases in YLDs are related to musculoskeletal disorders; mental and substance use disorders; diabetes, urogenital, blood, and endocrine diseases; and neurological
Table 1 shows DALYs for each cause in 2005 and 2013 and changes in numbers and age-standardised rates of the DALYs (for the same information for 1990 to 2013 see appendix p 4).

Decomposition of epidemiological patterns

We decomposed the variance of DALY rates for GBD level 2 causes into contributions from sociodemographic status, year, country, and unexplained sources (residual; table 2). Sociodemographic status explained more than 50% of the variance for diarrhoea, lower respiratory infections and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable diseases; musculoskeletal disorders; and other NCDs. Furthermore, sociodemographic status explains between a fifth and a half of the variance for HIV/AIDS and tuberculosis; neurological disorders; mental and substance use disorders; transport injuries; and forces of nature, war, and legal intervention. Sociodemographic status explained little of the variance in the DALY rates for neglected tropical diseases and malaria, for which time-invariant country differences account for 84.98% of the variance. Notably, less than 10% of the variance in the burden of several level 2 causes could be related to sociodemographic status, including cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Year explained less than 7% of variance for all causes. By contrast, time invariant intercountry variation was an important component of the variance in DALY rates for all causes, ranging from a low of 11.29% for neonatal disorders to 91.23% for self-harm and interpersonal violence. Intercountry variation explains more than two-thirds of the total variance in DALY rates for HIV/AIDS and tuberculosis; neglected tropical diseases and malaria; neoplasms; cardiovascular diseases; chronic respiratory diseases; cirrhosis; digestive diseases; mental and substance use disorders; diabetes, urogenital, blood, and endocrine disorders; unintentional injuries; and self-harm and interpersonal violence. Notably, together, sociodemographic status and country account for more than 90% of the variance for 17 of 21 GBD level 2 causes; indeed, the lowest fraction of variance accounted for by these three factors is 80.2% for forces of nature, war, and legal intervention.

Figure 5 shows the predicted global composition of YLLs and YLDs for level 2 causes at different levels of sociodemographic status, controlling for year and country. YLLs from diarrhoea, lower respiratory infections, and other common infections, and neonatal disorders fall substantially as sociodemographic status increases. Other YLLs that fall noticeably with rising sociodemographic status include YLLs from maternal causes, nutritional deficiencies, other non-communicable causes (including congenital causes), and unintentional injuries. YLLs from cardiovascular diseases at first increase slightly with increasing sociodemographic status, but then decrease at the highest levels of country sociodemographic status. Some important causes of global YLLs are not strongly related to sociodemographic status because they are largely country-specific, such as neglected tropical diseases and malaria, neoplasms, and intentional injuries. By contrast, overall YLDs decline slightly at first, but then increase substantially, showing the opposite trend to YLLs. The large increases in YLDs are related to musculoskeletal disorders; mental and substance use disorders; diabetes, urogenital, blood, and endocrine diseases; and neurological
disorders. As sociodemographic status rises, the steady decreases in YLLs and increases in YLDs cause the proportion of total DALYs attributable to YLDs to steadily rise from 9.9% at the lowest level of sociodemographic status to 49.1% in the highest vigintile. Above the tenth vigintile of sociodemographic status, the rise in YLDs and fall in YLLs nearly compensate for each other so that DALY rates have remained largely constant.

## Country-specific results

In 1990, life expectancy ranged from 46.9 years (95% UI 45.1–48.2) in the Central African Republic to 80.7 years (78.7–82.5) in Andorra, while HALE ranged from 40.4 years (38.2–42.5) in the Central African Republic to 70.2 years (67.7–72.5) in Japan. By 2013, life expectancy ranged from 48.3 years (46.5–50.1) in Lesotho to 83.9 years (82.3–85.5) in Andorra, and HALE ranged from 42.0 years (39.8–44.2) in Lesotho to 73.4 years (70.5–76.0) in Japan. Disaggregating by sex, in 1990, there were no countries in which men had attained a HALE of 70 years or more, and only in Japan and Andorra did women attain this. By 2013, HALE for men exceeded 70 years in only two countries (Japan and Singapore), whereas HALE for women exceeded 70 years in 40 countries (table 3). Of the 21 GBD regions, nine contained at least one country in which female HALE was at least 70 years in 2013. For most countries, changes in HALE were positive for both men and women between 1990 and 2013, and the differences were significant. However, HALE in 2013 was not significantly higher than it was in 1990 in 43 countries for men and in 32 countries for women. As life expectancy increases, the gap between life expectancy and HALE widens, increasing to more than 10 years at a life expectancy of 77 years for women and 78 years for men. The life expectancy minus HALE divided by life expectancy (the percentage of life expectancy lost because of poor health) ranged between 11.5% and 15.0%.

Figure 6 shows the ten most common causes of DALYs for each country in 2013. The leading causes of DALYs vary substantially across regions, representing both different levels of sociodemographic status and distinct regional patterns. In high-income regions, low back and neck pain, ischaemic heart disease, cerebrovascular disease, and tracheal, bronchus, and lung cancer are often among the four most common causes, although major depression, COPD, and diabetes come into the top four slots in some countries. In central and eastern Europe, cardiovascular diseases rank consistently in the most common causes of DALYs. Self-harm and depression frequently rank higher in eastern Europe than in central Europe or elsewhere. In central Asia, representative of the mixed levels of sociodemographic status present in the region, leading causes include neonatal encephalopathy and congenital causes. In central Latin America, violence, ischaemic heart disease, diabetes, low back and neck pain, and road injuries comprise the top five causes. Other examples of distinct regional patterns include the high ranking of COPD in east Asia, the dominance of malaria in west Africa, and the dominance of HIV/AIDS in eastern and southern sub-Saharan Africa. Within some regions, such as north Africa and the Middle East, the leading causes varied substantially.
disorders. As sociodemographic status rises, the steady decreases in YLLs and increases in YLDs cause the proportion of total DALYs attributable to YLDs to steadily rise from 9.9% at the lowest level of sociodemographic status to 49.1% in the highest vigintile. Above the tenth vigintile of sociodemographic status, the rise in YLDs and fall in YLLs nearly compensate for each other so that DALY rates have remained largely constant.

## Country-specific results

In 1990, life expectancy ranged from 46.9 years (95% UI 45.1–48.2) in the Central African Republic to 80.7 years (78.7–82.5) in Andorra, while HALE ranged from 40.4 years (38.2–42.5) in the Central African Republic to 70.2 years (67.7–72.5) in Japan. By 2013, life expectancy ranged from 48.3 years (46.5–50.1) in Lesotho to 83.9 years (82.3–85.5) in Andorra, and HALE ranged from 42.0 years (39.8–44.2) in Lesotho to 73.4 years (70.5–76.0) in Japan. Disaggregating by sex, in 1990, there were no countries in which men had attained a HALE of 70 years or more, and only in Japan and Andorra did women attain this. By 2013, HALE for men exceeded 70 years in only two countries (Japan and Singapore), whereas HALE for women exceeded 70 years in 40 countries (table 3). Of the 21 GBD regions, nine contained at least one country in which female HALE was at least 70 years in 2013. For most countries, changes in HALE were positive for both men and women between 1990 and 2013, and the differences were significant. However, HALE in 2013 was not significantly higher than it was in 1990 in 43 countries for men and in 32 countries for women. As life expectancy increases, the gap between life expectancy and HALE widens, increasing to more than 10 years at a life expectancy of 77 years for women and 78 years for men. The life expectancy minus HALE divided by life expectancy (the percentage of life expectancy lost because of poor health) ranged between 11.5% and 15.0%.

Figure 6 shows the ten most common causes of DALYs for each country in 2013. The leading causes of DALYs vary substantially across regions, representing both different levels of sociodemographic status and distinct regional patterns. In high-income regions, low back and neck pain, ischaemic heart disease, cerebrovascular disease, and tracheal, bronchus, and lung cancer are often among the four most common causes, although major depression, COPD, and diabetes come into the top four slots in some countries. In central and eastern Europe, cardiovascular diseases rank consistently in the most common causes of DALYs. Self-harm and depression frequently rank higher in eastern Europe than in central Europe or elsewhere. In central Asia, representative of the mixed levels of sociodemographic status present in the region, leading causes include neonatal encephalopathy and congenital causes. In central Latin America, violence, ischaemic heart disease, diabetes, low back and neck pain, and road injuries comprise the top five causes. Other examples of distinct regional patterns include the high ranking of COPD in east Asia, the dominance of malaria in west Africa, and the dominance of HIV/AIDS in eastern and southern sub-Saharan Africa. Within some regions, such as north Africa and the Middle East, the leading causes varied substantially.
Discussion

Global health is improving: life expectancy at birth rose by 6.2 years between 1990 and 2013, while HALE at birth increased by 5.4 years during the same interval; worldwide, age-standardised DALY rates fell by 27%. Global progress has accelerated since 2005 because of major reductions in HIV/AIDS and malaria, in addition to continued progress against other major communicable, maternal, neonatal, and nutritional disorders. Although the total volume of DALYs is down by only 3.6% over the 23 year period, this is largely explained by population growth and ageing driving up numbers of DALYs. Declines in age-standardised DALY rates are counterbalanced by population growth and ageing, so that, despite improvements in age-sex-specific health status, demands on health systems remain high. An example of these demands is the fact that the number of individuals in the world living in states of health characterised by a disability weight greater than 0.1 has increased by 43% from 1990 to 2013.

In 1971, Omran²⁷ outlined the concept of the epidemiological transition to describe the changing pattern of causes of death that results from sociodemographic development. The notion of the epidemiological transition has been expanded to recognise the phase in transition that leads to double burden of disease⁹,²⁸,²⁹ and the countertransitions of the HIV/AIDS epidemic and the rise of mortality in the former Soviet Union.²,¹⁰,¹¹,¹³,³⁰⁻³² Many studies have recognised regional and national variation in the epidemiological transition.⁹,¹⁴,³³⁻³⁵ Taking advantage of the database of the GBD 2013 country-level results from 1990 to 2013, we have quantified the extent to which sociodemographic status accounts for changes in epidemiological patterns, as opposed to other factors changing over time or static variation between countries. Isolation of this component of the variation of DALY rates allows examination of the shifts in disease and injury patterns that would be expected purely as a function of changing sociodemographic status. As sociodemographic status rises, YLLs from diarrhoea, lower respiratory infections, neonatal causes, maternal mortality, and other infectious causes decline substantially, while at the same time, there has been a slower rise in YLDs from musculoskeletal disorders, mental and substance use disorders, neurological disorders, and diabetes, urogenital, blood, and endocrine diseases. DALY rates for neoplasms and cardiovascular disease are minimally related to sociodemographic status; instead local factors have a profound effect. However, with rising sociodemographic status, the proportion of DALYs due to these causes increases because of decreases in other causes of YLLs. Although, DALY rates for cardiovascular disease seem not to be related to sociodemographic status, large declines have been recorded for these causes in high-income countries in age-standardised rates over the past decades. The wide variation between some high sociodemographic status countries, such as Japan and Finland, shows how other factors, such as diet, physical activity, and other risks, vary substantially within the same level of sociodemographic status and also affect cardiovascular disease outcomes. Furthermore, our analysis of the epidemiological transition is based on crude population rates, so reductions in age-specific cardiovascular rates associated with rising sociodemographic status are countered by shifts towards an older population. Our analysis of the epidemiological transition shows decreases in DALY rates for cardiovascular disease at the very highest levels of sociodemographic status. Notably, the predictable rise in YLD
Discussion

Global health is improving: life expectancy at birth rose by 6.2 years between 1990 and 2013, while HALE at birth increased by 5.4 years during the same interval; worldwide, age-standardised DALY rates fell by 27%. Global progress has accelerated since 2005 because of major reductions in HIV/AIDS and malaria, in addition to continued progress against other major communicable, maternal, neonatal, and nutritional disorders. Although the total volume of DALYs is down by only 3.6% over the 23 year period, this is largely explained by population growth and ageing driving up numbers of DALYs. Declines in age-standardised DALY rates are counterbalanced by population growth and ageing, so that, despite improvements in age-sex-specific health status, demands on health systems remain high. An example of these demands is the fact that the number of individuals in the world living in states of health characterised by a disability weight greater than 0.1 has increased by 43% from 1990 to 2013.

In 1971, Omran²⁷ outlined the concept of the epidemiological transition to describe the changing pattern of causes of death that results from sociodemographic development. The notion of the epidemiological transition has been expanded to recognise the phase in transition that leads to double burden of disease⁹,²⁸,²⁹ and the countertransitions of the HIV/AIDS epidemic and the rise of mortality in the former Soviet Union.²,¹⁰,¹¹,¹³,³⁰⁻³² Many studies have recognised regional and national variation in the epidemiological transition.⁹,¹⁴,³³⁻³⁵ Taking advantage of the database of the GBD 2013 country-level results from 1990 to 2013, we have quantified the extent to which sociodemographic status accounts for changes in epidemiological patterns, as opposed to other factors changing over time or static variation between countries. Isolation of this component of the variation of DALY rates allows examination of the shifts in disease and injury patterns that would be expected purely as a function of changing sociodemographic status. As sociodemographic status rises, YLLs from diarrhoea, lower respiratory infections, neonatal causes, maternal mortality, and other infectious causes decline substantially, while at the same time, there has been a slower rise in YLDs from musculoskeletal disorders, mental and substance use disorders, neurological disorders, and diabetes, urogenital, blood, and endocrine diseases. DALY rates for neoplasms and cardiovascular disease are minimally related to sociodemographic status; instead local factors have a profound effect. However, with rising sociodemographic status, the proportion of DALYs due to these causes increases because of decreases in other causes of YLLs. Although, DALY rates for cardiovascular disease seem not to be related to sociodemographic status, large declines have been recorded for these causes in high-income countries in age-standardised rates over the past decades. The wide variation between some high sociodemographic status countries, such as Japan and Finland, shows how other factors, such as diet, physical activity, and other risks, vary substantially within the same level of sociodemographic status and also affect cardiovascular disease outcomes. Furthermore, our analysis of the epidemiological transition is based on crude population rates, so reductions in age-specific cardiovascular rates associated with rising sociodemographic status are countered by shifts towards an older population. Our analysis of the epidemiological transition shows decreases in DALY rates for cardiovascular disease at the very highest levels of sociodemographic status. Notably, the predictable rise in YLD
rates for some causes (such as musculoskeletal disorders, diabetes mellitus, and mental and substance use disorders) driven by population ageing is not well recognised in the literature about the epidemiological transition.

Our decomposition of variance analysis shows that, for many NCDs, the main determinants of variation in DALY rates are country-specific effects, not the epidemiological transition. Global health can be understood in terms of a general theme in which change in epidemiological patterns is related to sociodemographic status, upon which country-specific patterns are overlaid. Little of the variation in DALY rates was attributable to the year, which contrasted with previous findings showing that the association between life expectancy and income and education has shifted over time.²⁴,³⁶⁻³⁸ Our analysis only covers a 23 year period, which might be too short to fully capture the effects of changing sociodemographic status. Some of the country effects, such as those noted for neglected tropical diseases and malaria, might have been related to sociodemographic status in a longer run analysis. The substantial effect of country variation on the epidemiological transition pattern reinforces the importance of estimating the burden of disease for each country individually. The GBD results can be used productively in the future to characterise the deviation of individual countries from the general epidemiological transition. Our analysis of the association between crude DALY rates and country sociodemographic status does not provide insights into within-country disease associations across individual levels of socioeconomic status. For example, findings from multiple studies have shown that individuals of lower socioeconomic status have increased rates of cardiovascular and circulatory diseases.³⁹⁻⁴⁷

HALE varies widely between countries and over time. As a single summary measure of population health, HALE is fairly simple to explain and provides an indicator that is affected by any changes in mortality rates or prevalence of disease or injury. HALE has been proposed as an indicator for the Sustainable Development Goals. As calculated through the GBD, HALE is an attractive measure that is sensitive to intervention and comparable over time and between populations. Although HALE needs input about the prevalence of multiple sequelae, the annual revisions of the GBD provide a widely available source for regular updates. By contrast, some other variants of health expectancies might be less appropriate for intertemporal or cross-country comparison. With measures that define disability according to arbitrary thresholds of disability weight, such as disability-free life expectancy (DFLE),⁴⁸ even slight changes in the disability weight threshold will profoundly affect conclusions about levels and changes in healthy life expectancy, as can be seen in figure 1. Moreover, these measures are non-standardised and hence not comparable: in some implementations of DFLE, the choice of the severity threshold to define disability is left to individual respondents in the surveys. For example, the European Union⁴⁹ has adopted a measure of healthy life expectancy based on survey responses to a single item on activity limitations. Such a measure is susceptible to variation in the meaning attached to categorical descriptions of limitation levels, both between individuals and over time, as seen in related survey items on health status.⁵⁰⁻⁵² An example of the sensitivity of DFLE measured in Europe is the reported decline in DFLE in Italy after 2004, which was caused by a change in question phrasing; we noted an increase in HALE for Italy in this study.⁵³ Although HALE and DFLE both use disability weights, the continuous scale of disability weights used in
rates for some causes (such as musculoskeletal disorders, diabetes mellitus, and mental and substance use disorders) driven by population ageing is not well recognised in the literature about the epidemiological transition.

Our decomposition of variance analysis shows that, for many NCDs, the main determinants of variation in DALY rates are country-specific effects, not the epidemiological transition. Global health can be understood in terms of a general theme in which change in epidemiological patterns is related to sociodemographic status, upon which country-specific patterns are overlaid. Little of the variation in DALY rates was attributable to the year, which contrasted with previous findings showing that the association between life expectancy and income and education has shifted over time.²⁴,³⁶⁻³⁸ Our analysis only covers a 23 year period, which might be too short to fully capture the effects of changing sociodemographic status. Some of the country effects, such as those noted for neglected tropical diseases and malaria, might have been related to sociodemographic status in a longer run analysis. The substantial effect of country variation on the epidemiological transition pattern reinforces the importance of estimating the burden of disease for each country individually. The GBD results can be used productively in the future to characterise the deviation of individual countries from the general epidemiological transition. Our analysis of the association between crude DALY rates and country sociodemographic status does not provide insights into within-country disease associations across individual levels of socioeconomic status. For example, findings from multiple studies have shown that individuals of lower socioeconomic status have increased rates of cardiovascular and circulatory diseases.³⁹⁻⁴⁷

HALE varies widely between countries and over time. As a single summary measure of population health, HALE is fairly simple to explain and provides an indicator that is affected by any changes in mortality rates or prevalence of disease or injury. HALE has been proposed as an indicator for the Sustainable Development Goals. As calculated through the GBD, HALE is an attractive measure that is sensitive to intervention and comparable over time and between populations. Although HALE needs input about the prevalence of multiple sequelae, the annual revisions of the GBD provide a widely available source for regular updates. By contrast, some other variants of health expectancies might be less appropriate for intertemporal or cross-country comparison. With measures that define disability according to arbitrary thresholds of disability weight, such as disability-free life expectancy (DFLE),⁴⁸ even slight changes in the disability weight threshold will profoundly affect conclusions about levels and changes in healthy life expectancy, as can be seen in figure 1. Moreover, these measures are non-standardised and hence not comparable: in some implementations of DFLE, the choice of the severity threshold to define disability is left to individual respondents in the surveys. For example, the European Union⁴⁹ has adopted a measure of healthy life expectancy based on survey responses to a single item on activity limitations. Such a measure is susceptible to variation in the meaning attached to categorical descriptions of limitation levels, both between individuals and over time, as seen in related survey items on health status.⁵⁰⁻⁵² An example of the sensitivity of DFLE measured in Europe is the reported decline in DFLE in Italy after 2004, which was caused by a change in question phrasing; we noted an increase in HALE for Italy in this study.⁵³ Although HALE and DFLE both use disability weights, the continuous scale of disability weights used in
HALE makes it less sensitive to measurement error than are the dichotomous (zero or one) weights used in DFLE.

Our findings support those of Salomon and colleagues,⁸ which showed that HALE is increasing more slowly than life expectancy: ie, as life expectancy increases, the expectation of years lived with multiple sequelae increases as well. The difference between life expectancy and HALE has increased, whereas the ratio of this difference to life expectancy has remained fairly constant. Whether or not this change should be termed an expansion of morbidity is not the issue. Rather, we saw that while health loss because of YLDs from cardiovascular and circulatory diseases and neoplasms might be decreasing, the real drivers of the difference between HALE and life expectancy are musculoskeletal disorders, mental and substance use disorders, neurological disorders, and diabetes, along with vision loss and hearing loss. Prevalence for all of these conditions is strongly age-related, and age-standardised rates for them are not declining. Even though the age of onset for mental health and substance use disorders is not strongly age-related, the prevalence of these conditions tends to rise with age. Prevalence of musculoskeletal disorders, neurological disorders, diabetes, and hearing and vision loss rise even more profoundly with age. As individuals increasingly survive to 80 years and older, the amount of time spent with a combination of these disorders increases, even though age-standardised rates have not increased over time. According to our analysis, the available therapies have not led to significant declines in age-standardised YLD rates. Very few, if any, of these disorders receive the attention they deserve in public policy discourse about health and health research priorities.

Global health progress has been driven by impressive progress in reducing age-standardised rates for a wide range of causes of death. Age-standardised YLD rates, however, are not declining. Many potential reasons exist to explain the general success for mortality and absence of success for disease prevalence. Research and development investments by funders such as the US National Institutes of Health (NIH) and the pharmaceutical industry have focused on cardiovascular diseases, neoplasms, and endocrine disorders.⁵⁴⁻⁵⁹ As we report, in the early phases of the epidemiological transition, the major driver of change in disease and injury patterns is progress in the reduction of YLLs. We believe that the historical focus of health research funding on causes of YLLs was probably appropriate. However, health progress now means that more research investment is needed for the disorders that debilitate, rather than kill. With each passing year, the shift towards YLDs as the leading causes of disease burden will be more evident. Action is needed now to develop preventive, curative, and ameliorative strategies for these conditions rather than waiting until this shift is even more obvious.

Controlling for sociodemographic status, substantial variation exists for DALY rates between countries. In our decomposition of variance, the importance of intercountry variation fluctuated by cause; for example, country level variation explains little variation for neonatal causes, but most variation for self-harm and interpersonal violence. These findings raise the question of whether the division of countries into 21 regions in GBD based on geographic contiguity and the levels and patterns of adult and child mortality rates is the best way to explain the variance in DALY rates. With country-specific results now available, more sophisticated clustering methods could be used, with various constraints, to propose a
HALE makes it less sensitive to measurement error than are the dichotomous (zero or one) weights used in DFLE.

Our findings support those of Salomon and colleagues,⁸ which showed that HALE is increasing more slowly than life expectancy: ie, as life expectancy increases, the expectation of years lived with multiple sequelae increases as well. The difference between life expectancy and HALE has increased, whereas the ratio of this difference to life expectancy has remained fairly constant. Whether or not this change should be termed an expansion of morbidity is not the issue. Rather, we saw that while health loss because of YLDs from cardiovascular and circulatory diseases and neoplasms might be decreasing, the real drivers of the difference between HALE and life expectancy are musculoskeletal disorders, mental and substance use disorders, neurological disorders, and diabetes, along with vision loss and hearing loss. Prevalence for all of these conditions is strongly age-related, and age-standardised rates for them are not declining. Even though the age of onset for mental health and substance use disorders is not strongly age-related, the prevalence of these conditions tends to rise with age. Prevalence of musculoskeletal disorders, neurological disorders, diabetes, and hearing and vision loss rise even more profoundly with age. As individuals increasingly survive to 80 years and older, the amount of time spent with a combination of these disorders increases, even though age-standardised rates have not increased over time. According to our analysis, the available therapies have not led to significant declines in age-standardised YLD rates. Very few, if any, of these disorders receive the attention they deserve in public policy discourse about health and health research priorities.

Global health progress has been driven by impressive progress in reducing age-standardised rates for a wide range of causes of death. Age-standardised YLD rates, however, are not declining. Many potential reasons exist to explain the general success for mortality and absence of success for disease prevalence. Research and development investments by funders such as the US National Institutes of Health (NIH) and the pharmaceutical industry have focused on cardiovascular diseases, neoplasms, and endocrine disorders.⁵⁴⁻⁵⁹ As we report, in the early phases of the epidemiological transition, the major driver of change in disease and injury patterns is progress in the reduction of YLLs. We believe that the historical focus of health research funding on causes of YLLs was probably appropriate. However, health progress now means that more research investment is needed for the disorders that debilitate, rather than kill. With each passing year, the shift towards YLDs as the leading causes of disease burden will be more evident. Action is needed now to develop preventive, curative, and ameliorative strategies for these conditions rather than waiting until this shift is even more obvious.

Controlling for sociodemographic status, substantial variation exists for DALY rates between countries. In our decomposition of variance, the importance of intercountry variation fluctuated by cause; for example, country level variation explains little variation for neonatal causes, but most variation for self-harm and interpersonal violence. These findings raise the question of whether the division of countries into 21 regions in GBD based on geographic contiguity and the levels and patterns of adult and child mortality rates is the best way to explain the variance in DALY rates. With country-specific results now available, more sophisticated clustering methods could be used, with various constraints, to propose a
more empirically calculated set of regions. Regions have two dimensions: analytical and presentational. The presentational dimension is easily addressed because results for any set of countries can easily be generated from the country-specific results. In fact, the GBD Compare data visualisation tool provides several alternative presentational groupings, such as WHO political regions or World Bank regions. However, regions have an analytical effect on the results if the super-region and region hierarchy have been used in the Bayesian modelling. In the GBD cause of death analysis, spatiotemporal Gaussian process regression models use the GBD hierarchy to borrow strength. In DisMod-MR 2.0, the regional hierarchy also affects estimation of the prior for each country analysis. More simply, where data are sparse or not available, the GBD regional groupings can have an important analytical effect. More research is needed on two fronts. First, to explore the extent to which alternative regional groupings would explain more of the variance in the DALY results (or any other GBD indicator). Second, whether analytical tools, such as cause of death ensemble modelling (CODEm)⁶⁰ or DisMod-MR 2.0,¹ could be modified to easily allow for different regional hierarchies for different causes.

This study has all the limitations previously reported for the GBD 2013 analysis of YLLs and YLDs.¹,² Additionally, a key limitation is the assumption that uncertainty is independent for YLLs and YLDs. In fact, for diseases modelled with DisMod-MR 2.0, we estimated a correlation between the uncertainty in condition-specific mortality and the uncertainty in prevalence. However, DisMod-MR 2.0 estimates excess mortality related to a cause, not the mortality that would be assigned to a cause according to the ICD principles of underlying cause. In future iterations of the GBD, it might be useful to attempt to use the correlation structure produced from DisMod-MR 2.0 as a proxy for the correlation between the underlying cause and prevalence. By assuming independence, we might be underestimating overall uncertainty in DALYs. However, more careful examination of the uncertainty in YLDs reveals that most uncertainty stems from uncertainty in disability weights and not from uncertainty in prevalence. We have no reason to assume that the uncertainty associated with valuations of health states in population surveys would be correlated with either disease or death outcomes. Inclusion of the smaller component of the correlation of prevalence with mortality in the estimation of DALY uncertainty would probably not substantially alter the large uncertainty already recorded for DALYs. Another key limitation, is that our assessment of the burden of disease related to sociodemographic status was affected by the choice of variables that we have included in our sociodemographic status indicator (income per person, average years of schooling after age 15 years, total fertility rate, and mean age of the population). Alternative measures of sociodemographic status could be developed that might explain more of the variance seen for some GBD level 2 causes of DALYs. However, we experimented with alternative formulations, including the addition of urbanisation and all combinations of the four variables in our index, and established that the approach we used had the most explanatory power. Other variables that would be interesting to include in a composite country-level sociodemographic status measure, such as the Gini coefficient, were not available for all countries in all years. Notably, where both measures are available, the correlation between the sociodemographic status indicator and the UN Human Development Index during the 23 year time period was 0.95.
more empirically calculated set of regions. Regions have two dimensions: analytical and presentational. The presentational dimension is easily addressed because results for any set of countries can easily be generated from the country-specific results. In fact, the GBD Compare data visualisation tool provides several alternative presentational groupings, such as WHO political regions or World Bank regions. However, regions have an analytical effect on the results if the super-region and region hierarchy have been used in the Bayesian modelling. In the GBD cause of death analysis, spatiotemporal Gaussian process regression models use the GBD hierarchy to borrow strength. In DisMod-MR 2.0, the regional hierarchy also affects estimation of the prior for each country analysis. More simply, where data are sparse or not available, the GBD regional groupings can have an important analytical effect. More research is needed on two fronts. First, to explore the extent to which alternative regional groupings would explain more of the variance in the DALY results (or any other GBD indicator). Second, whether analytical tools, such as cause of death ensemble modelling (CODEm)⁶⁰ or DisMod-MR 2.0,¹ could be modified to easily allow for different regional hierarchies for different causes.

This study has all the limitations previously reported for the GBD 2013 analysis of YLLs and YLDs.¹,² Additionally, a key limitation is the assumption that uncertainty is independent for YLLs and YLDs. In fact, for diseases modelled with DisMod-MR 2.0, we estimated a correlation between the uncertainty in condition-specific mortality and the uncertainty in prevalence. However, DisMod-MR 2.0 estimates excess mortality related to a cause, not the mortality that would be assigned to a cause according to the ICD principles of underlying cause. In future iterations of the GBD, it might be useful to attempt to use the correlation structure produced from DisMod-MR 2.0 as a proxy for the correlation between the underlying cause and prevalence. By assuming independence, we might be underestimating overall uncertainty in DALYs. However, more careful examination of the uncertainty in YLDs reveals that most uncertainty stems from uncertainty in disability weights and not from uncertainty in prevalence. We have no reason to assume that the uncertainty associated with valuations of health states in population surveys would be correlated with either disease or death outcomes. Inclusion of the smaller component of the correlation of prevalence with mortality in the estimation of DALY uncertainty would probably not substantially alter the large uncertainty already recorded for DALYs. Another key limitation, is that our assessment of the burden of disease related to sociodemographic status was affected by the choice of variables that we have included in our sociodemographic status indicator (income per person, average years of schooling after age 15 years, total fertility rate, and mean age of the population). Alternative measures of sociodemographic status could be developed that might explain more of the variance seen for some GBD level 2 causes of DALYs. However, we experimented with alternative formulations, including the addition of urbanisation and all combinations of the four variables in our index, and established that the approach we used had the most explanatory power. Other variables that would be interesting to include in a composite country-level sociodemographic status measure, such as the Gini coefficient, were not available for all countries in all years. Notably, where both measures are available, the correlation between the sociodemographic status indicator and the UN Human Development Index during the 23 year time period was 0.95.
In the post-Millennium Development Goal (MDG) era, there is much interest in identification of appropriate goals for population health and how these goals should be monitored.⁴ Increasingly, measurement frameworks to assess levels of health in populations have moved away from measures of survival to encompass more holistic measures of disability as well as mortality. Our findings suggest that this broader focus is probably going to be increasingly relevant to guide countries' public policy interventions. Large, impressive, and sustained gains are being made against the majority of leading causes of death in most countries, but as our findings show, these gains are not being accompanied by commensurate declines in age-standardised rates of disability, especially from major musculoskeletal disorders, mental and substance use disorders, neurological disorders, and diabetes. Moreover, the failure of health information systems to reliably describe trends in these disorders not only severely hampers policy responses, but contributes greatly to their further neglect and insufficient awareness of the significant part they now play in overall population health. Despite the important country variation in measures of population, now is the time for the global health community, donors and countries alike, to maximise the opportunities for health that have resulted from the data revolution, and ensure that priority is given to the development of scientifically valid, feasible, and informative data systems to measure progress in reducing disability. Improved data and monitoring can help decision makers to reduce DALYs from a wide range of causes by pursuing the most important opportunities for prevention, treatment, and rehabilitation.

## Supplementary Material

Refer to Web version on PubMed Central for supplementary material.

## Acknowledgments

On behalf of the GBD 2010 Genitourinary Diseases Expert Group, GR, NoP, and BB would like to acknowledge that their activities within the GBD 2013 have been made on the behalf of the International Society of Nephrology (ISN). ATA received institutional support and grants from the Graduate School of Medical Sciences, University Medical Center Groningen (UMCG). JM has received support from the National Health and Medical Research Council. LLY is also supported by the National Natural Sciences Foundation of China. UOM would like to acknowledge his funding by the German National Cohort Consortium. RB was provided funding support by the Brien Holden Vision Institute. INA would like to acknowledge her funding support from the National Health and Medical Research Council Public Health (Australian) Early Career Fellowship. KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. JS was supported by the National Natural Science Foundation for Young Scholars of China, (number 81200051); Research Fund for the Doctoral Program of Higher Education of China (number 20110071120060); Science Foundation for Young Scholars in Zhongshan Hospital (number 2012ZSQN04); and the Scientific Project for Fudan University (number 20520133474). RB is funded by an Australian National Health and Medical Research Council Senior Principal Research Fellow. TF is grateful to the Swiss National Science Foundation for an Early and an Advanced Postdoc Mobility fellowship (project numbers PBBSP3-146869 and P300P3-154634). SJY and IHO received funding for their work in a grant from the Korean Health Technology R&D Project (Ministry of Health & Welfare, Republic of Korea; grant number HI13C0729). ALT-L was supported by the CGIAR Research Program on Aquatic Agricultural Systems.

**Funding** Bill & Melinda Gates Foundation.

## GBD 2013 DALYs and HALE Collaborators

Christopher J L Murray, Ryan M Barber, Kyle J Foreman, Ayse Abbasoglu Ozgoren*, Foad Abd-Allah*, Semaw F Abera*, Victor Aboyans*, Jerry P Abraham*, Ibrahim Abubakar*,
In the post-Millennium Development Goal (MDG) era, there is much interest in identification of appropriate goals for population health and how these goals should be monitored.⁴ Increasingly, measurement frameworks to assess levels of health in populations have moved away from measures of survival to encompass more holistic measures of disability as well as mortality. Our findings suggest that this broader focus is probably going to be increasingly relevant to guide countries’ public policy interventions. Large, impressive, and sustained gains are being made against the majority of leading causes of death in most countries, but as our findings show, these gains are not being accompanied by commensurate declines in age-standardised rates of disability, especially from major musculoskeletal disorders, mental and substance use disorders, neurological disorders, and diabetes. Moreover, the failure of health information systems to reliably describe trends in these disorders not only severely hampers policy responses, but contributes greatly to their further neglect and insufficient awareness of the significant part they now play in overall population health. Despite the important country variation in measures of population, now is the time for the global health community, donors and countries alike, to maximise the opportunities for health that have resulted from the data revolution, and ensure that priority is given to the development of scientifically valid, feasible, and informative data systems to measure progress in reducing disability. Improved data and monitoring can help decision makers to reduce DALYs from a wide range of causes by pursuing the most important opportunities for prevention, treatment, and rehabilitation.

## Supplementary Material

Refer to Web version on PubMed Central for supplementary material.

## Acknowledgments

On behalf of the GBD 2010 Genitourinary Diseases Expert Group, GR, NoP, and BB would like to acknowledge that their activities within the GBD 2013 have been made on the behalf of the International Society of Nephrology (ISN). ATA received institutional support and grants from the Graduate School of Medical Sciences, University Medical Center Groningen (UMCG). JM has received support from the National Health and Medical Research Council. LLY is also supported by the National Natural Sciences Foundation of China. UOM would like to acknowledge his funding by the German National Cohort Consortium. RB was provided funding support by the Brien Holden Vision Institute. INA would like to acknowledge her funding support from the National Health and Medical Research Council Public Health (Australian) Early Career Fellowship. KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. JS was supported by the National Natural Science Foundation for Young Scholars of China, (number 81200051); Research Fund for the Doctoral Program of Higher Education of China (number 20110071120060); Science Foundation for Young Scholars in Zhongshan Hospital (number 2012ZSQN04); and the Scientific Project for Fudan University (number 20520133474). RB is funded by an Australian National Health and Medical Research Council Senior Principal Research Fellow. TF is grateful to the Swiss National Science Foundation for an Early and an Advanced Postdoc Mobility fellowship (project numbers PBBSP3-146869 and P300P3-154634). SJY and IHO received funding for their work in a grant from the Korean Health Technology R&D Project (Ministry of Health & Welfare, Republic of Korea; grant number HI13C0729). ALT-L was supported by the CGIAR Research Program on Aquatic Agricultural Systems.

**Funding** Bill & Melinda Gates Foundation.

## GBD 2013 DALYs and HALE Collaborators

Christopher J L Murray, Ryan M Barber, Kyle J Foreman, Ayse Abbasoglu Ozgoren*, Foad Abd-Allah*, Semaw F Abera*, Victor Aboyans*, Jerry P Abraham*, Ibrahim Abubakar*,
Laith J Abu-Raddad*, Niveen M Abu-Rmeileh*, Tom Achoki*, Ilana N Ackerman*, Zanfina Ademi*, Arsène K Adou*, José C Adsuar*, Ashkan Afshin*, Emilie E Agardh*, Sayed Saidul Alam*, Deena Alasfoor*, Mohammed I Albittar*, Miguel A Alegretti*, Zewdie A Alemu*, Rafael Alfonso-Cristancho*, Samia Alhabib*, Raghib Ali*, François Alla*, Peter Allebeck*, Mohammad A Almazroa*, Ubal Alsharif*, Elena Alvarez*, Nelson Alvis-Guzman*, Azmeraw T Amare*, Emmanuel A Ameh*, Heresh Amini*, Walid Ammar*, H Ross Anderson*, Benjamin O Anderson*, Carl Abelardo T Antonio*, Palwasha Anwari*, Johan Arnlöv*, Valentina S Arsic Arsenijevic*, Al Artaman*, Rana J Asghar*, Reza Assadi*, Lydia S Atkins*, Marco A Avila*, Baffour Awuah*, Victoria F Bachman*, Alaa Badawi*, Maria C Bahit*, Kalpana Balakrishnan*, Amitava Banerjee*, Suzanne L Barker-Collo*, Simon Barquera*, Lars Barregard*, Lope H Barrero*, Arindam Basu*, Sanjay Basu*, Mohammed O Basulaiman*, Justin Beardsley*, Neeraj Bedi*, Ettore Beghi*, Tolesa Bekele*, Michelle L Bell*, Corina Benjet*, Derrick A Bennett*, Isabela M Bensenor*, Habib Benzian*, Eduardo Bernabé*, Amelia Bertozzi-Villa*, Tariku J Beyene*, Neeraj Bhala*, Ashish Bhalla*, Zulfiqar A Bhutta*, Kelly Bienhoff*, Boris Bikbov*, Stan Biryukov*, Jed D Blore*, Christopher D Blosser*, Fiona M Blyth*, Megan A Bohensky*, Ian W Bolliger*, Berrak Bora Başara*, Natan M Bornstein*, Dipan Bose*, Soufiane Boufous*, Rupert R A Bourne*, Lindsay N Boyers*, Michael Brainin*, Carol E Brayne*, Alexandra Brazinova*, Nicholas J K Breitborde*, Hermann Brenner*, Adam D Briggs*, Peter M Brooks*, Jonathan C Brown*, Traolach S Brugha*, Rachelle Buchbinder*, Geoffrey C Buckle*, Christine M Budke*, Anne Bulchis*, Andrew G Bulloch*, Ismael R Campos-Nonato*, Hélène Carabin*, Jonathan R Carapetis*, Rosario Cárdenas*, David O Carpenter*, Valeria Caso*, Carlos A Castañeda-Orjuela*, Ruben E Castro*, Ferrán Catalá-López*, Fiorella Cavalleri*, Alanur Çavlin*, Vineet K Chadha*, Jung-Chen Chang*, Fiona J Charlson*, Honglei Chen*, Wanqing Chen*, Peggy P Chiang*, Odgerel Chimed-Ochir*, Rajiv Chowdhury*, Hanne Christensen*, Costas A Christophi*, Massimo Cirillo*, Matthew M Coates*, Luc E Coffeng*, Megan S Coggeshall*, Valentina Colistro*, Samantha M Colquhoun*, Graham S Cooke*, Cyrus Cooper*, Leslie T Cooper*, Luis M Coppola*, Monica Cortinovis*, Michael H Criqui*, John A Crump*, Lucia Cuevas-Nasu*, Hadi Danawi*, Lalit Dandona*, Rakhi Dandona*, Emily Dansereau*, Paul I Dargan*, Gail Davey*, Adrian Davis*, Dragos V Davitoiu*, Anand Dayama*, Diego De Leo*, Louisa Degenhardt*, Borja Del Pozo-Cruz*, Robert P Dellavalle*, Kebede Deribe*, Sarah Derrett*, Don C Des Jarlais*, Muluken Dessalegn*, Samath D Dharmaratne*, Mukesh K Dherani*, Cesar Diaz-Torné*, Daniel Dicker*, Eric L Ding*, Klara Dokova*, E Ray Dorsey*, Tim R Driscoll*, Leilei Duan,* Herbert C Duber*, Beth E Ebel*, Karen M Edmond*, Yousef M Elshrek*, Matthias Endres*, Sergey P Ermakov*, Holly E Erskine*, Babak Eshrati*, Alireza Esteghamati*, Kara Estep*, Emerito Jose A Faraon*, Farshad Farzadfar*, Derek F Fay*, Valery L Feigin*, David T Felson*, Seyed-Mohammad Fereshtehnejad*, Jefferson G Fernandes*, Alize J Ferrari*, Christina Fitzmaurice*, Abraham D Flaxman*, Thomas D Fleming*, Nataliya Foigt*, Mohammad H Forouzanfar*, F Gerry R Fowkes*, Urbano Fra.Paleo*, Richard C Franklin*, Thomas Fürst*, Belinda Gabbe*, Lynne Gaffikin*, Fortuné G Gankpé*, Johanna M Geleijnse*, Bradford D Gessner*, Peter Gething*, Katherine B Gibney*, Maurice Giroud*, Giorgia Giussani*, Hector Gomez Dantes*, Philimon Gona*, Diego González-Medina*, Richard A Gosselin*, Carolyn C Gotay*, Atsushi Goto*, Hebe N Gouda*, Nicholas Graetz*, Harish C Gugnani*, Rahul Gupta*, Rajeev Gupta*, Reyna A
Laith J Abu-Raddad*, Niveen M Abu-Rmeileh*, Tom Achoki*, Ilana N Ackerman*, Zanfina Ademi*, Arsène K Adou*, José C Adsuar*, Ashkan Afshin*, Emilie E Agardh*, Sayed Saidul Alam*, Deena Alasfoor*, Mohammed I Albittar*, Miguel A Alegretti*, Zewdie A Alemu*, Rafael Alfonso-Cristancho*, Samia Alhabib*, Raghib Ali*, François Alla*, Peter Allebeck*, Mohammad A Almazroa*, Ubal Alsharif*, Elena Alvarez*, Nelson Alvis-Guzman*, Azmeraw T Amare*, Emmanuel A Ameh*, Heresh Amini*, Walid Ammar*, H Ross Anderson*, Benjamin O Anderson*, Carl Abelardo T Antonio*, Palwasha Anwari*, Johan Arnlöv*, Valentina S Arsic Arsenijevic*, Al Artaman*, Rana J Asghar*, Reza Assadi*, Lydia S Atkins*, Marco A Avila*, Baffour Awuah*, Victoria F Bachman*, Alaa Badawi*, Maria C Bahit*, Kalpana Balakrishnan*, Amitava Banerjee*, Suzanne L Barker-Collo*, Simon Barquera*, Lars Barregard*, Lope H Barrero*, Arindam Basu*, Sanjay Basu*, Mohammed O Basulaiman*, Justin Beardsley*, Neeraj Bedi*, Ettore Beghi*, Tolesa Bekele*, Michelle L Bell*, Corina Benjet*, Derrick A Bennett*, Isabela M Bensenor*, Habib Benzian*, Eduardo Bernabé*, Amelia Bertozzi-Villa*, Tariku J Beyene*, Neeraj Bhala*, Ashish Bhalla*, Zulfiqar A Bhutta*, Kelly Bienhoff*, Boris Bikbov*, Stan Biryukov*, Jed D Blore*, Christopher D Blosser*, Fiona M Blyth*, Megan A Bohensky*, Ian W Bolliger*, Berrak Bora Başara*, Natan M Bornstein*, Dipan Bose*, Soufiane Boufous*, Rupert R A Bourne*, Lindsay N Boyers*, Michael Brainin*, Carol E Brayne*, Alexandra Brazinova*, Nicholas J K Breitborde*, Hermann Brenner*, Adam D Briggs*, Peter M Brooks*, Jonathan C Brown*, Traolach S Brugha*, Rachelle Buchbinder*, Geoffrey C Buckle*, Christine M Budke*, Anne Bulchis*, Andrew G Bulloch*, Ismael R Campos-Nonato*, Hélène Carabin*, Jonathan R Carapetis*, Rosario Cárdenas*, David O Carpenter*, Valeria Caso*, Carlos A Castañeda-Orjuela*, Ruben E Castro*, Ferrán Catalá-López*, Fiorella Cavalleri*, Alanur Çavlin*, Vineet K Chadha*, Jung-Chen Chang*, Fiona J Charlson*, Honglei Chen*, Wanqing Chen*, Peggy P Chiang*, Odgerel Chimed-Ochir*, Rajiv Chowdhury*, Hanne Christensen*, Costas A Christophi*, Massimo Cirillo*, Matthew M Coates*, Luc E Coffeng*, Megan S Coggeshall*, Valentina Colistro*, Samantha M Colquhoun*, Graham S Cooke*, Cyrus Cooper*, Leslie T Cooper*, Luis M Coppola*, Monica Cortinovis*, Michael H Criqui*, John A Crump*, Lucia Cuevas-Nasu*, Hadi Danawi*, Lalit Dandona*, Rakhi Dandona*, Emily Dansereau*, Paul I Dargan*, Gail Davey*, Adrian Davis*, Dragos V Davitoiu*, Anand Dayama*, Diego De Leo*, Louisa Degenhardt*, Borja Del Pozo-Cruz*, Robert P Dellavalle*, Kebede Deribe*, Sarah Derrett*, Don C Des Jarlais*, Muluken Dessalegn*, Samath D Dharmaratne*, Mukesh K Dherani*, Cesar Diaz-Torné*, Daniel Dicker*, Eric L Ding*, Klara Dokova*, E Ray Dorsey*, Tim R Driscoll*, Leilei Duan,* Herbert C Duber*, Beth E Ebel*, Karen M Edmond*, Yousef M Elshrek*, Matthias Endres*, Sergey P Ermakov*, Holly E Erskine*, Babak Eshrati*, Alireza Esteghamati*, Kara Estep*, Emerito Jose A Faraon*, Farshad Farzadfar*, Derek F Fay*, Valery L Feigin*, David T Felson*, Seyed-Mohammad Fereshtehnejad*, Jefferson G Fernandes*, Alize J Ferrari*, Christina Fitzmaurice*, Abraham D Flaxman*, Thomas D Fleming*, Nataliya Foigt*, Mohammad H Forouzanfar*, F Gerry R Fowkes*, Urbano Fra.Paleo*, Richard C Franklin*, Thomas Fürst*, Belinda Gabbe*, Lynne Gaffikin*, Fortuné G Gankpé*, Johanna M Geleijnse*, Bradford D Gessner*, Peter Gething*, Katherine B Gibney*, Maurice Giroud*, Giorgia Giussani*, Hector Gomez Dantes*, Philimon Gona*, Diego González-Medina*, Richard A Gosselin*, Carolyn C Gotay*, Atsushi Goto*, Hebe N Gouda*, Nicholas Graetz*, Harish C Gugnani*, Rahul Gupta*, Rajeev Gupta*, Reyna A
Gutiérrez*, Juanita Haagsma*, Nima Hafezi-Nejad*, Holly Hagan*, Yara A Halasa*,
Randah R Hamadeh*, Hannah Hamavid*, Mouhanad Hammami*, Jamie Hancock*, Graeme
J Hankey*, Gillian M Hansen*, Yuantao Hao*, Hilda L Harb*, Josep Maria Haro*, Rasmus
Havmoeller*, Simon I Hay*, Roderick J Hay*, Ileana B Heredia-Pi*, Kyle R Heuton*,
Pouria Heydarpour*, Hideki Higashi*, Martha Hijar*, Hans W Hoek*, Howard J Hoffman*,
H Dean Hosgood*, Mazeda Hossain*, Peter J Hotez*, Damian G Hoy*, Mohamed Hsairi*,
Guoqing Hu*, Cheng Huang*, John J Huang*, Abdullatif Husseini*, Chantal Huynh*,
Marissa L Iannarone*, Kim M Iburg*, Kaire Innos*, Manami Inoue*, Farhad Islami*,
Kathryn H Jacobsen*, Deborah L Jarvis*, Simerjot K Jassal*, Sun Ha Jee*, Panniyammakal
Jeemon*, Paul N Jensen*, Vivekanand Jha*, Guohong Jiang*, Ying Jiang*, Jost B Jonas*,
Knud Juel*, Haidong Kan*, André Karch*, Corine K Karema*, Chante Karimkhani*,
Ganesan Karthikeyan*, Nicholas J Kassebaum*, Anil Kaul*, Norito Kawakami*, Konstantin
Kazanjan*, Andrew H Kemp*, Andre P Kengne*, Andre Keren*, Yousef S Khader*, Shams
Eldin A Khalifa*, Ejaz A Khan*, Gulfaraz Khan*, Young-Ho Khang*, Christian Kieling*,
Daniel Kim*, Sungroul Kim*, Yunjin Kim*, Yohannes Kinfu*, Jonas M Kinge*, Miia
Kivipelto*, Luke D Knibbs*, Ann Kristin Knudsen*, Yoshihiro Kokubo*, Soewarta Kosen*,
Sanjay Krishnaswami*, Barthelemy Kuate Defo*, Burcu Kucuk Bicer*, Ernst J Kuipers*,
Chanda Kulkarni*, Veena S Kulkarni*, G Anil Kumar*, Hmwe H Kyu*, Taavi Lai*, Ratilal
Lalloo*, Tea Lallukka*, Hilton Lam*, Qing Lan*, Van C Lansingh*, Anders Larsson*,
Alicia E B Lawrynowicz*, Janet L Leasher*, James Leigh*, Ricky Leung*, Carly E Levitz*,
Bin Li*, Yichong Li*, Yongmei Li*, Stephen S Lim*, Maggie Lind*, Steven E Lipshultz*,
Shiwei Liu*, Yang Liu*, Belinda K Lloyd*, Katherine T Lofgren*, Giancarlo Logroscino*,
Katharine J Looker*, Joannie Lortet-Tieulent*, Paulo A Lotufo*, Rafael Lozano*, Robyn M
Lucas*, Raimundas Lunevicius*, Ronan A Lyons*, Stefan Ma*, Michael F Macintyre*,
Mark T Mackay*, Marek Majdan*, Reza Malekzadeh*, Wagner Marcenes*, David J
Margolis*, Christopher Margono*, Melvin B Marzan*, Joseph R Masci*, Mohammad T
Mashal*, Richard Matzopoulos*, Bongani M Mayosi*, Tasara T Mazorodze*, Neil W
Mcgill*, John J Mcgrath*, Martin Mckee*, Abigail Mclain*, Peter A Meaney*, Catalina
Medina*, Man Mohan Mehndiratta*, Wubegzier Mekonnen*, Yohannes A Melaku*,
Michele Meltzer*, Ziad A Memish*, George A Mensah*, Atte Meretoja*, Francis A
Mhimbira*, Renata Micha*, Ted R Miller*, Edward J Mills*, Philip B Mitchell*, Charles N
Mock*, Norlinah Mohamed Ibrahim*, Karzan A Mohammad*, Ali H Mokdad*, Glen L D
Mola*, Lorenzo Monasta*, Julio C Montañez Hernandez*, Marcella Montico*, Thomas J
Montine*, Meghan D Mooney*, Ami R Moore*, Maziar Moradi-Lakeh*, Andrew E
Moran*, Rintaro Mori*, Joanna Moschandreas*, Wilkister N Moturi*, Madeline L Moyer*,
Dariush Mozaffarian*, William T Msemburi*, Ulrich O Mueller*, Mitsuru Mukaigawara*,
Erin C Mullany*, Michele E Murdoch*, Joseph Murray*, Kinnari S Murthy*, Mohsen
Naghavi*, Aliya Naheed*, Kovin S Naidoo*, Luigi Naldi*, Devina Nand*, Vinay Nangia*,
K M Venkat Narayan*, Chakib Nejjari*, Sudan P Neupane*, Charles R Newton*, Marie
Ng*, Frida N Ngalesoni*, Grant Nguyen*, Muhammad I Nisar*, Sandra Nolte*, Ole F
Norheim*, Rosana E Norman*, Bo Norrving*, Luke Nyakarahuka*, In-Hwan Oh*,
Takayoshi Ohkubo*, Summer L Ohno*, Bolajoko O Olusanya*, John Nelson Opio*, Katrina
Ortblad*, Alberto Ortiz*, Amanda W Pain*, Jeyaraj D Pandian*, Carlo Irwin A Panelo*,
Christina Papachristou*, Eun-Kee Park*, Jae-Hyun Park*, Scott B Patten*, George C
Patton*, Vinod K Paul*, Boris I Pavlin*, Neil Pearce*, David M Pereira*, Rogelio Perez-
Gutiérrez*, Juanita Haagsma*, Nima Hafezi-Nejad*, Holly Hagan*, Yara A Halasa*,
Randah R Hamadeh*, Hannah Hamavid*, Mouhanad Hammami*, Jamie Hancock*, Graeme
J Hankey*, Gillian M Hansen*, Yuantao Hao*, Hilda L Harb*, Josep Maria Haro*, Rasmus
Havmoeller*, Simon I Hay*, Roderick J Hay*, Ileana B Heredia-Pi*, Kyle R Heuton*,
Pouria Heydarpour*, Hideki Higashi*, Martha Hijar*, Hans W Hoek*, Howard J Hoffman*,
H Dean Hosgood*, Mazeda Hossain*, Peter J Hotez*, Damian G Hoy*, Mohamed Hsairi*,
Guoqing Hu*, Cheng Huang*, John J Huang*, Abdullatif Husseini*, Chantal Huynh*,
Marissa L Iannarone*, Kim M Iburg*, Kaire Innos*, Manami Inoue*, Farhad Islami*,
Kathryn H Jacobsen*, Deborah L Jarvis*, Simerjot K Jassal*, Sun Ha Jee*, Panniyammakal
Jeemon*, Paul N Jensen*, Vivekanand Jha*, Guohong Jiang*, Ying Jiang*, Jost B Jonas*,
Knud Juel*, Haidong Kan*, André Karch*, Corine K Karema*, Chante Karimkhani*,
Ganesan Karthikeyan*, Nicholas J Kassebaum*, Anil Kaul*, Norito Kawakami*, Konstantin
Kazanjan*, Andrew H Kemp*, Andre P Kengne*, Andre Keren*, Yousef S Khader*, Shams
Eldin A Khalifa*, Ejaz A Khan*, Gulfaraz Khan*, Young-Ho Khang*, Christian Kieling*,
Daniel Kim*, Sungroul Kim*, Yunjin Kim*, Yohannes Kinfu*, Jonas M Kinge*, Miia
Kivipelto*, Luke D Knibbs*, Ann Kristin Knudsen*, Yoshihiro Kokubo*, Soewarta Kosen*,
Sanjay Krishnaswami*, Barthelemy Kuate Defo*, Burcu Kucuk Bicer*, Ernst J Kuipers*,
Chanda Kulkarni*, Veena S Kulkarni*, G Anil Kumar*, Hmwe H Kyu*, Taavi Lai*, Ratilal
Lalloo*, Tea Lallukka*, Hilton Lam*, Qing Lan*, Van C Lansingh*, Anders Larsson*,
Alicia E B Lawrynowicz*, Janet L Leasher*, James Leigh*, Ricky Leung*, Carly E Levitz*,
Bin Li*, Yichong Li*, Yongmei Li*, Stephen S Lim*, Maggie Lind*, Steven E Lipshultz*,
Shiwei Liu*, Yang Liu*, Belinda K Lloyd*, Katherine T Lofgren*, Giancarlo Logroscino*,
Katharine J Looker*, Joannie Lortet-Tieulent*, Paulo A Lotufo*, Rafael Lozano*, Robyn M
Lucas*, Raimundas Lunevicius*, Ronan A Lyons*, Stefan Ma*, Michael F Macintyre*,
Mark T Mackay*, Marek Majdan*, Reza Malekzadeh*, Wagner Marcenes*, David J
Margolis*, Christopher Margono*, Melvin B Marzan*, Joseph R Masci*, Mohammad T
Mashal*, Richard Matzopoulos*, Bongani M Mayosi*, Tasara T Mazorodze*, Neil W
Mcgill*, John J Mcgrath*, Martin Mckee*, Abigail Mclain*, Peter A Meaney*, Catalina
Medina*, Man Mohan Mehndiratta*, Wubegzier Mekonnen*, Yohannes A Melaku*,
Michele Meltzer*, Ziad A Memish*, George A Mensah*, Atte Meretoja*, Francis A
Mhimbira*, Renata Micha*, Ted R Miller*, Edward J Mills*, Philip B Mitchell*, Charles N
Mock*, Norlinah Mohamed Ibrahim*, Karzan A Mohammad*, Ali H Mokdad*, Glen L D
Mola*, Lorenzo Monasta*, Julio C Montañez Hernandez*, Marcella Montico*, Thomas J
Montine*, Meghan D Mooney*, Ami R Moore*, Maziar Moradi-Lakeh*, Andrew E
Moran*, Rintaro Mori*, Joanna Moschandreas*, Wilkister N Moturi*, Madeline L Moyer*,
Dariush Mozaffarian*, William T Msemburi*, Ulrich O Mueller*, Mitsuru Mukaigawara*,
Erin C Mullany*, Michele E Murdoch*, Joseph Murray*, Kinnari S Murthy*, Mohsen
Naghavi*, Aliya Naheed*, Kovin S Naidoo*, Luigi Naldi*, Devina Nand*, Vinay Nangia*,
K M Venkat Narayan*, Chakib Nejjari*, Sudan P Neupane*, Charles R Newton*, Marie
Ng*, Frida N Ngalesoni*, Grant Nguyen*, Muhammad I Nisar*, Sandra Nolte*, Ole F
Norheim*, Rosana E Norman*, Bo Norrving*, Luke Nyakarahuka*, In-Hwan Oh*,
Takayoshi Ohkubo*, Summer L Ohno*, Bolajoko O Olusanya*, John Nelson Opio*, Katrina
Ortblad*, Alberto Ortiz*, Amanda W Pain*, Jeyaraj D Pandian*, Carlo Irwin A Panelo*,
Christina Papachristou*, Eun-Kee Park*, Jae-Hyun Park*, Scott B Patten*, George C
Patton*, Vinod K Paul*, Boris I Pavlin*, Neil Pearce*, David M Pereira*, Rogelio Perez-
Padilla*, Fernando Perez-Ruiz*, Norberto Perico*, Aslam Pervaiz*, Konrad Pesudovs*, Carrie B Peterson*, Max Petzold*, Michael R Phillips*, Bryan K Phillips*, David E Phillips*, Frédéric B Piel*, Dietrich Plass*, Dan Poenaru*, Suzanne Polinder*, Daniel Pope*, Svetlana Popova*, Richie G Poulton*, Farshad Pourmalek*, Dorairaj Prabhakaran*, Noela M Prasad*, Rachel L Pullan*, Dima M Qato*, D Alex Quistberg*, Anwar Rafay*, Kazem Rahimi*, Sajjad U Rahman*, Murugesan Raju*, Saleem M Rana*, Homie Razavi*, K Srinath Reddy*, Amany Refaat*, Giuseppe Remuzzi*, Serge Resnikoff*, Antonio L Ribeiro*, Lee Richardson*, Jan Hendrik Richardus*, D Allen Roberts*, David Rojas-Rueda*, Luca Ronfani*, Gregory A Roth*, Dietrich Rothenbacher*, David H Rothstein*, Jane T Rowley*, Nobhojit Roy*, George M Ruhago*, Mohammad Y Saeedi*, Sukanta Saha*, Mohammad Ali Sahraian*, Uchechukwu K A Sampson*, Juan R Sanabria*, Logan Sandar*, Itamar S Santos*, Maheswar Satpathy*, Monika Sawhney*, Peter Scarborough*, Ione J Schneider*, Ben Schöttker*, Austin E Schumacher*, David C Schwebel*, James G Scott*, Soraya Seedat*, Sadaf G Sepanlou*, Peter T Serina*, Edson E Servan-Mori*, Katya A Shackelford*, Amira Shaheen*, Saeid Shahraz*, Teresa Shamah Levy*, Siyi Shangguan*, Jun She*, Sara Sheikhbahaei*, Peilin Shi*, Kenji Shibuya*, Yukito Shinohara*, Rahman Shiri*, Kawkab Shishani*, Ivy Shiue*, Mark G Shrime*, Inga D Sigfurdottir*, Donald H Silberberg*, Edgar P Simard*, Shireen Sindi*, Abhishek Singh*, Jasvinder A Singh*, Lavanya Singh*, Vegard Skirbekk*, Erica Leigh Slepak*, Karen Sliwa*, Samir Soneji*, Kjetil Søreide*, Sergey Soshnikov*, Luciano A Sposato*, Chandrashekhar T Sreeramareddy*, Jeffrey D Stanaway*, Vasiliki Stathopoulou*, Dan J Stein*, Murray B Stein*, Caitlyn Steiner*, Timothy J Steiner*, Antony Stevens*, Andrea Stewart*, Lars J Stovner*, Konstantinos Stroumpoulis*, Bruno F Sunguya*, Soumya Swaminathan*, Mamta Swaroop*, Bryan L Sykes*, Karen M Tabb*, Ken Takahashi*, Nikhil Tandon*, David Tanne*, Marcel Tanner*, Mohammad Tavakkoli*, Hugh R Taylor*, Braden J Te Ao*, Fabrizio Tediosi*, Awoke M Temesgen*, Tara Templin*, Margreet Ten Have*, Eric Y Tenkorang*, Abdullah S Terkawi*, Blake Thomson*, Andrew L Thorne-Lyman*, Amanda G Thrift*, George D Thurston*, Taavi Tillmann*, Marcello Tonelli*, Fotis Topouzis*, Hideaki Toyoshima*, Jefferson Traebert*, Bach X Tran*, Matias Trillini*, Thomas Truelsen*, Miltiadis Tsilimbaris*, Emin M Tuzcu*, Uche S Uchendu*, Kingsley N Ukwaja*, Eduardo A Undurraga*, Selen B Uzun*, Wim H Van Brakel*, Steven Van De Vijver*, Coen H van Gool*, Jim Van Os*, Tommi J Vasankari*, N Venketasubramanian*, Francesco S Violante*, Vasiliy V Vlassov*, Stein Emil Vollset*, Gregory R Wagner*, Joseph Wagner*, Stephen G Waller*, Xia Wan*, Haidong Wang*, Jianli Wang*, Linhong Wang*, Tati S Warouw*, Scott Weichenthal*, Elisabete Weiderpass*, Robert G Weintraub*, Wang Wenzhi*, Andrea Werdecker*, Ronny Westerman*, Harvey A Whiteford*, James D Wilkinson*, Thomas N Williams*, Charles D Wolfe*, Timothy M Wolock*, Anthony D Woolf*, Sarah Wulf*, Brittany Wurtz*, Gelin Xu*, Lijing L Yan*, Yuichiro Yano*, Pengpeng Ye*, Gökalp K Yentür*, Paul Yip*, Naohiro Yonemoto*, Seok-Jun Yoon*, Mustafa Z Younis*, Chuanhua Yu*, Maysaa E Zaki*, Yong Zhao*, Yingfeng Zheng*, David Zonies*, Xiaonong Zou*, Joshua A Salomon†, Alan D Lopez†, Theo Vos†. *Authors listed alphabetically. †Joint senior authors.
Padilla*, Fernando Perez-Ruiz*, Norberto Perico*, Aslam Pervaiz*, Konrad Pesudovs*, Carrie B Peterson*, Max Petzold*, Michael R Phillips*, Bryan K Phillips*, David E Phillips*, Frédéric B Piel*, Dietrich Plass*, Dan Poenaru*, Suzanne Polinder*, Daniel Pope*, Svetlana Popova*, Richie G Poulton*, Farshad Pourmalek*, Dorairaj Prabhakaran*, Noela M Prasad*, Rachel L Pullan*, Dima M Qato*, D Alex Quistberg*, Anwar Rafay*, Kazem Rahimi*, Sajjad U Rahman*, Murugesan Raju*, Saleem M Rana*, Homie Razavi*, K Srinath Reddy*, Amany Refaat*, Giuseppe Remuzzi*, Serge Resnikoff*, Antonio L Ribeiro*, Lee Richardson*, Jan Hendrik Richardus*, D Allen Roberts*, David Rojas-Rueda*, Luca Ronfani*, Gregory A Roth*, Dietrich Rothenbacher*, David H Rothstein*, Jane T Rowley*, Nobhojit Roy*, George M Ruhago*, Mohammad Y Saeedi*, Sukanta Saha*, Mohammad Ali Sahraian*, Uchechukwu K A Sampson*, Juan R Sanabria*, Logan Sandar*, Itamar S Santos*, Maheswar Satpathy*, Monika Sawhney*, Peter Scarborough*, Ione J Schneider*, Ben Schöttker*, Austin E Schumacher*, David C Schwebel*, James G Scott*, Soraya Seedat*, Sadaf G Sepanlou*, Peter T Serina*, Edson E Servan-Mori*, Katya A Shackelford*, Amira Shaheen*, Saeid Shahraz*, Teresa Shamah Levy*, Siyi Shangguan*, Jun She*, Sara Sheikhbahaei*, Peilin Shi*, Kenji Shibuya*, Yukito Shinohara*, Rahman Shiri*, Kawkab Shishani*, Ivy Shiue*, Mark G Shrime*, Inga D Sigfurdottir*, Donald H Silberberg*, Edgar P Simard*, Shireen Sindi*, Abhishek Singh*, Jasvinder A Singh*, Lavanya Singh*, Vegard Skirbekk*, Erica Leigh Slepak*, Karen Sliwa*, Samir Soneji*, Kjetil Søreide*, Sergey Soshnikov*, Luciano A Sposato*, Chandrashekhar T Sreeramareddy*, Jeffrey D Stanaway*, Vasiliki Stathopoulou*, Dan J Stein*, Murray B Stein*, Caitlyn Steiner*, Timothy J Steiner*, Antony Stevens*, Andrea Stewart*, Lars J Stovner*, Konstantinos Stroumpoulis*, Bruno F Sunguya*, Soumya Swaminathan*, Mamta Swaroop*, Bryan L Sykes*, Karen M Tabb*, Ken Takahashi*, Nikhil Tandon*, David Tanne*, Marcel Tanner*, Mohammad Tavakkoli*, Hugh R Taylor*, Braden J Te Ao*, Fabrizio Tediosi*, Awoke M Temesgen*, Tara Templin*, Margreet Ten Have*, Eric Y Tenkorang*, Abdullah S Terkawi*, Blake Thomson*, Andrew L Thorne-Lyman*, Amanda G Thrift*, George D Thurston*, Taavi Tillmann*, Marcello Tonelli*, Fotis Topouzis*, Hideaki Toyoshima*, Jefferson Traebert*, Bach X Tran*, Matias Trillini*, Thomas Truelsen*, Miltiadis Tsilimbaris*, Emin M Tuzcu*, Uche S Uchendu*, Kingsley N Ukwaja*, Eduardo A Undurraga*, Selen B Uzun*, Wim H Van Brakel*, Steven Van De Vijver*, Coen H van Gool*, Jim Van Os*, Tommi J Vasankari*, N Venketasubramanian*, Francesco S Violante*, Vasiliy V Vlassov*, Stein Emil Vollset*, Gregory R Wagner*, Joseph Wagner*, Stephen G Waller*, Xia Wan*, Haidong Wang*, Jianli Wang*, Linhong Wang*, Tati S Warouw*, Scott Weichenthal*, Elisabete Weiderpass*, Robert G Weintraub*, Wang Wenzhi*, Andrea Werdecker*, Ronny Westerman*, Harvey A Whiteford*, James D Wilkinson*, Thomas N Williams*, Charles D Wolfe*, Timothy M Wolock*, Anthony D Woolf*, Sarah Wulf*, Brittany Wurtz*, Gelin Xu*, Lijing L Yan*, Yuichiro Yano*, Pengpeng Ye*, Gökalp K Yentür*, Paul Yip*, Naohiro Yonemoto*, Seok-Jun Yoon*, Mustafa Z Younis*, Chuanhua Yu*, Maysaa E Zaki*, Yong Zhao*, Yingfeng Zheng*, David Zonies*, Xiaonong Zou*, Joshua A Salomon†, Alan D Lopez†, Theo Vos†. *Authors listed alphabetically. †Joint senior authors.
Affiliations

Institute for Health Metrics and Evaluation (Prof C J L Murray D Phil, R M Barber BS, K J Foreman MPH, T Achoki MD, A Afshin MD, V F Bachman BA, A Bertozzi-Villa BA, K Bienhoff MA, S Biryukov BS, J D Blore PhD, I W Bolliger BA, J C Brown MAIS, A Bulchis MPH, M M Coates BS, L E Coffeng PhD, M S Coggeshall BA, Prof L Dandona PhD, E Dansereau BA, D Dicker BS, H C Duber MD, K Estep MPA, C Fitzmaurice MD, A D Flaxman PhD, T D Fleming BS, Prof M H Forouzanfar PhD, D González-Medina BA, N Graetz BS, J Haagsma PhD, H Hamavid BA, J Hancock MLS, G M Hansen MSW, Prof S I Hay DSc, K R Heuton BChe, H Higashi PhD, C Huynh BA, M L Iannarone MSc, N J Kassebaum MD, H H Kyu PhD, C E Levitz MPH, S S Lim PhD, M Lind BS, K T Lofgren MPH, R Lozano PhD, M F MacIntyre MEd, C Margono BS, A McLain MA, A H Mokdad PhD, M D Mooney BS, M Moradi-Lakeh PhD, M L Moyer BS, W T Msemburi MPhil, E C Mullany BA, Prof M Naghavi PhD, M Ng PhD, G Nguyen BA, S L Ohno BA, K Ortblad MPH, A W Pain MPH, B K Phillips BA, D E Phillips BS, L Richardson BS, D A Roberts BS, G A Roth MD, L Sandar BS, A E Schumacher BS, P T Serina MPH, K A Shackelford BA, L Singh BS, E Slepak MLIS, J D Stanaway PhD, C Steiner MPH, A Stevens PhD, A Stewart MPH, A M Temesgen PhD, T Templin BA, B Thomson BA, T Vos PhD, J Wagner BS, X Wan PhD, H Wang PhD, T M Wolock BA, S Wulf MPH, B Wurtz MPH), Harborview Injury Prevention and Research Center (B E Ebel MD), Seattle Children's Hospital (N J Kassebaum MD) University of Washington, Seattle, WA, USA (R Alfonso-Cristancho PhD, Prof B O Anderson MD, C D Blosser MD, P N Jensen PhD, C N Mock PhD, T J Montine PhD, D Quistberg PhD); Department of Infectious Disease Epidemiology (T Fürst PhD), Imperial College London, London, UK (G S Cooke DPhil, K J Foreman MPH, Prof D L Jarvis MD, Prof T N Williams MD); Institute of Population Studies (A Abbasoglu Ozgoren MSc, A Çavlin PhD), Institute of Public Health (B Kucuk Bicer PhD), Hacettepe University, Ankara, Turkey; Faculty of Medicine, Cairo-University, Cairo, Egypt (Prof F Abd-Allah MD); School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia (S F Abera MSc); Kilte Awlaelo-Health and Demographic Surveillance Site, Mekelle, Ethiopia (S F Abera MSc); Dupuytren University Hospital, Limoges, France (Prof V Aboyans PhD); Family Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, USA (J P Abraham MD); Institute for Global Health (J P Abraham MD), Department of Nutrition (A L Thorne-Lyman ScD), School of Public Health (J P Abraham MD, E L Ding ScD, G R Wagner MD), Harvard University, Boston, MA, USA (I R Campos-Nonato PhD, J A Salomon PhD, M G Shrime MD); Department of Epidemiology and Public Health (H Benzian PhD), University College London, London, UK (Prof I Abubakar PhD); Weill Cornell Medical College Ar-Rayyan Qatar, Doha, Qatar (L J Abu-Raddad PhD); Institute of Community and Public Health, Birzeit University, Ramallah, Palestine (N M Abu-Rmeileh PhD); General Practice and Primary Health Care Academic Centre (P P Chiang PhD), Departments of Medicine and the Florey (A Meretoja PhD), University of Melbourne, Melbourne, VIC, Australia (I N Ackerman PhD, Z Ademi PhD, J D Blore PhD, M A Bohensky PhD, Prof P M Brooks MD, S M Colquhoun PhD, Prof A D Lopez PhD, Prof G C Patton MD, Prof H R Taylor AC, R G Weintraub MBBS); University of Basel, Basel, Switzerland (Z Ademi PhD, H Amini MSPH), Swiss Tropical and Public Health Institute (Prof M Tanner PhD, F Tediosi PhD), Basel University, Basel,
Affiliations

Institute for Health Metrics and Evaluation (Prof C J L Murray D Phil, R M Barber BS, K J Foreman MPH, T Achoki MD, A Afshin MD, V F Bachman BA, A Bertozzi-Villa BA, K Bienhoff MA, S Biryukov BS, J D Blore PhD, I W Bolliger BA, J C Brown MAIS, A Bulchis MPH, M M Coates BS, L E Coffeng PhD, M S Coggeshall BA, Prof L Dandona PhD, E Dansereau BA, D Dicker BS, H C Duber MD, K Estep MPA, C Fitzmaurice MD, A D Flaxman PhD, T D Fleming BS, Prof M H Forouzanfar PhD, D González-Medina BA, N Graetz BS, J Haagsma PhD, H Hamavid BA, J Hancock MLS, G M Hansen MSW, Prof S I Hay DSc, K R Heuton BChe, H Higashi PhD, C Huynh BA, M L Iannarone MSc, N J Kassebaum MD, H H Kyu PhD, C E Levitz MPH, S S Lim PhD, M Lind BS, K T Lofgren MPH, R Lozano PhD, M F MacIntyre MEd, C Margono BS, A McLain MA, A H Mokdad PhD, M D Mooney BS, M Moradi-Lakeh PhD, M L Moyer BS, W T Msemburi MPhil, E C Mullany BA, Prof M Naghavi PhD, M Ng PhD, G Nguyen BA, S L Ohno BA, K Ortblad MPH, A W Pain MPH, B K Phillips BA, D E Phillips BS, L Richardson BS, D A Roberts BS, G A Roth MD, L Sandar BS, A E Schumacher BS, P T Serina MPH, K A Shackelford BA, L Singh BS, E Slepak MLIS, J D Stanaway PhD, C Steiner MPH, A Stevens PhD, A Stewart MPH, A M Temesgen PhD, T Templin BA, B Thomson BA, T Vos PhD, J Wagner BS, X Wan PhD, H Wang PhD, T M Wolock BA, S Wulf MPH, B Wurtz MPH), Harborview Injury Prevention and Research Center (B E Ebel MD), Seattle Children's Hospital (N J Kassebaum MD) University of Washington, Seattle, WA, USA (R Alfonso-Cristancho PhD, Prof B O Anderson MD, C D Blosser MD, P N Jensen PhD, C N Mock PhD, T J Montine PhD, D Quistberg PhD); Department of Infectious Disease Epidemiology (T Fürst PhD), Imperial College London, London, UK (G S Cooke DPhil, K J Foreman MPH, Prof D L Jarvis MD, Prof T N Williams MD); Institute of Population Studies (A Abbasoglu Ozgoren MSc, A Çavlin PhD), Institute of Public Health (B Kucuk Bicer PhD), Hacettepe University, Ankara, Turkey; Faculty of Medicine, Cairo-University, Cairo, Egypt (Prof F Abd-Allah MD); School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia (S F Abera MSc); Kilte Awlaelo-Health and Demographic Surveillance Site, Mekelle, Ethiopia (S F Abera MSc); Dupuytren University Hospital, Limoges, France (Prof V Aboyans PhD); Family Medicine Residency Program at California Hospital, University of Southern California, Los Angeles, CA, USA (J P Abraham MD); Institute for Global Health (J P Abraham MD), Department of Nutrition (A L Thorne-Lyman ScD), School of Public Health (J P Abraham MD, E L Ding ScD, G R Wagner MD), Harvard University, Boston, MA, USA (I R Campos-Nonato PhD, J A Salomon PhD, M G Shrime MD); Department of Epidemiology and Public Health (H Benzian PhD), University College London, London, UK (Prof I Abubakar PhD); Weill Cornell Medical College Ar-Rayyan Qatar, Doha, Qatar (L J Abu-Raddad PhD); Institute of Community and Public Health, Birzeit University, Ramallah, Palestine (N M Abu-Rmeileh PhD); General Practice and Primary Health Care Academic Centre (P P Chiang PhD), Departments of Medicine and the Florey (A Meretoja PhD), University of Melbourne, Melbourne, VIC, Australia (I N Ackerman PhD, Z Ademi PhD, J D Blore PhD, M A Bohensky PhD, Prof P M Brooks MD, S M Colquhoun PhD, Prof A D Lopez PhD, Prof G C Patton MD, Prof H R Taylor AC, R G Weintraub MBBS); University of Basel, Basel, Switzerland (Z Ademi PhD, H Amini MSPH), Swiss Tropical and Public Health Institute (Prof M Tanner PhD, F Tediosi PhD), Basel University, Basel,
Switzerland (Z Ademi PhD); Association Ivoirienne pour le Bien-Être Familial, Abidjan, Côte d'Ivoire (A K Adou MD); University of Extremadura, Cáceres, Spain (Prof J C Adsuar PhD, U-F Paleo PhD); Friedman School of Nutrition Science and Policy (A Afshin MD, R Micha PhD, D Mozaffarian MD), Tufts University, Boston, MA, USA (S Shangguan MD, P Shi PhD); Institution of Public Health Sciences, Stockholm, Sweden (E E Agardh PhD); International Centre for Diarrhoeal Disease Research (ICDDR), Bangladesh, Dhaka, Bangladesh (S Alam MSc, A Naheed PhD); Ministry of Health, Al Khuwair, Oman (D Alasfoor MSc); Independent, Damascus, Syria (M I Albittar BS); Departamento de Medicina Preventiva y Social (M A Alegretti MD), Universidad de la República—Facultad de Medicina, Montevideo, Uruguay (F Cavalleri BS); Debre Markos University, Addis Ababa, Ethiopia (Z A Alemu MPH); King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia (S Alhabib PhD); Department of Zoology (P Gething PhD), University of Oxford, Oxford, UK (R Ali MSc, D A Bennett PhD, A D Briggs MSc, Prof S I Hay DSc, F B Piel PhD, K Rahimi DM, P Scarborough DPhil); Melbourne Health, Parkville, VIC, Australia (K B Gibney FRACP); School of Public Health, University of Lorraine, Nancy, France (Prof F Alla PhD); Department of Public Health Sciences (P Allebeck PhD, N Roy MD), Department of Neurobiology, Care Sciences and Society (NVS) (S Fereshtehnejad MD), Department of Medical Epidemiology and Biostatistics (E Weiderpass PhD), Aging Research Center (Prof M Kivipelto PhD), Karolinska Institute, Stockholm, Sweden (R Havmoeller PhD, S Sindi PhD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, M O Basulaiman PhD, M Y Saeedi PhD); Charité University Medicine Berlin, Berlin, Germany (U Alsharif MPH, Prof M Endres MD); Government, Madrid, Spain (E Alvarez PhD); Universidad de Cartagena, Cartagena de Indias, Colombia (Prof N Alvis-Guzman PhD); Department of Epidemiology (A T Amare MPH), Department of Psychiatry (Prof H W Hoek MD), University Medical Center Groningen, University of Groningen, Groningen, Netherlands; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia (A T Amare); Ahmadu Bello University, Zaria, Nigeria (Prof E A Ameh MBBS); Kurdistan Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran (H Amini MSPH); Ministry of Public Health, Beirut, Lebanon (W Ammar PhD, H L Harb MPH); St George's, University of London, London, UK (Prof H R Anderson MD); Department of Health Policy and Administration, College of Public Health (C T Antonio MD), University of the Philippines Manila, Manila, Philippines (C I A Panelo MD); Self employee, Kabul, Afghanistan (P Anwari MS); Department of Medical Sciences, Uppsala University, Uppsala, Sweden (Prof J Arnlöv PhD); Dalarna University, Falun, Sweden (Prof J Arnlöv PhD); School of Medicine, Institute of Microbiology and Immunology, University of Belgrade, Belgrade, Serbia (Prof V S Arsic Arsenijevic PhD); University Children's Hospital Belgrade, Belgrade, Serbia (Prof V S Arsic Arsenijevic PhD); Consultant, Windsor, ON, Canada (A Artaman PhD); South Asian Public Health Forum, Islamabad, Pakistan (R J Asghar MD); Mashhad University of Medical Sciences, Mashhad, Iran (R Assadi PhD); Wellness, Human Services and Gender Relations, Ministry Of Health, Castries, Saint Lucia (L S Atkins MPH); National Institute of Public Health, Cuernavaca, Mexico (M A Avila BS, S Barquera PhD, I R Campos-Nonato PhD, L Cuevas-Nasu MsC, H Gomez Dantes MC, I Heredia-Pi PhD, R Lozano PhD, C Medina MS, J C Montañez Hernandez MSc, Prof E E Servan-Mori MSc, T Shamah Levy PhD); Komfo Anokye Teaching Hospital, Kumasi, Ghana (B Awuah MD); Public Health
Switzerland (Z Ademi PhD); Association Ivoirienne pour le Bien-Être Familial, Abidjan, Côte d'Ivoire (A K Adou MD); University of Extremadura, Cáceres, Spain (Prof J C Adsuar PhD, U-F Paleo PhD); Friedman School of Nutrition Science and Policy (A Afshin MD, R Micha PhD, D Mozaffarian MD), Tufts University, Boston, MA, USA (S Shangguan MD, P Shi PhD); Institution of Public Health Sciences, Stockholm, Sweden (E E Agardh PhD); International Centre for Diarrhoeal Disease Research (ICDDR), Bangladesh, Dhaka, Bangladesh (S Alam MSc, A Naheed PhD); Ministry of Health, Al Khuwair, Oman (D Alasfoor MSc); Independent, Damascus, Syria (M I Albittar BS); Departamento de Medicina Preventiva y Social (M A Alegretti MD), Universidad de la República—Facultad de Medicina, Montevideo, Uruguay (F Cavalleri BS); Debre Markos University, Addis Ababa, Ethiopia (Z A Alemu MPH); King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia (S Alhabib PhD); Department of Zoology (P Gething PhD), University of Oxford, Oxford, UK (R Ali MSc, D A Bennett PhD, A D Briggs MSc, Prof S I Hay DSc, F B Piel PhD, K Rahimi DM, P Scarborough DPhil); Melbourne Health, Parkville, VIC, Australia (K B Gibney FRACP); School of Public Health, University of Lorraine, Nancy, France (Prof F Alla PhD); Department of Public Health Sciences (P Allebeck PhD, N Roy MD), Department of Neurobiology, Care Sciences and Society (NVS) (S Fereshtehnejad MD), Department of Medical Epidemiology and Biostatistics (E Weiderpass PhD), Aging Research Center (Prof M Kivipelto PhD), Karolinska Institute, Stockholm, Sweden (R Havmoeller PhD, S Sindi PhD); Ministry of Health, Riyadh, Saudi Arabia (M A AlMazroa MD, M O Basulaiman PhD, M Y Saeedi PhD); Charité University Medicine Berlin, Berlin, Germany (U Alsharif MPH, Prof M Endres MD); Government, Madrid, Spain (E Alvarez PhD); Universidad de Cartagena, Cartagena de Indias, Colombia (Prof N Alvis-Guzman PhD); Department of Epidemiology (A T Amare MPH), Department of Psychiatry (Prof H W Hoek MD), University Medical Center Groningen, University of Groningen, Groningen, Netherlands; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia (A T Amare); Ahmadu Bello University, Zaria, Nigeria (Prof E A Ameh MBBS); Kurdistan Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran (H Amini MSPH); Ministry of Public Health, Beirut, Lebanon (W Ammar PhD, H L Harb MPH); St George's, University of London, London, UK (Prof H R Anderson MD); Department of Health Policy and Administration, College of Public Health (C T Antonio MD), University of the Philippines Manila, Manila, Philippines (C I A Panelo MD); Self employee, Kabul, Afghanistan (P Anwari MS); Department of Medical Sciences, Uppsala University, Uppsala, Sweden (Prof J Arnlöv PhD); Dalarna University, Falun, Sweden (Prof J Arnlöv PhD); School of Medicine, Institute of Microbiology and Immunology, University of Belgrade, Belgrade, Serbia (Prof V S Arsic Arsenijevic PhD); University Children's Hospital Belgrade, Belgrade, Serbia (Prof V S Arsic Arsenijevic PhD); Consultant, Windsor, ON, Canada (A Artaman PhD); South Asian Public Health Forum, Islamabad, Pakistan (R J Asghar MD); Mashhad University of Medical Sciences, Mashhad, Iran (R Assadi PhD); Wellness, Human Services and Gender Relations, Ministry Of Health, Castries, Saint Lucia (L S Atkins MPH); National Institute of Public Health, Cuernavaca, Mexico (M A Avila BS, S Barquera PhD, I R Campos-Nonato PhD, L Cuevas-Nasu MsC, H Gomez Dantes MC, I Heredia-Pi PhD, R Lozano PhD, C Medina MS, J C Montañez Hernandez MSc, Prof E E Servan-Mori MSc, T Shamah Levy PhD); Komfo Anokye Teaching Hospital, Kumasi, Ghana (B Awuah MD); Public Health
Agency of Canada, Toronto, ON, Canada (A Badawi PhD); INECO Neurociencias, Rosario, Argentina (M C Bahit MD); Sri Ramachandra University, Chennai, India (K Balakrishnan PhD); University of Birmingham, Birmingham, UK (A Banerjee DPhil); School of Psychology (S L Barker-Collo PhD), University of Auckland, Auckland, New Zealand (B del Pozo-Cruz PhD); Department of Occupational and Environmental Health, University of Gothenburg, Gothenburg, Sweden (Prof L Barregard MD); Department of Industrial Engineering, Pontificia Universidad Javeriana, Bogota, Colombia (L H Barrero ScD); School of Health Sciences, University of Canterbury, Christchurch, New Zealand (A Basu PhD); School of Medicine (L Gaffikin DrPH), Stanford University, Stanford, CA, USA (S Basu PhD); Oxford University, Ho Chi Minh City, Vietnam (J Beardsley MBChB); College of Public Health and Tropical Medicine, Jazan, Saudi Arabia (N Bedi MD); IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy (E Beghi MD, M Cortinovis Biotech D, G Giussani Biol D); Madawalabu University, Bale Goba, Ethiopia (T Bekele MPH); Yale University, New Haven, CT, USA (Prof M L Bell PhD, J J Huang MD); National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico (C Benjet PhD, R A Gutiérrez PhD); University of Sao Paulo, Sao Paulo, Brazil (I M Bensenor PhD, Prof P A Lotufo DrPH, Prof I S Santos PhD, Prof A H Kemp PhD); Department of Epidemiology and Health Promotion, College of Dentistry (H Benzian PhD), Nelson Institute of Environmental Medicine, School of Medicine (Prof G D Thurston ScD), New York University, New York, NY, USA (Prof H Hagan PhD); King's College London, London, UK (E Bernabé PhD, Prof R J Hay MD, Prof C D Wolfe MD); School of Public Health (K Deribe MPH), Addis Ababa University, Addis Ababa, Ethiopia (T J Beyene DVM, W Mekonnen PhD); Queen Elizabeth Hospital Birmingham, Birmingham, UK (N Bhala DPhil); University of Otago Medical School, New Zealand (N Bhala DPhil); Postgraduate Institute of Medical Education and Research, Chandigarh, India (A Bhalla MD, Prof V Jha DM); Medical Center (Z A Bhutta PhD), Aga Khan University, Karachi, Pakistan (M I Nisar MSc); A.I.Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia (B Bikbov MD); Sydney School of Public Health (T R Driscoll PhD), University of Sydney, Sydney, NSW, Australia (F M Blyth PhD, Prof A H Kemp PhD, J Leigh PhD); General Directorate of Health Research (B Bora Başara PhD, G K Yentür PhD), Ministry of Health, Ankara, Turkey (S B Uzun MD); Tel Aviv Saurasky Medical Center, Tel Aviv, Israel (Prof N M Bornstein MD); World Bank, Washington, DC, USA (D Bose PhD); Transport and Road Safety (TARS) Research (S Boufous PhD), BHVI (Prof S ResnikoffMD), University of New South Wales, Kensington, NSW, Australia (Prof L Degenhardt PhD, Prof P B Mitchell MD); Anglia Ruskin University, Cambridge, UK (Prof R R A Bourne FRCOphth); Georgetown University, Washington, DC, USA (L N Boyers BA); Danube-University Krems, Krems, Austria (Prof M Brainin PhD); Cambridge Institute of Public Health, Cambridge, UK (Prof C E Brayne MD); Faculty of Health Sciences and Social Work (A Brazinova PhD), Department of Public Health (M Majdan PhD), Trnava University, Trnava, Slovakia; The Ohio State University, Columbus, OH, USA (Prof N J K Breitborde PhD); University of Arizona, Tucson, AZ, USA (Prof N J K Breitborde PhD); Division of Clinical Epidemiology and Aging Research (B Schöttker MPH), German Cancer Research Center, Heidelberg, Germany (Prof H Brenner MD); University of Leicester, Leicester, UK (Prof T S Brugha MD); Monash Department of Clinical Epidemiology, Cabrini Institute,
Agency of Canada, Toronto, ON, Canada (A Badawi PhD); INECO Neurociencias, Rosario, Argentina (M C Bahit MD); Sri Ramachandra University, Chennai, India (K Balakrishnan PhD); University of Birmingham, Birmingham, UK (A Banerjee DPhil); School of Psychology (S L Barker-Collo PhD), University of Auckland, Auckland, New Zealand (B del Pozo-Cruz PhD); Department of Occupational and Environmental Health, University of Gothenburg, Gothenburg, Sweden (Prof L Barregard MD); Department of Industrial Engineering, Pontificia Universidad Javeriana, Bogota, Colombia (L H Barrero ScD); School of Health Sciences, University of Canterbury, Christchurch, New Zealand (A Basu PhD); School of Medicine (L Gaffikin DrPH), Stanford University, Stanford, CA, USA (S Basu PhD); Oxford University, Ho Chi Minh City, Vietnam (J Beardsley MBChB); College of Public Health and Tropical Medicine, Jazan, Saudi Arabia (N Bedi MD); IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy (E Beghi MD, M Cortinovis Biotech D, G Giussani Biol D); Madawalabu University, Bale Goba, Ethiopia (T Bekele MPH); Yale University, New Haven, CT, USA (Prof M L Bell PhD, J J Huang MD); National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico (C Benjet PhD, R A Gutiérrez PhD); University of Sao Paulo, Sao Paulo, Brazil (I M Bensenor PhD, Prof P A Lotufo DrPH, Prof I S Santos PhD, Prof A H Kemp PhD); Department of Epidemiology and Health Promotion, College of Dentistry (H Benzian PhD), Nelson Institute of Environmental Medicine, School of Medicine (Prof G D Thurston ScD), New York University, New York, NY, USA (Prof H Hagan PhD); King's College London, London, UK (E Bernabé PhD, Prof R J Hay MD, Prof C D Wolfe MD); School of Public Health (K Deribe MPH), Addis Ababa University, Addis Ababa, Ethiopia (T J Beyene DVM, W Mekonnen PhD); Queen Elizabeth Hospital Birmingham, Birmingham, UK (N Bhala DPhil); University of Otago Medical School, New Zealand (N Bhala DPhil); Postgraduate Institute of Medical Education and Research, Chandigarh, India (A Bhalla MD, Prof V Jha DM); Medical Center (Z A Bhutta PhD), Aga Khan University, Karachi, Pakistan (M I Nisar MSc); A.I.Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia (B Bikbov MD); Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia (B Bikbov MD); Sydney School of Public Health (T R Driscoll PhD), University of Sydney, Sydney, NSW, Australia (F M Blyth PhD, Prof A H Kemp PhD, J Leigh PhD); General Directorate of Health Research (B Bora Başara PhD, G K Yentür PhD), Ministry of Health, Ankara, Turkey (S B Uzun MD); Tel Aviv Saurasky Medical Center, Tel Aviv, Israel (Prof N M Bornstein MD); World Bank, Washington, DC, USA (D Bose PhD); Transport and Road Safety (TARS) Research (S Boufous PhD), BHVI (Prof S ResnikoffMD), University of New South Wales, Kensington, NSW, Australia (Prof L Degenhardt PhD, Prof P B Mitchell MD); Anglia Ruskin University, Cambridge, UK (Prof R R A Bourne FRCOphth); Georgetown University, Washington, DC, USA (L N Boyers BA); Danube-University Krems, Krems, Austria (Prof M Brainin PhD); Cambridge Institute of Public Health, Cambridge, UK (Prof C E Brayne MD); Faculty of Health Sciences and Social Work (A Brazinova PhD), Department of Public Health (M Majdan PhD), Trnava University, Trnava, Slovakia; The Ohio State University, Columbus, OH, USA (Prof N J K Breitborde PhD); University of Arizona, Tucson, AZ, USA (Prof N J K Breitborde PhD); Division of Clinical Epidemiology and Aging Research (B Schöttker MPH), German Cancer Research Center, Heidelberg, Germany (Prof H Brenner MD); University of Leicester, Leicester, UK (Prof T S Brugha MD); Monash Department of Clinical Epidemiology, Cabrini Institute,
Melbourne, VIC, Australia (Prof R Buchbinder PhD); Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (Prof R Buchbinder PhD), Eastern Health Clinical School (B K Lloyd PhD), Monash University, Melbourne, VIC, Australia (Prof B Gabbe PhD, K B Gibney FRACP, Prof A G Thrift PhD); University of California San Francisco, San Francisco, CA, USA (G C Buckle MD, R A Gosselin MD); Texas A&M University, College Station, TX, USA (C M Budke PhD); University of Calgary, Calgary, AB, Canada (A G Bulloch PhD, Prof S B Patten PhD, Prof M Tonelli MD, J Wang PhD); University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA (H Carabin PhD); Telethon Institute for Child Health Research, Subiaco, WA, Australia (Prof J R Carapetis PhD); Universidad Autonoma Metropolitana, Mexico City, Mexico (R Cárdenas ScD); University at Albany, Rensselaer, NY, USA (Prof D O Carpenter MD); University of Perugia, Perugia, Italy (V Caso MD); Colombian National Health Observatory, Bogota, Colombia (C A Castañeda-Orjuela MS); Epidemiology and Public Health Evaluation Group, Public Health Department, Universidades Nacional de Colombia, Bogota, Colombia (C A Castañeda-Orjuela MS); Universidad Diego Portales, Santiago, Chile (R E Castro PhD); Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Ministry of Health, Madrid, Spain (F Catalá-López PhD); Department of Medicine, University of Valencia/CIBERSAM, Valencia, Spain (F Catalá-López PhD); National Tuberculosis Institute, Bengaluru, India (V K Chadha MD); College of Medicine, National Taiwan University, Taipei, Taiwan (Prof J Chang PhD); School of Population Health (D G Hoy PhD), School of Public Health (L D Knibbs PhD), Centre for Clinical Research (J G Scott PhD), University of Queensland, Brisbane, QLD, Australia (F J Charlson MIPH, H E Erskine B PsySc, A J Ferrari B PsySc, H N Gouda PhD, Prof J J McGrath MD, Prof H A Whiteford MD); Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA (H Chen PhD); Department of Health Development (Y Jiang PhD), Institute of Industrial Ecological Sciences (Y Jiang PhD, Prof K Takahashi MD), Department of Environmental Epidemiology (Y Jiang PhD, O Chimed-Ochir MPH, Prof K Takahashi MD) University of Occupational and Environmental Health, Kitakyushu, Japan; University of Cambridge, Cambridge, UK (R Chowdhury PhD, J Murray PhD); Bispebjerg University Hospital, Copenhagen, Denmark (Prof H Christensen DMSCi); Cyprus University of Technology, Limassol, Cyprus (C A Christophi PhD); University of Salerno, Baronissi, Italy (Prof M Cirillo MD); Universidad de la República, Montevideo, Uruguay (V Colistro MSc); Ministerio de Salud Pública, Montevideo, Uruguay (V Colistro); Murdoch Childrens Research Institute, Melbourne, VIC, Australia (S M Colquhoun PhD); MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK (Prof C Cooper FMedSci); University of California, San Diego, La Jolla, CA, USA (M H Criqui MD, S K Jassal MD, M B Stein MD); Mayo Clinic, Rochester, MN, USA (L T Cooper MD); Hospital Municipal Ramon Santamarina, Tandil, Argentina (L M Coppola MD); Centre for International Health, Dunedin School of Medicine (Prof J A Crump MD), Department of Preventive and Social Medicine, Dunedin School of Medicine (S Derrett PhD), University of Otago, Dunedin, New Zealand (Prof R G Poulton PhD); School of Public Health, College of Health, Massey University, Palmerston North, New Zealand (S Derrett PhD); Walden University, Minneapolis, MN, USA (H Danawi PhD); Public Health Foundation of India, New Delhi, India (Prof L Dandona PhD, R Dandona
Melbourne, VIC, Australia (Prof R Buchbinder PhD); Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (Prof R Buchbinder PhD), Eastern Health Clinical School (B K Lloyd PhD), Monash University, Melbourne, VIC, Australia (Prof B Gabbe PhD, K B Gibney FRACP, Prof A G Thrift PhD); University of California San Francisco, San Francisco, CA, USA (G C Buckle MD, R A Gosselin MD); Texas A&M University, College Station, TX, USA (C M Budke PhD); University of Calgary, Calgary, AB, Canada (A G Bulloch PhD, Prof S B Patten PhD, Prof M Tonelli MD, J Wang PhD); University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA (H Carabin PhD); Telethon Institute for Child Health Research, Subiaco, WA, Australia (Prof J R Carapetis PhD); Universidad Autonoma Metropolitana, Mexico City, Mexico (R Cárdenas ScD); University at Albany, Rensselaer, NY, USA (Prof D O Carpenter MD); University of Perugia, Perugia, Italy (V Caso MD); Colombian National Health Observatory, Bogota, Colombia (C A Castañeda-Orjuela MS); Epidemiology and Public Health Evaluation Group, Public Health Department, Universidades Nacional de Colombia, Bogota, Colombia (C A Castañeda-Orjuela MS); Universidad Diego Portales, Santiago, Chile (R E Castro PhD); Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Ministry of Health, Madrid, Spain (F Catalá-López PhD); Department of Medicine, University of Valencia/CIBERSAM, Valencia, Spain (F Catalá-López PhD); National Tuberculosis Institute, Bengaluru, India (V K Chadha MD); College of Medicine, National Taiwan University, Taipei, Taiwan (Prof J Chang PhD); School of Population Health (D G Hoy PhD), School of Public Health (L D Knibbs PhD), Centre for Clinical Research (J G Scott PhD), University of Queensland, Brisbane, QLD, Australia (F J Charlson MIPH, H E Erskine B PsySc, A J Ferrari B PsySc, H N Gouda PhD, Prof J J McGrath MD, Prof H A Whiteford MD); Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA (H Chen PhD); Department of Health Development (Y Jiang PhD), Institute of Industrial Ecological Sciences (Y Jiang PhD, Prof K Takahashi MD), Department of Environmental Epidemiology (Y Jiang PhD, O Chimed-Ochir MPH, Prof K Takahashi MD) University of Occupational and Environmental Health, Kitakyushu, Japan; University of Cambridge, Cambridge, UK (R Chowdhury PhD, J Murray PhD); Bispebjerg University Hospital, Copenhagen, Denmark (Prof H Christensen DMSCi); Cyprus University of Technology, Limassol, Cyprus (C A Christophi PhD); University of Salerno, Baronissi, Italy (Prof M Cirillo MD); Universidad de la República, Montevideo, Uruguay (V Colistro MSc); Ministerio de Salud Pública, Montevideo, Uruguay (V Colistro); Murdoch Childrens Research Institute, Melbourne, VIC, Australia (S M Colquhoun PhD); MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK (Prof C Cooper FMedSci); University of California, San Diego, La Jolla, CA, USA (M H Criqui MD, S K Jassal MD, M B Stein MD); Mayo Clinic, Rochester, MN, USA (L T Cooper MD); Hospital Municipal Ramon Santamarina, Tandil, Argentina (L M Coppola MD); Centre for International Health, Dunedin School of Medicine (Prof J A Crump MD), Department of Preventive and Social Medicine, Dunedin School of Medicine (S Derrett PhD), University of Otago, Dunedin, New Zealand (Prof R G Poulton PhD); School of Public Health, College of Health, Massey University, Palmerston North, New Zealand (S Derrett PhD); Walden University, Minneapolis, MN, USA (H Danawi PhD); Public Health Foundation of India, New Delhi, India (Prof L Dandona PhD, R Dandona
PhD, G Kumar PhD, K S Murthy MPH, K Reddy DM [Card]); Guy's and St. Thomas' NHS Foundation Trust, London, UK (P I Dargan FRCP); Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton, UK (Prof G Davey MD); Public Health England, London, UK (A Davis PhD, D F Fay MSc); University of Medicine and Pharmacy Bucharest, Bucharest, Romania (D V Davitoiu PhD); Department of Surgery, Jacobi Medical Center, Atlanta, GA, USA (A Dayama MD); School of Dentistry and Oral Health (Prof R Lalloo PhD), Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); US Department of Veterans Affairs, Eastern Colorado Healthcare System, Denver, CO, USA (R P Dellavalle MD); Brighton and Sussex Medical School, Brighton, UK (K Deribe MPH); Mount Sinai Beth Israel, New York, NY, USA (Prof D C Des Jarlais PhD); Icahn School of Medicine at Mount Sinai New York City, NY, USA (Prof D C Des Jarlais PhD); Africa Medical and Research Foundation in Ethiopia, Addis Ababa, Ethiopia (M Dessalegn MPH); University of Peradeniya, Peradeniya, Sri Lanka (S D Dharmaratne MD); School of Medicine (Prof R Lunevicius PhD), The University of Liverpool, Liverpool, UK (M K Dherani PhD, D Pope PhD); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (C Diaz-Torné MD); Department of Social Medicine, Faculty of Public Health, Medical University—Varna, Varna, Bulgaria (K Dokova PhD); University of Rochester Medical Center, Rochester, NY, USA (Prof E R Dorsey MD); University of Western Australia, Perth, WA, Australia (Prof K M Edmond PHD, Prof G J Hankey MD); Food Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, Libya (Prof Y M Elshrek PhD); The Institute of Social and Economic Studies of Population, Russian Academy of Sciences, Moscow, Russia (Prof S P Ermakov DSc); Federal Research Institute for Health Organization and Informatics, Ministry of Health of Russian Federation, Moscow, Russia (Prof S P Ermakov DSc); Arak University of Medical Sciences and Health Affairs, Arak, Iran (B Eshrati PhD); Non-Communicable Diseases Research Center, Endocrinology and Metabolic Research Institute (Prof A Esteghamati MD, F Farzadfar MD, N Hafezi-Nejad MD, S Sheikhbahaei MD), Multiple Sclerosis Research Center, Neuroscience Institute (P Heydarpour MD, M Sahraian MD), Digestive Diseases Research Institute (S G Sepanlou MD), Tehran University of Medical Sciences, Tehran, Iran; DHPA, UP College of Public Health, Manila, Philippines (E A Faraon MD); National Institute for Stroke and Applied Neurosciences (V L Feigin PhD), Auckland University of Technology, Auckland, New Zealand (B J Te Ao MPH); Boston University, Boston, MA, USA (Prof D T Felson MD); Institute of Education and Sciences, German Hospital Oswaldo Cruz, São Paulo, Brazil (Prof J G Fernandes PhD); Institute of Gerontology, Academy of Medical Science, Kiev, Ukraine (N Foigt PhD); University of Edinburgh, Edinburgh, UK (Prof F R Fowkes PhD); James Cook University, Townsville, QLD, Australia (R C Franklin PhD); Leras Afrique, Cotonou, Benin (F G Gankpé MD); CHU Hassan II, Fez, Morocco (F G Gankpé MD); Division of Human Nutrition, Wageningen University, Wageningen, Netherlands (J M Geleijnse PhD); Agence de Medecine Preventive, Paris, France (B D Gessner MD); University Hospital of Dijon, Dijon, France (Prof M Giroud MD); University of Massachusetts Boston, Boston, MA, USA (Prof P Gona PhD); School of Population and Public Health (F Pourmalek PhD), University of British Columbia, Vancouver, BC, Canada (C C Gotay PhD); Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan (A Goto MD); Saint James School of Medicine, Kralendijk, Netherlands Antilles (Prof H C Gugnani PhD); West Virginia Bureau for Public Health, Charleston, WV,
PhD, G Kumar PhD, K S Murthy MPH, K Reddy DM [Card]); Guy's and St. Thomas' NHS Foundation Trust, London, UK (P I Dargan FRCP); Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton, UK (Prof G Davey MD); Public Health England, London, UK (A Davis PhD, D F Fay MSc); University of Medicine and Pharmacy Bucharest, Bucharest, Romania (D V Davitoiu PhD); Department of Surgery, Jacobi Medical Center, Atlanta, GA, USA (A Dayama MD); School of Dentistry and Oral Health (Prof R Lalloo PhD), Griffith University, Brisbane, QLD, Australia (Prof D De Leo DSc); US Department of Veterans Affairs, Eastern Colorado Healthcare System, Denver, CO, USA (R P Dellavalle MD); Brighton and Sussex Medical School, Brighton, UK (K Deribe MPH); Mount Sinai Beth Israel, New York, NY, USA (Prof D C Des Jarlais PhD); Icahn School of Medicine at Mount Sinai New York City, NY, USA (Prof D C Des Jarlais PhD); Africa Medical and Research Foundation in Ethiopia, Addis Ababa, Ethiopia (M Dessalegn MPH); University of Peradeniya, Peradeniya, Sri Lanka (S D Dharmaratne MD); School of Medicine (Prof R Lunevicius PhD), The University of Liverpool, Liverpool, UK (M K Dherani PhD, D Pope PhD); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (C Diaz-Torné MD); Department of Social Medicine, Faculty of Public Health, Medical University—Varna, Varna, Bulgaria (K Dokova PhD); University of Rochester Medical Center, Rochester, NY, USA (Prof E R Dorsey MD); University of Western Australia, Perth, WA, Australia (Prof K M Edmond PHD, Prof G J Hankey MD); Food Science Department, Faculty of Agriculture, University of Tripoli, Tripoli, Libya (Prof Y M Elshrek PhD); The Institute of Social and Economic Studies of Population, Russian Academy of Sciences, Moscow, Russia (Prof S P Ermakov DSc); Federal Research Institute for Health Organization and Informatics, Ministry of Health of Russian Federation, Moscow, Russia (Prof S P Ermakov DSc); Arak University of Medical Sciences and Health Affairs, Arak, Iran (B Eshrati PhD); Non-Communicable Diseases Research Center, Endocrinology and Metabolic Research Institute (Prof A Esteghamati MD, F Farzadfar MD, N Hafezi-Nejad MD, S Sheikhbahaei MD), Multiple Sclerosis Research Center, Neuroscience Institute (P Heydarpour MD, M Sahraian MD), Digestive Diseases Research Institute (S G Sepanlou MD), Tehran University of Medical Sciences, Tehran, Iran; DHPA, UP College of Public Health, Manila, Philippines (E A Faraon MD); National Institute for Stroke and Applied Neurosciences (V L Feigin PhD), Auckland University of Technology, Auckland, New Zealand (B J Te Ao MPH); Boston University, Boston, MA, USA (Prof D T Felson MD); Institute of Education and Sciences, German Hospital Oswaldo Cruz, São Paulo, Brazil (Prof J G Fernandes PhD); Institute of Gerontology, Academy of Medical Science, Kiev, Ukraine (N Foigt PhD); University of Edinburgh, Edinburgh, UK (Prof F R Fowkes PhD); James Cook University, Townsville, QLD, Australia (R C Franklin PhD); Leras Afrique, Cotonou, Benin (F G Gankpé MD); CHU Hassan II, Fez, Morocco (F G Gankpé MD); Division of Human Nutrition, Wageningen University, Wageningen, Netherlands (J M Geleijnse PhD); Agence de Medecine Preventive, Paris, France (B D Gessner MD); University Hospital of Dijon, Dijon, France (Prof M Giroud MD); University of Massachusetts Boston, Boston, MA, USA (Prof P Gona PhD); School of Population and Public Health (F Pourmalek PhD), University of British Columbia, Vancouver, BC, Canada (C C Gotay PhD); Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan (A Goto MD); Saint James School of Medicine, Kralendijk, Netherlands Antilles (Prof H C Gugnani PhD); West Virginia Bureau for Public Health, Charleston, WV,
USA (R Gupta MD); Fortis Escorts Hospital, Jaipur, India (R Gupta PhD); Brandeis University, Waltham, MA, USA (Y A Halasa MS MA, E A Undurraga PhD); Arabian Gulf University, Manama, Bahrain (Prof R R Hamadeh DPhil); Wayne County Department of Health and Human Services, Detroit, MI, USA (M Hammami MD); School of Public Health (Prof Y Hao PhD), Zhongshan Ophthalmic Center (Y Zheng MD), Sun Yae-Sen University, Guangzhou, China; Parc Sanitari Sant Joan de Déu—CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain (J Haro MD); Universitat de Barcelona, Barcelona, Spain (J Haro MD); International Foundation for Dermatology, London, UK (Prof R J Hay MD); Fundacion Entornos AC, Cuernavaca, Mexico (M Hijar PhD); Department of Epidemiology (Prof H W Hoek MD), Columbia University, New York, NY, USA (A E Moran MD); Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (H J Hoffman MA), Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (G A Mensah MD), National Heart Lung and Blood Institute (U K A Sampson MD), National Institutes of Health, Bethesda, MD, USA; Albert Einstein College of Medicine, Bronx, NY, USA (Prof H Hosgood PhD); London School of Hygiene & Tropical Medicine, London, UK (M Hossain MSc, Prof M McKee DSc, Prof N Pearce PhD, R L Pullan PhD, T Tillmann MBChB); Baylor College of Medicine, Houston, TX, USA (P J Hotez PhD); Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia (D G Hoy PhD); National Institute of Public Health, Tunis, Tunisia (Prof M Hsairi MD); School of Public Health, Central South University, Changsha, China (G Hu PhD); George Washington University, Washington, DC, USA (Prof C Huang PhD); Qatar University, Doha, Qatar (A Husseini PhD); Aarhus University, Aarhus, Denmark (K M Iburg PhD); National Institute for Health Development, Tallinn, Estonia (K Innos PhD); Graduate School of Medicine (M Inoue PhD), School of Public Health (Prof N Kawakami MD), The University of Tokyo, Tokyo, Japan (K Shibuya MD); American Cancer Society, New York, NY, USA (F Islami PhD); George Mason University, Fairfax, VA, USA (K H Jacobsen PhD); Graduate School of Public Health, Yonsei University, Seoul, South Korea (Prof S Jee PhD); Centre for Chronic Disease Control, New Delhi, India (P Jeemon PhD, D Prabhakaran DM); Tianjin Centers for Disease Control and Prevention, Tianjin, China (G Jiang MD); Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Indonesia (Prof J B Jonas MD); The National Institute of Public Health, Copenhagen, Denmark (Prof K Juel PhD); Zhongshan Hospital (J She MD), Fudan University, Shanghai, China (H Kan MD); Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany (A Karch MD); Hannover-Braunschweig Site, German Center for Infection Research (DZIF), Braunschweig, Germany (A Karch MD); Malaria and Other Parasitic Diseases Division, Ministry of Health, Kigali City, Rwanda (C K Karema MSc); Case Western University Hospitals, Cleveland, OH, USA (C Karimkhani MD); All India Institute of Medical Sciences, New Delhi, India (Prof G Karthikeyan DM, V K Paul MD, Prof N Tandon PhD, M Satpathy PhD); Oklahoma State University, Tulsa, OK, USA (A Kaul MD); National Center for Disease Control and Public Health, Tbilisi, Georgia (K Kazanjan MS); South African Medical Research Council, Cape Town, South Africa (A P Kengne PhD, R Matzopoulos PhD, W T Msemburi MPhil, Prof D J Stein MD); Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa (Prof K Sliwa PhD), School of Public Health and Family Medicine (R Matzopoulos PhD), University of Cape Town, Cape Town, South Africa (A P Kengne PhD, Prof B M
USA (R Gupta MD); Fortis Escorts Hospital, Jaipur, India (R Gupta PhD); Brandeis
University, Waltham, MA, USA (Y A Halasa MS MA, E A Undurraga PhD); Arabian Gulf
University, Manama, Bahrain (Prof R R Hamadeh DPhil); Wayne County Department of
Health and Human Services, Detroit, MI, USA (M Hammami MD); School of Public Health
(Prof Y Hao PhD), Zhongshan Ophthalmic Center (Y Zheng MD), Sun Yae-Sen University,
Guangzhou, China; Parc Sanitari Sant Joan de Déu—CIBERSAM, Sant Boi de Llobregat,
Barcelona, Spain (J Haro MD); Universitat de Barcelona, Barcelona, Spain (J Haro MD);
International Foundation for Dermatology, London, UK (Prof R J Hay MD); Fundacion
Entornos AC, Cuernavaca, Mexico (M Hijar PhD); Department of Epidemiology (Prof H W
Hoek MD), Columbia University, New York, NY, USA (A E Moran MD); Epidemiology
and Statistics Program, National Institute on Deafness and Other Communication Disorders
(H J Hoffman MA), Center for Translation Research and Implementation Science, National
Heart, Lung, and Blood Institute (G A Mensah MD), National Heart Lung and Blood
Institute (U K A Sampson MD), National Institutes of Health, Bethesda, MD, USA; Albert
Einstein College of Medicine, Bronx, NY, USA (Prof H Hosgood PhD); London School of
Hygiene & Tropical Medicine, London, UK (M Hossain MSc, Prof M McKee DSc, Prof N
Pearce PhD, R L Pullan PhD, T Tillmann MBChB); Baylor College of Medicine, Houston,
TX, USA (P J Hotez PhD); Public Health Division, Secretariat of the Pacific Community,
Noumea, New Caledonia (D G Hoy PhD); National Institute of Public Health, Tunis, Tunisia
(Prof M Hsairi MD); School of Public Health, Central South University, Changsha, China
(G Hu PhD); George Washington University, Washington, DC, USA (Prof C Huang PhD);
Qatar University, Doha, Qatar (A Husseini PhD); Aarhus University, Aarhus, Denmark (K
M Iburg PhD); National Institute for Health Development, Tallinn, Estonia (K Innos PhD);
Graduate School of Medicine (M Inoue PhD), School of Public Health (Prof N Kawakami
MD), The University of Tokyo, Tokyo, Japan (K Shibuya MD); American Cancer Society,
New York, NY, USA (F Islami PhD); George Mason University, Fairfax, VA, USA (K H
Jacobsen PhD); Graduate School of Public Health, Yonsei University, Seoul, South Korea
(Prof S Jee PhD); Centre for Chronic Disease Control, New Delhi, India (P Jeemon PhD, D
Prabhakaran DM); Tianjin Centers for Disease Control and Prevention, Tianjin, China (G
Jiang MD); Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-
University Heidelberg, Mannheim, Indonesia (Prof J B Jonas MD); The National Institute of
Public Health, Copenhagen, Denmark (Prof K Juel PhD); Zhongshan Hospital (J She MD),
Fudan University, Shanghai, China (H Kan MD); Department of Epidemiology, Helmholtz
Centre for Infection Research, Braunschweig, Germany (A Karch MD); Hannover-
Braunschweig Site, German Center for Infection Research (DZIF), Braunschweig, Germany
(A Karch MD); Malaria and Other Parasitic Diseases Division, Ministry of Health, Kigali
City, Rwanda (C K Karema MSc); Case Western University Hospitals, Cleveland, OH, USA
(C Karimkhani MD); All India Institute of Medical Sciences, New Delhi, India (Prof G
Karthikeyan DM, V K Paul MD, Prof N Tandon PhD, M Satpathy PhD); Oklahoma State
University, Tulsa, OK, USA (A Kaul MD); National Center for Disease Control and Public
Health, Tbilisi, Georgia (K Kazanjan MS); South African Medical Research Council, Cape
Town, South Africa (A P Kengne PhD, R Matzopoulos PhD, W T Msemburi MPhil, Prof D
J Stein MD); Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in
Africa (Prof K Sliwa PhD), School of Public Health and Family Medicine (R Matzopoulos
PhD), University of Cape Town, Cape Town, South Africa (A P Kengne PhD, Prof B M
Mayosi DPhil, Prof D J Stein MD); Cardiology, Hadassah Ein Kerem University Hospital, Jerusalem, Israel (Prof A Keren MD); Jordan University of Science and Technology, Irbid, Jordan (Prof Y S Khader ScD); Supreme Council of Health, Doha, Qatar (S A Khalifa MSc); Health Services Academy, Islamabad, Pakistan (E A Khan MPH); Expanded Programme on Immunization, Islamabad, Pakistan (E A Khan MPH); UAE University, Al Ain, United Arab Emirates (G Khan PhD); Seoul National University College of Medicine, Seoul, South Korea (Prof Y Khang MD); Federal University of Rio Grande do Sul, Porto Alegre, Brazil (C Kieling PhD); Northeastern University, Boston, MA, USA (Prof D Kim DrPH); Soonchunhyang University, Seoul, South Korea (S Kim PhD); Southern University College, Johor, Malaysia (Y Kim PhD); University of Canberra, Canberra, ACT, Australia (Y Kinfu PhD); Department of Health Registries (A Knudsen PhD), Norwegian Institute of Public Health, Oslo, Norway (J M Kinge PhD, Prof V Skirbekk MD, Prof S Vollset MD); National Cerebral and Cardiovascular Center, Suita, Japan (Y Kokubo PhD); Center for Community Empowerment, Health Policy and Humanities, NIHRD, Jakarta, Indonesia (S Kosen MD); Oregon Health and Science University, Portland, OR, USA (S Krishnaswami MD, D Zonies MD); University of Montreal, Montreal, QC, Canada (Prof B Kuate Defo PhD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (Prof E J Kuipers PhD, S Polinder MS, Prof J Richardus PhD); Rajrajeswari Medical College & Hospital, Bangalore, India (Prof C Kulkarni MD); Arkansas State University, Jonesboro, AR, USA (V S Kulkarni PhD); Fourth View Consulting, Tallinn, Estonia (T Lai PhD); Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, Adelaide, SA, Australia (Prof R Lalloo PhD); Disability Prevention Research Centre (T Lallukka PhD), Finnish Institute of Occupational Health, Helsinki, Finland (R Shiri PhD); Faculty of Medicine, University of Helsinki, Helsinki, Finland (T Lallukka PhD); Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines (Prof H Lam PhD); National Cancer Institute, Rockville, MD, USA (Q Lan PhD); Help Me See, Inc, New York, NY, USA (V C Lansing PhD); Instituto Mexicano de Oftalmologia, Queretaro, Mexico (V C Lansing PhD); Uppsala University, Uppsala, Sweden (Prof A Larsson PhD); Instituto Nacional de Epidemiología "Dr. Juan H. Jara", Mar del Plata, Argentina (A E B Lawrynowicz MPH); Nova Southeastern University College of Optometry, Fort Lauderdale, FL, USA (J L Leasher OD); SUNY-Albany, Rensselaer, NY, USA (R Leung PhD); Jinan Central Hospital, Jinan, China (B Li PhD); National Center for Chronic and Noncommunible Disease Control and Prevention, China CDC, Beijing, China (Y Li MPH, S Liu PhD, L Duan MS, Prof L Wang MD, P Ye MPH); Anolinx, LLC, Salt Lake City, UT, USA (Y Li PhD); Wayne State University, Miami, FL, USA (Prof S E Lipshultz MD); Rollins School of Public Health (E P Simard PhD), Emory University, Atlanta, GA, USA (Prof Y Liu PhD, Prof K Narayan MD); Turning Point, Eastern Health, Melbourne, VIC, Australia (B K Lloyd PhD); University of Bari, Bari, Italy (Prof G Logroscino PhD); University of Bristol, Bristol, UK (K J Looker PhD); American Cancer Society, Atlanta, GA, USA (J Lortet-Tieulent MSc); The Australian National University, Canberra, ACT, Australia (Prof R M Lucas PhD); Aintree University Hospitals NHS Foundation Trust, Liverpool, UK (Prof R Lunevicius PhD); Swansea University, Swansea, UK (Prof R A Lyons MD); Ministry of Health Singapore, Singapore, Singapore (S Ma PhD); Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore (S Ma PhD); Murdoch Children's Research Institute (R G Weintraub
Mayosi DPhil, Prof D J Stein MD); Cardiology, Hadassah Ein Kerem University Hospital, Jerusalem, Israel (Prof A Keren MD); Jordan University of Science and Technology, Irbid, Jordan (Prof Y S Khader ScD); Supreme Council of Health, Doha, Qatar (S A Khalifa MSc); Health Services Academy, Islamabad, Pakistan (E A Khan MPH); Expanded Programme on Immunization, Islamabad, Pakistan (E A Khan MPH); UAE University, Al Ain, United Arab Emirates (G Khan PhD); Seoul National University College of Medicine, Seoul, South Korea (Prof Y Khang MD); Federal University of Rio Grande do Sul, Porto Alegre, Brazil (C Kieling PhD); Northeastern University, Boston, MA, USA (Prof D Kim DrPH); Soonchunhyang University, Seoul, South Korea (S Kim PhD); Southern University College, Johor, Malaysia (Y Kim PhD); University of Canberra, Canberra, ACT, Australia (Y Kinfu PhD); Department of Health Registries (A Knudsen PhD), Norwegian Institute of Public Health, Oslo, Norway (J M Kinge PhD, Prof V Skirbekk MD, Prof S Vollset MD); National Cerebral and Cardiovascular Center, Suita, Japan (Y Kokubo PhD); Center for Community Empowerment, Health Policy and Humanities, NIHRD, Jakarta, Indonesia (S Kosen MD); Oregon Health and Science University, Portland, OR, USA (S Krishnaswami MD, D Zonies MD); University of Montreal, Montreal, QC, Canada (Prof B Kuate Defo PhD); Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands (Prof E J Kuipers PhD, S Polinder MS, Prof J Richardus PhD); Rajrajeswari Medical College & Hospital, Bangalore, India (Prof C Kulkarni MD); Arkansas State University, Jonesboro, AR, USA (V S Kulkarni PhD); Fourth View Consulting, Tallinn, Estonia (T Lai PhD); Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, Adelaide, SA, Australia (Prof R Lalloo PhD); Disability Prevention Research Centre (T Lallukka PhD), Finnish Institute of Occupational Health, Helsinki, Finland (R Shiri PhD); Faculty of Medicine, University of Helsinki, Helsinki, Finland (T Lallukka PhD); Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines (Prof H Lam PhD); National Cancer Institute, Rockville, MD, USA (Q Lan PhD); Help Me See, Inc, New York, NY, USA (V C Lansing PhD); Instituto Mexicano de Oftalmologia, Queretaro, Mexico (V C Lansing PhD); Uppsala University, Uppsala, Sweden (Prof A Larsson PhD); Instituto Nacional de Epidemiología "Dr. Juan H. Jara", Mar del Plata, Argentina (A E B Lawrynowicz MPH); Nova Southeastern University College of Optometry, Fort Lauderdale, FL, USA (J L Leasher OD); SUNY-Albany, Rensselaer, NY, USA (R Leung PhD); Jinan Central Hospital, Jinan, China (B Li PhD); National Center for Chronic and Noncommunible Disease Control and Prevention, China CDC, Beijing, China (Y Li MPH, S Liu PhD, L Duan MS, Prof L Wang MD, P Ye MPH); Anolinx, LLC, Salt Lake City, UT, USA (Y Li PhD); Wayne State University, Miami, FL, USA (Prof S E Lipshultz MD); Rollins School of Public Health (E P Simard PhD), Emory University, Atlanta, GA, USA (Prof Y Liu PhD, Prof K Narayan MD); Turning Point, Eastern Health, Melbourne, VIC, Australia (B K Lloyd PhD); University of Bari, Bari, Italy (Prof G Logroscino PhD); University of Bristol, Bristol, UK (K J Looker PhD); American Cancer Society, Atlanta, GA, USA (J Lortet-Tieulent MSc); The Australian National University, Canberra, ACT, Australia (Prof R M Lucas PhD); Aintree University Hospitals NHS Foundation Trust, Liverpool, UK (Prof R Lunevicius PhD); Swansea University, Swansea, UK (Prof R A Lyons MD); Ministry of Health Singapore, Singapore, Singapore (S Ma PhD); Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore (S Ma PhD); Murdoch Children's Research Institute (R G Weintraub
MBBS), Royal Children's Hospital, Melbourne, VIC, Australia (M T Mackay MBBS); Digestive Disease Research Institute, Shariati Hospital, Tehran, Iran (Prof R Malekzadeh MD); Shiraz University of Medical Sciences, Shiraz, Iran (Prof R Malekzadeh MD); Queen Mary University of London, London, UK (Prof W Marcenes PhD); Pereleman School of Medicine (P A Meaney MD), University of Pennsylvania, Philadelphia, PA, USA (D J Margolis PhD, D H Silberberg MD); University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines (M B Marzan MSc); Elmhurst Hospital Center, Mount Sinai Services, Elmhurst, NY, USA (J R Masci MD); Ministry of Public Health, Kabul, Afghanistan (M T Mashal PhD); AIDC EC, Port Elizabeth, South Africa (T T Mazorodze MA); Royal Prince Alfred Hospital, Camperdown, NSW, Australia (N W McGill MB BS); Children's Hospital of Philadelphia, Philadelphia, PA, USA (P A Meaney MD); Janakpuri Superspecialty Hospital, New Delhi, India (Prof M Mehndiratta DM); Mekelle University, Mekelle, Ethiopia (Y A Melaku MPH); Thomas Jefferson University, Philadelphia, PA, USA (M Meltzer MD); Saudi Ministry of Health, Riyadh, Saudi Arabia (Prof Z A Memish MD); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (A Meretoja PhD); Ifakara Health Institute, Bagamoyo, Tanzania (F A Mhimbira MS); Pacific Institute for Research & Evaluation, Calverton, MD, USA (T R Miller PhD); Curtin University Centre for Population Health, Perth, WA, Australia (T R Miller PhD); University of Ottawa, Ottawa, ON, Canada (E J Mills PhD); Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Bandar Tun Razak, Malaysia (Prof N Mohamed Ibrahim MRCP); University of Salahaddin, Erbil, Iraq (K A Mohammad PhD); University of Papua New Guinea, Boroko, Papua New Guinea (Prof G L D Mola MD); Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (L Monasta DSc, L Ronfani PhD, M Montico MSc); University of North Texas, Denton, TX, USA (Prof A R Moore PhD); Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran (M Moradi-Lakeh PhD); National Center for Child Health and Development, Setagaya, Japan (R Mori PhD); Department of Medicine (Prof M Tsilimbaris PhD), University of Crete, Crete, Greece (J Moschandreas PhD); Egerton University, Egerton, Kenya (W N Moturi PhD); Philipps-University Marburg, Marburg, Germany (Prof U O Mueller PhD); Okinawa Chubu Hospital, Okinawa, Japan (M Mukaigawara MD); West Herts Hospitals NHS Trust, Watford, UK (M E Murdoch FRCP); University of KwaZulu-Natal, Durban, South Africa (Prof K S Naidoo PhD); Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy (Prof L Naldi MD); Ministry of Health, Suva, Fiji (D Nand MPH [Hons]); Suraj Eye Institute, Nagpur, India (Prof V Nangia MD); Faculty of Medicine, Fez, Morocco (Prof C Nejjari PhD); University of Oslo, Oslo, Norway (S P Neupane PhD); Kilifi, Kenya (Prof C R Newton MD); Ministry of Health and Social Welfare, Dar es Salaam, Tanzania (F N Ngalesoni MSc); Charité University Medicine Berlin, Berlin, Germany (S Nolte PhD, C Papachristou PhD); Deakin University, Melbourne, VIC, Australia (S Nolte PhD); Department of Global Public Health and Primary Care (Prof S Vollset MD), University of Bergen, Bergen, Norway (Prof O F Norheim PhD); Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia (R E Norman PhD); Department of Clinical Sciences, Lund University, Lund, Sweden (Prof B Norrving PhD); Makerere University, Kampala, Uganda (L Nyakarahuka MPH); Kyung Hee University, Seoul, South Korea (Prof I Oh PhD); Teikyo University School of Medicine, Tokyo, Japan (Prof T Ohkubo MD); Center for Healthy Start Initiative,
MBBS), Royal Children's Hospital, Melbourne, VIC, Australia (M T Mackay MBBS); Digestive Disease Research Institute, Shariati Hospital, Tehran, Iran (Prof R Malekzadeh MD); Shiraz University of Medical Sciences, Shiraz, Iran (Prof R Malekzadeh MD); Queen Mary University of London, London, UK (Prof W Marcenes PhD); Pereleman School of Medicine (P A Meaney MD), University of Pennsylvania, Philadelphia, PA, USA (D J Margolis PhD, D H Silberberg MD); University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines (M B Marzan MSc); Elmhurst Hospital Center, Mount Sinai Services, Elmhurst, NY, USA (J R Masci MD); Ministry of Public Health, Kabul, Afghanistan (M T Mashal PhD); AIDC EC, Port Elizabeth, South Africa (T T Mazorodze MA); Royal Prince Alfred Hospital, Camperdown, NSW, Australia (N W McGill MB BS); Children's Hospital of Philadelphia, Philadelphia, PA, USA (P A Meaney MD); Janakpuri Superspecialty Hospital, New Delhi, India (Prof M Mehndiratta DM); Mekelle University, Mekelle, Ethiopia (Y A Melaku MPH); Thomas Jefferson University, Philadelphia, PA, USA (M Meltzer MD); Saudi Ministry of Health, Riyadh, Saudi Arabia (Prof Z A Memish MD); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (A Meretoja PhD); Ifakara Health Institute, Bagamoyo, Tanzania (F A Mhimbira MS); Pacific Institute for Research & Evaluation, Calverton, MD, USA (T R Miller PhD); Curtin University Centre for Population Health, Perth, WA, Australia (T R Miller PhD); University of Ottawa, Ottawa, ON, Canada (E J Mills PhD); Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Bandar Tun Razak, Malaysia (Prof N Mohamed Ibrahim MRCP); University of Salahaddin, Erbil, Iraq (K A Mohammad PhD); University of Papua New Guinea, Boroko, Papua New Guinea (Prof G L D Mola MD); Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy (L Monasta DSc, L Ronfani PhD, M Montico MSc); University of North Texas, Denton, TX, USA (Prof A R Moore PhD); Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran (M Moradi-Lakeh PhD); National Center for Child Health and Development, Setagaya, Japan (R Mori PhD); Department of Medicine (Prof M Tsilimbaris PhD), University of Crete, Crete, Greece (J Moschandreas PhD); Egerton University, Egerton, Kenya (W N Moturi PhD); Philipps-University Marburg, Marburg, Germany (Prof U O Mueller PhD); Okinawa Chubu Hospital, Okinawa, Japan (M Mukaigawara MD); West Herts Hospitals NHS Trust, Watford, UK (M E Murdoch FRCP); University of KwaZulu-Natal, Durban, South Africa (Prof K S Naidoo PhD); Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy (Prof L Naldi MD); Ministry of Health, Suva, Fiji (D Nand MPH [Hons]); Suraj Eye Institute, Nagpur, India (Prof V Nangia MD); Faculty of Medicine, Fez, Morocco (Prof C Nejjari PhD); University of Oslo, Oslo, Norway (S P Neupane PhD); Kilifi, Kenya (Prof C R Newton MD); Ministry of Health and Social Welfare, Dar es Salaam, Tanzania (F N Ngalesoni MSc); Charité University Medicine Berlin, Berlin, Germany (S Nolte PhD, C Papachristou PhD); Deakin University, Melbourne, VIC, Australia (S Nolte PhD); Department of Global Public Health and Primary Care (Prof S Vollset MD), University of Bergen, Bergen, Norway (Prof O F Norheim PhD); Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia (R E Norman PhD); Department of Clinical Sciences, Lund University, Lund, Sweden (Prof B Norrving PhD); Makerere University, Kampala, Uganda (L Nyakarahuka MPH); Kyung Hee University, Seoul, South Korea (Prof I Oh PhD); Teikyo University School of Medicine, Tokyo, Japan (Prof T Ohkubo MD); Center for Healthy Start Initiative,
Ikoyi, Nigeria (B O Olusanya PhD); Lira District Local Government, Lira Municipal Council, Uganda (J N Opio MPH); IIS-Fundacion Jimenez Diaz, Madrid, Spain (Prof A Ortiz PhD); Christian Medical College Ludhiana, Ludhiana, India (J D Pandian DM); Kosin University College of Medicine, Busan, South Korea (E Park PhD); School of Medicine, Sungkyunkwan University, Suwon, South Korea (Prof J Park MPH); Independent Researcher, Boroko, Papua New Guinea (B I Pavlin MD); REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal (Prof D M Pereira PhD); National Institute of Respiratory Diseases, Mexico City, Mexico (Prof R Perez-Padilla MD); Hopsital Universitario Cruces, OSI EE-Cruces, Barakaldo, Spain (F Perez-Ruiz PhD); Biocruces Health Research Institute, Baracaldo, Spain (F Perez-Ruiz PhD); Mario Negri Institute for Pharmacological Research, Ranica, Italy (N Perico MD, M Trillini MD); Postgraduate Medical Institute, Lahore, Pakistan (A Pervaiz MHA); Flinders University, Adelaide, SA, Australia (Prof K Pesudovs PhD); Aalborg University, Aalborg Esst, Denmark (C B Peterson PhD); Health Metrics Unit, Gothenburg, Sweden (Prof M Petzold PhD); The University of the Witwatersrand, Johannesburg, South Africa (Prof M Petzold PhD); Shanghai Jiao Tong University School of Medicine, Shanghai, China (Prof M R Phillips MD); Emory University, Atlanta, GA, USA (Prof M R Phillips MD); Section Exposure Assessment and Environmental Health Indicators, Federal Environment Agency, Berlin, Germany (D Plass Dr. PH); Montreal Children's Hospital, McGill University, Montreal, QC, Canada (Prof D Poenaru MD); MyungSung Medical College, Addis Ababa, Ethiopia (Prof D Poenaru MD); Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada (S Popova PhD); The Fred Hollows Foundation, Sydney, NSW, Australia (N M Prasad DO); University of Illinois, Chicago, IL, USA (D M Qato PhD); Contech International Health Consultants, Lahore, Pakistan (A Rafay MS); Hamad Medical Corporation, Doha, Qatar (S U Rahman FCPS); University of Missouri, Columbia, MO, USA (M Raju PhD); Contech School of Public Health, Lahore, Pakistan (A Rafay MS, Prof S M Rana PhD); Contech Internal Health Consultants, Lahore, Pakistan (Prof S M Rana PhD); Center for Disease Analysis, Louisville, CO, USA (H Razavi PhD); Suez Canal University, Ismailia, Egypt (Prof A Refaat PhD); Centro Anna Maria Astori, IRCCS Mario Negri Institute for Pharmacological Research, Bergamo, Italy (Prof G Remuzzi MD); International Health and Development, Geneva, Switzerland (Prof S Resnikoff MD); Hospital das Clinica da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Prof A L Ribeiro PhD); Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (D Rojas-Rueda PhD); Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany (Prof D Rothenbacher MD); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA (D H Rothstein MD); Independent researcher, London, UK (J T Rowley PhD); BARC Hospital, HBNI University, Mumbai, India (N Roy MD); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (G M Ruhago MA, B F Sunguya MSc); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, QLD, Australia (S Saha PhD); Case Western Reserve University, Cleveland, OH, USA (J R Sanabria MD); Cancer Treatment Centers of America—RFU Chicago Medical School, North Chicago, IL, USA (J R Sanabria MD); Marshall University, Huntington, WV, USA (M Sawhney PhD); Federal University of Santa Catarina, Florianópolis, Brazil (I J Schneider PhD); University of Alabama at Birmingham, Birmingham, AL, USA (D C
Ikoyi, Nigeria (B O Olusanya PhD); Lira District Local Government, Lira Municipal Council, Uganda (J N Opio MPH); IIS-Fundacion Jimenez Diaz, Madrid, Spain (Prof A Ortiz PhD); Christian Medical College Ludhiana, Ludhiana, India (J D Pandian DM); Kosin University College of Medicine, Busan, South Korea (E Park PhD); School of Medicine, Sungkyunkwan University, Suwon, South Korea (Prof J Park MPH); Independent Researcher, Boroko, Papua New Guinea (B I Pavlin MD); REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal (Prof D M Pereira PhD); National Institute of Respiratory Diseases, Mexico City, Mexico (Prof R Perez-Padilla MD); Hopsital Universitario Cruces, OSI EE-Cruces, Barakaldo, Spain (F Perez-Ruiz PhD); Biocruces Health Research Institute, Baracaldo, Spain (F Perez-Ruiz PhD); Mario Negri Institute for Pharmacological Research, Ranica, Italy (N Perico MD, M Trillini MD); Postgraduate Medical Institute, Lahore, Pakistan (A Pervaiz MHA); Flinders University, Adelaide, SA, Australia (Prof K Pesudovs PhD); Aalborg University, Aalborg Esst, Denmark (C B Peterson PhD); Health Metrics Unit, Gothenburg, Sweden (Prof M Petzold PhD); The University of the Witwatersrand, Johannesburg, South Africa (Prof M Petzold PhD); Shanghai Jiao Tong University School of Medicine, Shanghai, China (Prof M R Phillips MD); Emory University, Atlanta, GA, USA (Prof M R Phillips MD); Section Exposure Assessment and Environmental Health Indicators, Federal Environment Agency, Berlin, Germany (D Plass Dr. PH); Montreal Children's Hospital, McGill University, Montreal, QC, Canada (Prof D Poenaru MD); MyungSung Medical College, Addis Ababa, Ethiopia (Prof D Poenaru MD); Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada (S Popova PhD); The Fred Hollows Foundation, Sydney, NSW, Australia (N M Prasad DO); University of Illinois, Chicago, IL, USA (D M Qato PhD); Contech International Health Consultants, Lahore, Pakistan (A Rafay MS); Hamad Medical Corporation, Doha, Qatar (S U Rahman FCPS); University of Missouri, Columbia, MO, USA (M Raju PhD); Contech School of Public Health, Lahore, Pakistan (A Rafay MS, Prof S M Rana PhD); Contech Internal Health Consultants, Lahore, Pakistan (Prof S M Rana PhD); Center for Disease Analysis, Louisville, CO, USA (H Razavi PhD); Suez Canal University, Ismailia, Egypt (Prof A Refaat PhD); Centro Anna Maria Astori, IRCCS Mario Negri Institute for Pharmacological Research, Bergamo, Italy (Prof G Remuzzi MD); International Health and Development, Geneva, Switzerland (Prof S Resnikoff MD); Hospital das Clinica da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Prof A L Ribeiro PhD); Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (D Rojas-Rueda PhD); Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany (Prof D Rothenbacher MD); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA (D H Rothstein MD); Independent researcher, London, UK (J T Rowley PhD); BARC Hospital, HBNI University, Mumbai, India (N Roy MD); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (G M Ruhago MA, B F Sunguya MSc); Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, QLD, Australia (S Saha PhD); Case Western Reserve University, Cleveland, OH, USA (J R Sanabria MD); Cancer Treatment Centers of America—RFU Chicago Medical School, North Chicago, IL, USA (J R Sanabria MD); Marshall University, Huntington, WV, USA (M Sawhney PhD); Federal University of Santa Catarina, Florianópolis, Brazil (I J Schneider PhD); University of Alabama at Birmingham, Birmingham, AL, USA (D C
Schwebel PhD, J A Singh MD); Stellenbosch University, Cape Town, South Africa (Prof S Seedat PhD); An-Najah University, Nablus, Palestine (A Shaheen PhD); Tufts Medical Center, Boston, MA, USA (Prof S Shahraz PhD); University of Pittsburgh Medical Center, Pittsburgh, PA, USA (S Shangguan); Tachikawa Hospital, Tokyo, Japan (Y Shinohara PhD); Finnish Institute of Occupational Health, Helsinki, Finland (R Shiri PhD); Washington State University, Spokane, WA, USA (K Shishani PhD); Northumbria University, Newcastle upon Tyne, UK (I Shiue PhD); Alzheimer's Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK (I Shiue PhD); Reykjavik University, Reykjavik, Iceland (I D Sigfusdottir PhD); International Institute for Population Sciences, Mumbai, India (A Singh PhD); Dartmouth College, Lebanon, NH, USA (S Soneji PhD); Stavanger University Hospital, Stavanger, Norway (K Søreide PhD); Federal Research Institute for Health Organization and Informatics, Ministry of Health of the Russian Federation, Moscow, Russia (S Soshnikov PhD); Department of Clinical Neurological Sciences, Western University, London, ON, Canada (L A Sposato MD); Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Cheras, Malaysia (C T Sreeramareddy MPH); "Attikon" University Hospital, Athens, Greece (V Stathopoulou PhD); Department of Neuroscience (Prof L J Stovner PhD), Norwegian University of Science and Technology, Trondheim, Norway (Prof T J Steiner PhD); Norwegian Advisory Unit on Headache, St Olavs Hospital, Trondheim, Norway (Prof L J Stovner PhD); "Alexandra" General Hospital of Athens, Athens, Greece (K Stroumpoulis PhD); Centre Hospitalier Public du Cotentin, Cherbourg, France (K Stroumpoulis); National Institute for Research in Tuberculosis, Chennai, India (S Swaminathan MD); Northwestern University, Chicago, IL, USA (M Swaroop MD, Y Yano MD); University of California Irvine, Irvine, CA, USA (Prof B L Sykes PhD); University of Illinois at Urbana-Champaign, Champaign, IL, USA (K M Tabb PhD); Chaim Sheba Medical Center, Tel Hashomer, Israel (Prof D Tanne MD); Tel Aviv University, Tel Aviv, Israel (Prof D Tanne MD); Westchester Medical Center, Valhalla, NY, USA (M Tavakkoli MD); Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands (M Ten Have PhD); Memorial University, St John's, NL, Canada (E Y Tenkorang PhD); Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA (A S Terkawi MD); Outcomes Research Consortium, Cleveland, OH, USA (A S Terkawi); Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia (A S Terkawi); WorldFish, Penang, Malaysia (A L Thorne-Lyman ScD); Aristotle University of Thessaloniki, Thessaloniki, Greece (Prof F Topouzis PhD); Health Care Center of Anjo Kosei Hospital, Anjo City, Japan (H Toyoshima MD); University of Southern Santa Catarina, Palhoça, Brazil (Prof J Traebert PhD); Johns Hopkins University, Baltimore, MD, USA (B X Tran PhD); Hanoi Medical University, Hanoi, Vietnam (B X Tran PhD); Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (T Truelsen DSc); Cleveland Clinic, Cleveland, OH, USA (Prof E M Tuzcu MD); Department of Veterans Affairs, Washington, DC, USA (U S Uchendu MD); Department of Internal Medicine Federal Teaching Hospital, Abakaliki, Nigeria (K N Ukwaja MD); Netherlands Leprosy Relief, Amsterdam, Netherlands (W H van Brakel PhD); African Population and Health Research Center, Nariobi, Kenya (S van de Vijver MD); National Institute for Public Health and the Environment, Bilthoven, Netherlands (C H van Gool PhD); Maastricht University Medical Centre, Maastricht, Netherlands (Prof J van Os PhD); UKK Institute for Health Promotion Research, Tampere, Finland (Prof T J Vasankari PhD);