Article Text

Download PDFPDF

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017
  1. Spencer L James1,
  2. Chris D Castle1,
  3. Zachary V Dingels1,
  4. Jack T Fox1,
  5. Erin B Hamilton1,
  6. Zichen Liu1,
  7. Nicholas L S Roberts1,
  8. Dillon O Sylte1,
  9. Nathaniel J Henry1,
  10. Kate E LeGrand1,
  11. Ahmed Abdelalim2,
  12. Amir Abdoli3,
  13. Ibrahim Abdollahpour4,
  14. Rizwan Suliankatchi Abdulkader5,
  15. Aidin Abedi6,
  16. Akine Eshete Abosetugn7,
  17. Abdelrahman I Abushouk8,
  18. Oladimeji M Adebayo9,
  19. Marcela Agudelo-Botero10,
  20. Tauseef Ahmad11,12,
  21. Rushdia Ahmed13,14,
  22. Muktar Beshir Ahmed15,
  23. Miloud Taki Eddine Aichour16,
  24. Fares Alahdab17,
  25. Genet Melak Alamene18,
  26. Fahad Mashhour Alanezi19,
  27. Animut Alebel20,
  28. Niguse Meles Alema21,
  29. Suliman A Alghnam22,
  30. Samar Al-Hajj23,24,
  31. Beriwan Abdulqadir Ali25,26,
  32. Saqib Ali27,
  33. Mahtab Alikhani28,
  34. Cyrus Alinia29,
  35. Vahid Alipour30,31,
  36. Syed Mohamed Aljunid32,33,
  37. Amir Almasi-Hashiani34,
  38. Nihad A Almasri35,
  39. Khalid Altirkawi36,
  40. Yasser Sami Abdeldayem Amer37,38,
  41. Saeed Amini39,
  42. Arianna Maever Loreche Amit40,41,
  43. Catalina Liliana Andrei42,
  44. Alireza Ansari-Moghaddam43,
  45. Carl Abelardo T Antonio44,45,
  46. Seth Christopher Yaw Appiah46,47,
  47. Jalal Arabloo30,
  48. Morteza Arab-Zozani48,
  49. Zohreh Arefi49,
  50. Olatunde Aremu50,
  51. Filippo Ariani51,
  52. Amit Arora52,53,
  53. Malke Asaad54,
  54. Babak Asghari55,
  55. Nefsu Awoke56,
  56. Beatriz Paulina Ayala Quintanilla57,58,
  57. Getinet Ayano59,
  58. Martin Amogre Ayanore60,
  59. Samad Azari30,
  60. Ghasem Azarian61,
  61. Alaa Badawi62,63,
  62. Ashish D Badiye64,
  63. Eleni Bagli65,66,
  64. Atif Amin Baig67,68,
  65. Mohan Bairwa69,70,
  66. Ahad Bakhtiari71,
  67. Arun Balachandran72,73,
  68. Maciej Banach74,75,
  69. Srikanta K Banerjee76,
  70. Palash Chandra Banik77,
  71. Amrit Banstola78,
  72. Suzanne Lyn Barker-Collo79,
  73. Till Winfried Bärnighausen80,81,
  74. Lope H Barrero82,
  75. Akbar Barzegar83,
  76. Mohsen Bayati84,
  77. Bayisa Abdissa Baye85,
  78. Neeraj Bedi86,87,
  79. Masoud Behzadifar88,
  80. Tariku Tesfaye Bekuma89,
  81. Habte Belete90,
  82. Corina Benjet91,
  83. Derrick A Bennett92,
  84. Isabela M Bensenor93,
  85. Kidanemaryam Berhe94,
  86. Pankaj Bhardwaj95,96,
  87. Anusha Ganapati Bhat97,
  88. Krittika Bhattacharyya98,99,
  89. Sadia Bibi100,
  90. Ali Bijani101,
  91. Muhammad Shahdaat Bin Sayeed102,103,
  92. Guilherme Borges91,
  93. Antonio Maria Borzì104,
  94. Soufiane Boufous105,
  95. Alexandra Brazinova106,
  96. Nikolay Ivanovich Briko107,
  97. Shyam S Budhathoki108,
  98. Josip Car109,110,
  99. Rosario Cárdenas111,
  100. Félix Carvalho112,
  101. João Mauricio Castaldelli-Maia113,
  102. Carlos A Castañeda-Orjuela114,115,
  103. Giulio Castelpietra116,117,
  104. Ferrán Catalá-López118,119,
  105. Ester Cerin120,121,
  106. Joht S Chandan122,
  107. Wagaye Fentahun Chanie123,
  108. Soosanna Kumary Chattu124,
  109. Vijay Kumar Chattu125,
  110. Irini Chatziralli126,127,
  111. Neha Chaudhary128,129,
  112. Daniel Youngwhan Cho130,
  113. Mohiuddin Ahsanul Kabir Chowdhury131,132,
  114. Dinh-Toi Chu133,
  115. Samantha M Colquhoun134,
  116. Maria-Magdalena Constantin135,136,
  117. Vera M Costa112,
  118. Giovanni Damiani137,138,
  119. Ahmad Daryani139,
  120. Claudio Alberto Dávila-Cervantes140,
  121. Feleke Mekonnen Demeke141,
  122. Asmamaw Bizuneh Demis142,143,
  123. Gebre Teklemariam Demoz144,145,
  124. Desalegn Getnet Demsie21,
  125. Afshin Derakhshani146,
  126. Kebede Deribe147,148,
  127. Rupak Desai149,
  128. Mostafa Dianati Nasab150,
  129. Diana Dias da Silva151,
  130. Zahra Sadat Dibaji Forooshani152,
  131. Kerrie E Doyle153,
  132. Tim Robert Driscoll154,
  133. Eleonora Dubljanin155,
  134. Bereket Duko Adema156,157,
  135. Arielle Wilder Eagan158,159,
  136. Aziz Eftekhari160,161,
  137. Elham Ehsani-Chimeh162,
  138. Maysaa El Sayed Zaki163,
  139. Demelash Abewa Elemineh164,
  140. Shaimaa I El-Jaafary2,
  141. Ziad El-Khatib165,166,
  142. Christian Lycke Ellingsen167,168,
  143. Mohammad Hassan Emamian169,
  144. Daniel Adane Endalew170,
  145. Sharareh Eskandarieh171,
  146. Pawan Sirwan Faris172,173,
  147. Andre Faro174,
  148. Farshad Farzadfar175,
  149. Yousef Fatahi176,
  150. Wubalem Fekadu90,177,
  151. Tomas Y Ferede178,
  152. Seyed-Mohammad Fereshtehnejad179,180,
  153. Eduarda Fernandes181,
  154. Pietro Ferrara182,
  155. Garumma Tolu Feyissa183,
  156. Irina Filip184,185,
  157. Florian Fischer186,
  158. Morenike Oluwatoyin Folayan187,
  159. Masoud Foroutan188,
  160. Joel Msafiri Francis189,
  161. Richard Charles Franklin190,191,
  162. Takeshi Fukumoto192,193,
  163. Biniyam Sahiledengle Geberemariyam194,
  164. Abadi Kahsu Gebre195,
  165. Ketema Bizuwork Gebremedhin196,
  166. Gebreamlak Gebremedhn Gebremeskel197,198,
  167. Berhe Gebremichael199,
  168. Getnet Azeze Gedefaw200,201,
  169. Birhanu Geta202,
  170. Mansour Ghafourifard203,
  171. Farhad Ghamari204,
  172. Ahmad Ghashghaee205,
  173. Asadollah Gholamian206,207,
  174. Tiffany K Gill208,
  175. Alessandra C Goulart93,209,
  176. Ayman Grada210,
  177. Michal Grivna211,
  178. Mohammed Ibrahim Mohialdeen Gubari212,
  179. Rafael Alves Guimarães213,
  180. Yuming Guo214,215,
  181. Gaurav Gupta216,
  182. Juanita A Haagsma217,
  183. Nima Hafezi-Nejad218,219,
  184. Hassan Haghparast Bidgoli220,
  185. Brian James Hall221,
  186. Randah R Hamadeh222,
  187. Samer Hamidi223,
  188. Josep Maria Haro224,225,
  189. Md Mehedi Hasan226,
  190. Amir Hasanzadeh227,228,
  191. Soheil Hassanipour229,
  192. Hadi Hassankhani230,231,
  193. Hamid Yimam Hassen232,233,
  194. Rasmus Havmoeller234,
  195. Khezar Hayat235,236,
  196. Delia Hendrie59,
  197. Fatemeh Heydarpour237,
  198. Martha Híjar238,239,
  199. Hung Chak Ho240,
  200. Chi Linh Hoang241,
  201. Michael K Hole242,
  202. Ramesh Holla243,
  203. Naznin Hossain244,245,
  204. Mehdi Hosseinzadeh246,247,
  205. Sorin Hostiuc248,249,
  206. Guoqing Hu250,
  207. Segun Emmanuel Ibitoye251,
  208. Olayinka Stephen Ilesanmi252,
  209. Irena Ilic155,
  210. Milena D Ilic253,
  211. Leeberk Raja Inbaraj254,
  212. Endang Indriasih255,
  213. Seyed Sina Naghibi Irvani256,
  214. Sheikh Mohammed Shariful Islam257,258,
  215. M Mofizul Islam259,
  216. Rebecca Q Ivers260,
  217. Kathryn H Jacobsen261,
  218. Mohammad Ali Jahani262,
  219. Nader Jahanmehr263,264,
  220. Mihajlo Jakovljevic265,
  221. Farzad Jalilian266,
  222. Sudha Jayaraman267,
  223. Achala Upendra Jayatilleke268,269,
  224. Ravi Prakash Jha270,
  225. Yetunde O John-Akinola251,
  226. Jost B Jonas271,272,
  227. Nitin Joseph273,
  228. Farahnaz Joukar229,
  229. Jacek Jerzy Jozwiak274,
  230. Suresh Banayya Jungari275,
  231. Mikk Jürisson276,
  232. Ali Kabir277,
  233. Rajendra Kadel278,
  234. Amaha Kahsay94,
  235. Leila R Kalankesh279,
  236. Rohollah Kalhor280,281,
  237. Teshome Abegaz Kamil282,
  238. Tanuj Kanchan283,
  239. Neeti Kapoor64,
  240. Manoochehr Karami284,
  241. Amir Kasaeian285,286,
  242. Hagazi Gebremedhin Kassaye21,
  243. Taras Kavetskyy287,288,
  244. Hafte Kahsay Kebede289,
  245. Peter Njenga Keiyoro290,
  246. Abraham Getachew Kelbore291,
  247. Bayew Kelkay292,
  248. Yousef Saleh Khader293,
  249. Morteza Abdullatif Khafaie294,
  250. Nauman Khalid295,
  251. Ibrahim A Khalil296,
  252. Rovshan Khalilov297,
  253. Mohammad Khammarnia298,
  254. Ejaz Ahmad Khan299,
  255. Maseer Khan300,
  256. Tripti Khanna301,302,
  257. Habibolah Khazaie303,
  258. Fatemeh Khosravi Shadmani304,
  259. Roba Khundkar305,
  260. Daniel N Kiirithio306,
  261. Young-Eun Kim307,
  262. Daniel Kim308,
  263. Yun Jin Kim309,
  264. Adnan Kisa310,
  265. Sezer Kisa311,
  266. Hamidreza Komaki312,313,
  267. Shivakumar K M Kondlahalli314,
  268. Vladimir Andreevich Korshunov107,
  269. Ai Koyanagi315,316,
  270. Moritz U G Kraemer317,318,
  271. Kewal Krishan319,
  272. Burcu Kucuk Bicer320,321,
  273. Nuworza Kugbey322,323,
  274. Vivek Kumar324,
  275. Nithin Kumar273,
  276. G Anil Kumar325,
  277. Manasi Kumar326,327,
  278. Girikumar Kumaresh328,
  279. Om P Kurmi327,329,
  280. Oluwatosin Kuti330,
  281. Carlo La Vecchia331,
  282. Faris Hasan Lami332,
  283. Prabhat Lamichhane333,
  284. Justin J Lang334,
  285. Van C Lansingh335,336,
  286. Dennis Odai Laryea337,
  287. Savita Lasrado338,
  288. Arman Latifi339,
  289. Paolo Lauriola340,
  290. Janet L Leasher341,
  291. Shaun Wen Huey Lee342,343,
  292. Tsegaye Lolaso Lenjebo344,
  293. Miriam Levi51,345,
  294. Shanshan Li214,
  295. Shai Linn346,
  296. Xuefeng Liu347,
  297. Alan D Lopez1,348,349,
  298. Paulo A Lotufo350,
  299. Raimundas Lunevicius351,352,
  300. Ronan A Lyons353,
  301. Mohammed Madadin354,
  302. Muhammed Magdy Abd El Razek355,
  303. Narayan Bahadur Mahotra356,
  304. Marek Majdan357,
  305. Azeem Majeed358,
  306. Jeadran N Malagon-Rojas359,360,
  307. Venkatesh Maled361,362,
  308. Reza Malekzadeh363,364,
  309. Deborah Carvalho Malta365,
  310. Navid Manafi366,367,
  311. Amir Manafi368,
  312. Ana-Laura Manda369,
  313. Narayana Manjunatha370,
  314. Fariborz Mansour-Ghanaei229,
  315. Borhan Mansouri371,
  316. Mohammad Ali Mansournia372,
  317. Joemer C Maravilla373,
  318. Lyn M March374,
  319. Amanda J Mason-Jones375,
  320. Seyedeh Zahra Masoumi376,
  321. Benjamin Ballard Massenburg130,
  322. Pallab K Maulik377,378,
  323. Gebrekiros Gebremichael Meles379,
  324. Addisu Melese141,
  325. Zeleke Aschalew Melketsedik380,
  326. Peter T N Memiah381,
  327. Walter Mendoza382,
  328. Ritesh G Menezes383,
  329. Meresa Berwo Mengesha384,
  330. Melkamu Merid Mengesha385,
  331. Tuomo J Meretoja386,387,
  332. Atte Meretoja388,389,
  333. Hayimro Edemealem Merie164,
  334. Tomislav Mestrovic390,391,
  335. Bartosz Miazgowski392,
  336. Tomasz Miazgowski393,
  337. Ted R Miller59,394,
  338. GK Mini395,396,
  339. Andreea Mirica397,398,
  340. Erkin M Mirrakhimov399,400,
  341. Mehdi Mirzaei-Alavijeh266,
  342. Prasanna Mithra273,
  343. Babak Moazen401,402,
  344. Masoud Moghadaszadeh403,404,
  345. Efat Mohamadi405,
  346. Yousef Mohammad406,
  347. Karzan Abdulmuhsin Mohammad407,408,
  348. Aso Mohammad Darwesh409,
  349. Naser Mohammad Gholi Mezerji410,
  350. Abdollah Mohammadian-Hafshejani411,
  351. Milad Mohammadoo-Khorasani412,
  352. Reza Mohammadpourhodki413,
  353. Shafiu Mohammed80,414,
  354. Jemal Abdu Mohammed415,
  355. Farnam Mohebi175,416,
  356. Mariam Molokhia417,
  357. Lorenzo Monasta418,
  358. Yoshan Moodley419,
  359. Mahmood Moosazadeh420,
  360. Masoud Moradi421,
  361. Ghobad Moradi422,423,
  362. Maziar Moradi-Lakeh424,
  363. Farhad Moradpour422,
  364. Lidia Morawska425,
  365. Ilais Moreno Velásquez426,
  366. Naho Morisaki427,
  367. Shane Douglas Morrison130,
  368. Tilahun Belete Mossie90,
  369. Atalay Goshu Muluneh428,
  370. Srinivas Murthy429,
  371. Kamarul Imran Musa430,
  372. Ghulam Mustafa431,432,
  373. Ashraf F Nabhan433,434,
  374. Ahamarshan Jayaraman Nagarajan435,436,
  375. Gurudatta Naik437,
  376. Mukhammad David Naimzada438,439,
  377. Farid Najafi440,
  378. Vinay Nangia441,
  379. Bruno Ramos Nascimento442,
  380. Morteza Naserbakht424,443,
  381. Vinod Nayak444,
  382. Duduzile Edith Ndwandwe445,
  383. Ionut Negoi446,447,
  384. Josephine W Ngunjiri448,
  385. Cuong Tat Nguyen449,
  386. Huong Lan Thi Nguyen449,
  387. Rajan Nikbakhsh450,451,
  388. Dina Nur Anggraini Ningrum452,453,
  389. Chukwudi A Nnaji445,454,
  390. Peter S Nyasulu455,
  391. Felix Akpojene Ogbo112,
  392. Onome Bright Oghenetega456,
  393. In-Hwan Oh457,
  394. Emmanuel Wandera Okunga458,
  395. Andrew T Olagunju459,460,
  396. Tinuke O Olagunju461,
  397. Ahmed Omar Bali462,
  398. Obinna E Onwujekwe463,
  399. Kwaku Oppong Asante464,465,
  400. Heather M Orpana466,467,
  401. Erika Ota468,
  402. Nikita Otstavnov438,469,
  403. Stanislav S Otstavnov438,470,
  404. Mahesh P A471,
  405. Jagadish Rao Padubidri472,
  406. Smita Pakhale473,
  407. Keyvan Pakshir474,
  408. Songhomitra Panda-Jonas475,
  409. Eun-Kee Park476,
  410. Sangram Kishor Patel477,478,
  411. Ashish Pathak165,479,
  412. Sanghamitra Pati480,
  413. George C Patton481,482,
  414. Kebreab Paulos483,
  415. Amy E Peden191,484,
  416. Veincent Christian Filipino Pepito485,
  417. Jeevan Pereira486,
  418. Hai Quang Pham449,
  419. Michael R Phillips487,488,
  420. Marina Pinheiro489,
  421. Roman V Polibin490,
  422. Suzanne Polinder217,
  423. Hossein Poustchi363,
  424. Swayam Prakash491,
  425. Dimas Ria Angga Pribadi492,
  426. Parul Puri493,
  427. Zahiruddin Quazi Syed96,
  428. Mohammad Rabiee494,
  429. Navid Rabiee495,
  430. Amir Radfar496,497,
  431. Anwar Rafay498,
  432. Ata Rafiee499,
  433. Alireza Rafiei500,501,
  434. Fakher Rahim502,503,
  435. Siavash Rahimi504,
  436. Vafa Rahimi-Movaghar505,
  437. Muhammad Aziz Rahman506,507,
  438. Ali Rajabpour-Sanati508,
  439. Fatemeh Rajati421,
  440. Ivo Rakovac509,
  441. Kavitha Ranganathan510,
  442. Sowmya J Rao511,
  443. Vahid Rashedi512,
  444. Prateek Rastogi513,
  445. Priya Rathi514,
  446. Salman Rawaf358,515,
  447. Lal Rawal516,
  448. Reza Rawassizadeh517,
  449. Vishnu Renjith518,
  450. Andre M N Renzaho519,520,
  451. Serge Resnikoff521,
  452. Aziz Rezapour522,
  453. Ana Isabel Ribeiro523,
  454. Jennifer Rickard524,525,
  455. Carlos Miguel Rios González526,527,
  456. Luca Ronfani418,
  457. Gholamreza Roshandel363,528,
  458. Anas M Saad529,
  459. Yogesh Damodar Sabde530,
  460. Siamak Sabour531,
  461. Basema Saddik532,
  462. Saeed Safari533,
  463. Roya Safari-Faramani534,
  464. Hamid Safarpour535,
  465. Mahdi Safdarian505,536,
  466. S Mohammad Sajadi537,
  467. Payman Salamati505,
  468. Farkhonde Salehi538,
  469. Saleh Salehi Zahabi539,540,
  470. Marwa R Rashad Salem541,
  471. Hosni Salem542,
  472. Omar Salman543,544,
  473. Inbal Salz545,
  474. Abdallah M Samy546,
  475. Juan Sanabria547,548,
  476. Lidia Sanchez Riera549,550,
  477. Milena M Santric Milicevic551,552,
  478. Abdur Razzaque Sarker553,
  479. Arash Sarveazad554,
  480. Brijesh Sathian555,556,
  481. Monika Sawhney557,
  482. Susan M Sawyer558,559,
  483. Sonia Saxena560,
  484. Mehdi Sayyah561,
  485. David C Schwebel562,
  486. Soraya Seedat563,
  487. Subramanian Senthilkumaran564,
  488. Sadaf G Sepanlou363,364,
  489. Seyedmojtaba Seyedmousavi565,
  490. Feng Sha566,
  491. Faramarz Shaahmadi567,
  492. Saeed Shahabi568,
  493. Masood Ali Shaikh569,
  494. Mehran Shams-Beyranvand570,
  495. Morteza Shamsizadeh571,
  496. Mahdi Sharif-Alhoseini505,
  497. Hamid Sharifi572,
  498. Aziz Sheikh573,574,
  499. Mika Shigematsu575,
  500. Jae Il Shin576,577,
  501. Rahman Shiri578,
  502. Soraya Siabani579,580,
  503. Inga Dora Sigfusdottir581,582,
  504. Pankaj Kumar Singh583,
  505. Jasvinder A Singh584,585,
  506. Dhirendra Narain Sinha586,587,
  507. Catalin-Gabriel Smarandache588,589,
  508. Emma U R Smith590,591,
  509. Amin Soheili592,593,
  510. Bija Soleymani237,
  511. Ali Reza Soltanian594,
  512. Joan B Soriano595,596,
  513. Muluken Bekele Sorrie597,
  514. Ireneous N Soyiri598,599,
  515. Dan J Stein600,601,
  516. Mark A Stokes602,
  517. Mu'awiyyah Babale Sufiyan603,
  518. Hafiz Ansar Rasul Suleria604,
  519. Bryan L Sykes605,
  520. Rafael Tabarés-Seisdedos606,607,
  521. Karen M Tabb608,
  522. Biruk Wogayehu Taddele609,
  523. Degena Bahrey Tadesse197,610,
  524. Animut Tagele Tamiru611,
  525. Ingan Ukur Tarigan255,
  526. Yonatal Mesfin Tefera612,613,
  527. Arash Tehrani-Banihashemi424,614,
  528. Merhawi Gebremedhin Tekle199,
  529. Gebretsadkan Hintsa Tekulu615,
  530. Ayenew Kassie Tesema616,
  531. Berhe Etsay Tesfay617,
  532. Rekha Thapar273,
  533. Asres Bedaso Tilahune618,
  534. Kenean Getaneh Tlaye142,
  535. Hamid Reza Tohidinik372,572,
  536. Roman Topor-Madry619,620,
  537. Bach Xuan Tran621,
  538. Khanh Bao Tran622,623,
  539. Jaya Prasad Tripathy624,
  540. Alexander C Tsai625,626,
  541. Lorainne Tudor Car627,
  542. Saif Ullah628,
  543. Irfan Ullah629,630,
  544. Maida Umar631,
  545. Bhaskaran Unnikrishnan273,
  546. Era Upadhyay632,
  547. Olalekan A Uthman633,
  548. Pascual R Valdez634,635,
  549. Tommi Juhani Vasankari636,
  550. Narayanaswamy Venketasubramanian637,638,
  551. Francesco S Violante639,640,
  552. Vasily Vlassov641,
  553. Yasir Waheed642,
  554. Girmay Teklay Weldesamuel197,
  555. Andrea Werdecker643,644,
  556. Taweewat Wiangkham645,
  557. Haileab Fekadu Wolde428,
  558. Dawit Habte Woldeyes646,
  559. Dawit Zewdu Wondafrash647,648,
  560. Temesgen Gebeyehu Wondmeneh415,
  561. Adam Belay Wondmieneh196,649,
  562. Ai-Min Wu650,
  563. Rajaram Yadav493,
  564. Ali Yadollahpour651,
  565. Yuichiro Yano652,
  566. Sanni Yaya653,
  567. Vahid Yazdi-Feyzabadi654,655,
  568. Paul Yip656,657,
  569. Engida Yisma658,
  570. Naohiro Yonemoto659,
  571. Seok-Jun Yoon307,
  572. Yoosik Youm660,
  573. Mustafa Z Younis661,662,
  574. Zabihollah Yousefi663,664,
  575. Yong Yu665,
  576. Chuanhua Yu666,667,
  577. Hasan Yusefzadeh29,
  578. Telma Zahirian Moghadam30,668,
  579. Zoubida Zaidi669,
  580. Sojib Bin Zaman131,670,
  581. Mohammad Zamani671,
  582. Maryam Zamanian34,
  583. Hamed Zandian668,672,
  584. Ahmad Zarei673,
  585. Fatemeh Zare674,
  586. Zhi-Jiang Zhang675,
  587. Yunquan Zhang676,677,
  588. Sanjay Zodpey678,
  589. Lalit Dandona1,325,349,
  590. Rakhi Dandona1,325,
  591. Louisa Degenhardt1,679,
  592. Samath Dhamminda Dharmaratne1,349,680,
  593. Simon I Hay1,349,
  594. Ali H Mokdad1,349,
  595. Robert C Reiner Jr1,349,
  596. Benn Sartorius349,681,
  597. Theo Vos1,349
  1. 1 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
  2. 2 Department of Neurology, Cairo University, Cairo, Egypt
  3. 3 Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
  4. 4 Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5 Department of Public Health, Ministry of Health, Riyadh, Saudi Arabia
  6. 6 Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
  7. 7 Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
  8. 8 Cardiovascular Medicine, Ain Shams University, Abbasia, Egypt
  9. 9 Department of Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
  10. 10 School of Medicine Center for Politics, Population and Health Research, National Autonomous University of Mexico, Mexico City, Mexico
  11. 11 Department of Epidemiology and Health Statistics, Southeast University Nanjing, Nanjing, China
  12. 12 Department of Microbiology, Hazara University Mansehra, Mansehra, Pakistan
  13. 13 James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  14. 14 Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
  15. 15 Department of Epidemiology, Jimma University, Jimma, Ethiopia
  16. 16 Higher National School of Veterinary Medicine, Algiers, Algeria
  17. 17 Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
  18. 18 School of Health Sciences, Madda Walabu University, Bale Goba, Ethiopia
  19. 19 Department of Computer Sciences, Imam Abdulrehman Bin Faisal University, Dammam, Saudi Arabia
  20. 20 Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
  21. 21 Department of Pharmacy, Adigrat University, Adigrat, Ethiopia
  22. 22 Department of Population Health Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  23. 23 Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon
  24. 24 British Columbia Injury Research Prevention Unit, British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
  25. 25 Medical Technical Institute, Erbil Polytechnic University, Erbil, Iraq
  26. 26 Faculty of Pharmacy, Ishik University, Erbil, Iraq
  27. 27 Department of Information Systems, College of Economics and Political Science, Sultan Qaboos University, Muscat, Oman
  28. 28 School of Health Management and Information Sciences, Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
  29. 29 Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, Iran
  30. 30 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  31. 31 Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
  32. 32 Department of Health Policy and Management, Kuwait University, Safat, Kuwait
  33. 33 International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
  34. 34 Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
  35. 35 Physiotherapy Department, The University of Jordan, Amman, Jordan
  36. 36 King Saud University, Riyadh, Saudi Arabia
  37. 37 Clinical Practice Guidelines Unit, King Saud University, Riyadh, Saudi Arabia
  38. 38 Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
  39. 39 Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
  40. 40 Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, Philippines
  41. 41 Online Programs for Applied Learning, Johns Hopkins University, Baltimore, MD, USA
  42. 42 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  43. 43 Department of Epidemiology and Biostatistics, Health Promotion Research Center, Zahedan, Iran
  44. 44 Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
  45. 45 Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
  46. 46 Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  47. 47 Center for International Health, Ludwig Maximilians University, Munich, Germany
  48. 48 Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
  49. 49 Department of Health Promotion and Education, Tehran University of Medical Sciences, Tehran, Iran
  50. 50 School of Health Sciences, Birmingham City University, Birmingham, UK
  51. 51 Regional Centre for the Analysis of Data on Occupational and Work-related Injuries and Diseases, Local Health Unit Tuscany Centre, Florence, Italy
  52. 52 School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
  53. 53 Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
  54. 54 Department of Plastic Surgery, University of Texas, Houston, TX, USA
  55. 55 Department of Microbiology, Hamedan University of Medical Sciences, Azad Tabriz University, Iran
  56. 56 Department of Nursing, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  57. 57 The Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
  58. 58 General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
  59. 59 School of Public Health, Curtin University, Perth, WA, Australia
  60. 60 Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
  61. 61 Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
  62. 62 Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, Ontario, Canada
  63. 63 Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
  64. 64 Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
  65. 65 Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
  66. 66 Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology, Ioannina, Greece
  67. 67 Biochemistry Unit, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
  68. 68 School of Health Sciences, Univeristi Sultan Zainal Abidin, Kuala Terengganu, Malaysia
  69. 69 Institute of Health Management Research, Indian Institute of Health Management Research University, Jaipur, India
  70. 70 Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
  71. 71 Health Policy And Management Department, Tehran University of Medical Sciences, Tehran, Iran
  72. 72 Department of Demography, University of Groningen, Groningen, Netherlands
  73. 73 Population Research Centre, Institute for Social and Economic Change, Bengaluru, India
  74. 74 Department of Hypertension, Medical University of Lodz, Lodz, Poland
  75. 75 Polish Mothers’ Memorial Hospital Research Institute, Lodz, Poland
  76. 76 School of Health Sciences, Walden University, Minneapolis, MN, USA
  77. 77 Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
  78. 78 Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
  79. 79 School of Psychology, University of Auckland, Auckland, New Zealand
  80. 80 Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
  81. 81 T H Chan School of Public Health, Harvard University, Boston, MA, USA
  82. 82 Department of Industrial Engineering, Pontifical Javeriana University, Bogota, Colombia
  83. 83 Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
  84. 84 Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  85. 85 Department of Public Health, Ambo University, Ambo, Ethiopia
  86. 86 Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
  87. 87 Jazan University, Jazan, Saudi Arabia
  88. 88 Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
  89. 89 Institute of Health Sciences, School of Public Health, Wollega University, Nekemte, Ethiopia
  90. 90 Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
  91. 91 Department of Epidemiology and Psychosocial Reseach, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
  92. 92 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  93. 93 Department of Internal Medicine, University of São Paulo, São Paulo, Brazil
  94. 94 Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
  95. 95 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
  96. 96 Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India
  97. 97 Department of Internal Medicine, University of Massachusetts Medical School, Springfield, MA, USA
  98. 98 Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India
  99. 99 Department of Statistics, University of Calcutta, Kolkata, India
  100. 100 Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Faisalabad, Pakistan
  101. 101 Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
  102. 102 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
  103. 103 Department of Clinical Pharmacy and Pharmacology, University of Dhaka, Dhaka, Bangladesh
  104. 104 Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
  105. 105 Transport and Road Safety (TARS) Research Department, University of New South Wales, Sydney, New South Wales, Australia
  106. 106 Institute of Epidemiology, Comenius University, Bratislava, Slovakia
  107. 107 Department of Epidemiology and Evidence Based Medicine, I M Sechenov First Moscow State Medical University, Moscow, Russia
  108. 108 Research Department, Golden Community, Kathmandu, Nepal
  109. 109 Centre for Population Health Sciences, Nanyang Technological University, Singapore
  110. 110 Global eHealth Unit, Imperial College London, London, UK
  111. 111 Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
  112. 112 Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
  113. 113 Department of Psychiatry, University of São Paulo, São Paulo, Brazil
  114. 114 Colombian National Health Observatory, National Institute of Health, Bogota, Colombia
  115. 115 Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
  116. 116 Primary Care Services Area, Central Health Directorate, Region Friuli Venezia Giulia, Trieste, Italy
  117. 117 Department of Medicine (DAME), University of Udine, Udine, Italy
  118. 118 National School of Public Health, Carlos III Health Institute, Madrid, Spain
  119. 119 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
  120. 120 Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
  121. 121 School of Public Health, University of Hong Kong, Hong Kong, China
  122. 122 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  123. 123 Department of Gynecology and Obstetrics, University of Gondar, Gondar, Ethiopia
  124. 124 Department of Public Health, Texila American University, Georgetown, Guyana
  125. 125 Department of Medicine, University of Toronto, Toronto, Canada
  126. 126 2nd Department of Ophthalmology, University of Athens, Haidari, Greece
  127. 127 Ophthalmology Private Practice Office, Independent Consultant, Athens, Greece
  128. 128 Department of Pediatrics, Harvard University, Boston, MA, USA
  129. 129 Department of Neonatology, Beth Israel Deaconess Medical center, Boston, MA, USA
  130. 130 Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA
  131. 131 Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
  132. 132 Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
  133. 133 Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
  134. 134 Research School of Population Health, Australian National University, Action, ACT, Australia
  135. 135 Department of Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  136. 136 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
  137. 137 Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
  138. 138 Department of Dermatology, University of Milan, Milan, Italy
  139. 139 Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  140. 140 Population and Development, Facultad Latinoamericana de Ciencias Sociales Mexico, Mexico City, Mexico
  141. 141 Department of Medical Laboratory Sciences, Bahir Dar University, Bahir Dar, Ethiopia
  142. 142 Department of Nursing, Woldia University, Woldia, Ethiopia
  143. 143 School of Nursing, Jimma University, Jimma, Ethiopia
  144. 144 School of Pharmacy, Aksum University, Aksum, Ethiopia
  145. 145 Addis Ababa University, Addis Ababa, Ethiopia
  146. 146 Immunology Research Center, Tabriz University of Medical Sciences, Iran
  147. 147 Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
  148. 148 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
  149. 149 Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
  150. 150 Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
  151. 151 Faculty of Pharmacy, University of Porto, Porto, Portugal
  152. 152 Tehran University of Medical Sciences, Tehran, Iran
  153. 153 School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, VIC, Australia
  154. 154 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
  155. 155 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  156. 156 Public Health Department, Hawassa University, Hawassa, Ethiopia
  157. 157 Curtin University, Perth, WA, Australia
  158. 158 Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
  159. 159 Department of Social Services, Tufts Medical Center, Boston, MA, USA
  160. 160 Department of Pharmacology and Toxicology, Maragheh University of Medical Sciences, Maragheh, Iran
  161. 161 Department of Pharmacology and Toxicology, Tabriz University of Medical Sciences, Tabriz, Iran
  162. 162 National Institute for Health Researches, Tehran University of Medical Sciences, Tehran, Iran
  163. 163 Department of Clinical Pathology, Mansoura University, Mansoura, Egypt
  164. 164 Department of Statistics, Debre Markos University, Debre Markos, Ethiopia
  165. 165 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  166. 166 World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
  167. 167 Department of Pathology, Stavanger University Hospital, Stavanger, Norway
  168. 168 Norwegian Institute of Public Health, Oslo, Norway
  169. 169 Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
  170. 170 Department of Midwifery, Wolkite University, Wolkite, Ethiopia
  171. 171 Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
  172. 172 Biology Department, Salahaddin University-Erbil, Erbil, Iraq
  173. 173 Biology and Biotechnolaniogy"L Spallanzani", University of Pavia, Pavia, Italy
  174. 174 Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
  175. 175 Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  176. 176 Pharmaceutical Nanotechnology, Tehran University of Medical Sciences, Tehran, Iran
  177. 177 Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
  178. 178 Nursing Department, Hawassa University, Hawassa, Ethiopia
  179. 179 Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
  180. 180 Division of Neurology, University of Ottawa, Ottawa, ON, Canada
  181. 181 REQUIMTE/LAQV, University of Porto, Porto, Portugal
  182. 182 Research Centre on Public Health (CESP), University of Milan Bicocca, Monza, Italy
  183. 183 Department of Health Education & Behavioral Sciences, Jimma University, Jimma, Ethiopia
  184. 184 Psychiatry Department, Kaiser Permanente, Fontana, CA, USA
  185. 185 School of Health Sciences, A T Still University, Mesa, AZ, USA
  186. 186 Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
  187. 187 Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
  188. 188 Abadan School of Medical Sciences, Abadan University of Medical Sciences, Abadan, Iran
  189. 189 Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
  190. 190 College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, QLD, Australia
  191. 191 Royal Life Saving Society, Sydney, NSW, Australia
  192. 192 Department of Dermatology, Kobe University, Kobe, Japan
  193. 193 Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, PA, USA
  194. 194 Public Health Department, Madda Walabu University, Bale-Robe, Ethiopia
  195. 195 School of Pharmacy, Mekelle University, Mekelle, Ethiopia
  196. 196 Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
  197. 197 Department of Nursing, Aksum University, Aksum, Ethiopia
  198. 198 Department of Nursing, Mekelle University, Mekelle, Ethiopia
  199. 199 School of Public Health, Haramaya University, Harar, Ethiopia
  200. 200 Bahir Dar University, Bahir Dar, Ethiopia
  201. 201 Haramaya University, Dire Dawa, Ethiopia
  202. 202 Department of Pharmacy, Wollo University, Dessie, Ethiopia
  203. 203 Department of Medical Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
  204. 204 Occupational Health Department, Arak University of Medical Sciences, Arak, Iran
  205. 205 Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
  206. 206 Science and Research Branch, Islamic Azad University, Tehran, Iran
  207. 207 Young Researchers and Elite Club, Rasht Branch, Islamic Azad University, Rasht, Iran
  208. 208 Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
  209. 209 Center for Clinical and Epidemiological Research, University of São Paulo, Sao Paulo, Brazil
  210. 210 Department of Dermatology, Boston University, Boston, MA, USA
  211. 211 Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
  212. 212 Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq
  213. 213 Instituto de Patologia Tropical e Saúde Pública, Federal University of Goias, Goiânia, Brazil
  214. 214 School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  215. 215 Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
  216. 216 Non-Communicable Diseases (NCD), World Health Organization (WHO), New Delhi, India
  217. 217 Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
  218. 218 Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
  219. 219 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  220. 220 Institute for Global Health, University College London, London, UK
  221. 221 Global and Community Mental Health Research Group, University of Macau, Macao, China
  222. 222 Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
  223. 223 School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
  224. 224 Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
  225. 225 Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
  226. 226 Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
  227. 227 Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
  228. 228 Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
  229. 229 Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
  230. 230 School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
  231. 231 Independent Consultant, Tabriz, Iran
  232. 232 Department of Public Health, Mizan-Tepi University, Tepi, Ethiopia
  233. 233 Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
  234. 234 Department of Clinical Sciences, Karolinska University Hospital, Stockholm, Sweden
  235. 235 Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
  236. 236 Department of Pharmacy Administration and Clinical Pharmacy, Xian Jiaotong University, Xian, China
  237. 237 Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  238. 238 Research Coordination, AC Environments Foundation, Cuernavaca, Mexico
  239. 239 CISS, National Institute of Public Health, Cuernavaca, Mexico
  240. 240 Department of Urban Planning and Design, University of Hong Kong, Hong Kong, China
  241. 241 Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
  242. 242 Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, TX, USA
  243. 243 Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
  244. 244 Department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka, Bangladesh
  245. 245 Department of Pharmacology, Bangladesh Industrial Gases Limited, Tangail, Bangladesh
  246. 246 Department of Computer Engineering, Islamic Azad University, Tehran, Iran
  247. 247 Computer Science Department, University of Human Development, Sulaymaniyah, Iraq
  248. 248 Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  249. 249 Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
  250. 250 Department of Epidemiology and Health Statistics, Central South University, Changsha, China
  251. 251 Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
  252. 252 Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
  253. 253 Department of Epidemiology, University of Kragujevac, Kragujevac, Serbia
  254. 254 Department of Family Medicine, Bangalore Baptist Hospital, Bangalore, India
  255. 255 Center for Health Resource and Services Research and Development, National Institute of Health Research & Development, Jakarta, Indonesia
  256. 256 Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  257. 257 Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
  258. 258 Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  259. 259 School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC, Australia
  260. 260 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
  261. 261 Department of Global and Community Health, George Mason University, Fairfax, VA, USA
  262. 262 Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
  263. 263 School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  264. 264 Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  265. 265 Department for Health Care and Public Health, I M Sechenov First Moscow State Medical University, Moscow, Russia
  266. 266 Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  267. 267 Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
  268. 268 Institute of Medicine, University of Colombo, Colombo, Sri Lanka
  269. 269 Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
  270. 270 Department of Community Medicine, Banaras Hindu University, Varanasi, India
  271. 271 Department of Ophthalmology, Heidelberg University, Mannheim, Germany
  272. 272 Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Tongren Hospital, Beijing, China
  273. 273 Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
  274. 274 Department of Family Medicine and Public Health, University of Opole, Opole, Poland
  275. 275 School of Health Sciences, Savitribai Phule Pune University, Pune, India
  276. 276 Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
  277. 277 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
  278. 278 Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
  279. 279 Department of Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
  280. 280 Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
  281. 281 Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
  282. 282 School of Public Health, Department of Health Informatics and Health Innovation, A C S Medical College and Hospital, Mekelle, Ethiopia
  283. 283 Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
  284. 284 Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
  285. 285 Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  286. 286 Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
  287. 287 Department of Applied Physics, The John Paul II Catholic University of Lublin, Lublin Voivodeship, Poland
  288. 288 Department of Biology and Chemistry, Drohobych Ivan Franko State Pedagogical University, Drohobych, Ukraine
  289. 289 Department of Pharmacy, Jimma University, Jimma, Ethiopia
  290. 290 Open, Distance and eLearning Campus, University of Nairobi, Nairobi, Kenya
  291. 291 Department of Dermatology, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  292. 292 Department of Midwifery, University of Gondar, Gondar, Ethiopia
  293. 293 Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
  294. 294 Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  295. 295 School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
  296. 296 Department of Global Health, University of Washington, Seattle, WA, USA
  297. 297 Department of Physiology, Baku State University, Baku, Azerbaijan
  298. 298 Health Care Management, Zahedan University of Medical Sciences, zahedan, Iran
  299. 299 Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
  300. 300 Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
  301. 301 Department of Health Research, Indian Council of Medical Research, New Delhi, India
  302. 302 Centre for Ethics, Jawahar Lal Nehru University, New Delhi, India
  303. 303 Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
  304. 304 Department of Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
  305. 305 Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
  306. 306 Research and Data Solutions, Synotech Consultant, Nairobi, Kenya
  307. 307 Department of Preventive Medicine, Korea University, Seoul, South Korea
  308. 308 Department of Health Sciences, Northeastern University, Boston, MA, USA
  309. 309 School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
  310. 310 School of Health Sciences, Kristiania University College, Oslo, Norway
  311. 311 Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
  312. 312 Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
  313. 313 Brain Engineering Research Center, Institute for Research in Fundamental Sciences, Tehran, Iran
  314. 314 Department of Public Health Dentistry, Deemed University, karad, India
  315. 315 CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
  316. 316 Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
  317. 317 Department of Zoology, University of Oxford, Oxford, UK
  318. 318 Harvard Medical School, Harvard University, Boston, MA, USA
  319. 319 Department of Anthropology, Panjab University, Chandigarh, India
  320. 320 Department of Public Health, Yuksek Ihtisas University, Ankara, Turkey
  321. 321 Department of Public Health, Hacettepe University, Ankara, Turkey
  322. 322 Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
  323. 323 Department of Psychology and Health Promotion, University of KwaZulu-Natal, Durban, South Africa
  324. 324 Department of Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
  325. 325 Public Health Foundation of India, Gurugram, India
  326. 326 Department of Psychiatry, University of Nairobi, Nairobi, Kenya
  327. 327 Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
  328. 328 Mechanical and Industrial Engineering, Indian Institute of Technology, Roorkee, Roorkee, India
  329. 329 Department of Medicine, McMaster University, Hamilton, ON, Canada
  330. 330 Health and Nutrition Section, United Nations Childrens’ Fund (UNICEF), Accra, Ghana
  331. 331 Department of Clinical Medicine and Community Health, University of Milan, Milano, Italy
  332. 332 Department of Community and Family Medicine, University of Baghdad, Baghdad, Iraq
  333. 333 School of Medicine, Deakin University, Geelong, VIC, Australia
  334. 334 Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
  335. 335 HelpMeSee, New York, NY, USA
  336. 336 International Relations, Mexican Institute of Ophthalmology, Queretaro, Mexico
  337. 337 Disease Control Department, Ghana Health Service, Accra, Ghana
  338. 338 Department of Otorhinolaryngology (ENT), Father Muller Medical College, Mangalore, India
  339. 339 Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
  340. 340 Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
  341. 341 College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
  342. 342 School of Pharmacy, Monash University, Bandar Sunway, Malaysia
  343. 343 School of Pharmacy, Taylor’s University Lakeside Campus, Subang Jaya, Malaysia
  344. 344 School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  345. 345 Department of Health Sciences, University of Florence, Florence, Italy
  346. 346 School of Public Health, University of Haifa, Haifa, Israel
  347. 347 Department of Systems, Populations and Leadership, University of Michigan, Ann Arbor, MI, USA
  348. 348 School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  349. 349 Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
  350. 350 Department of Medicine, University of São Paulo, Sao Paulo, Brazil
  351. 351 Department of General Surgery, Aintree University Hospital National Health Service (NHS) Foundation Trust, Liverpool, UK
  352. 352 Department of Surgery, University of Liverpool, Liverpool, UK
  353. 353 Health Data Research UK, Swansea University, Swansea, UK
  354. 354 College of Medicine, Pathology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  355. 355 Ophthalmology Department, Aswan Faculty of Medicine, Aswan, Egypt
  356. 356 Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
  357. 357 Department of Public Health, Trnava University, Trnava, Slovakia
  358. 358 Department of Primary Care and Public Health, Imperial College London, London, UK
  359. 359 Public Health Research Department, National Health Institute Colombia, Bogota, Colombia
  360. 360 Faculty of Medicine, El Bosque University, Bogota, Colombia
  361. 361 Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India
  362. 362 Rajiv Gandhi University of Health Sciences, Bangalore, India
  363. 363 Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  364. 364 Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  365. 365 Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
  366. 366 Department of Ophthalmology, Iran University of Medical Sciences, Tehran, Iran
  367. 367 Ophthalmology Department, University of Manitoba, Winnipeg, MB, Canada
  368. 368 Department of Surgery, University of Virginia, Charlottesville, VA, USA
  369. 369 Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
  370. 370 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
  371. 371 Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  372. 372 Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
  373. 373 Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
  374. 374 Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia
  375. 375 Department of Health Sciences, University of York, York, UK
  376. 376 Department of Midwifery-Reproductive Health, Hamadan University of Medical Sciences, Hamadan, Iran
  377. 377 Research Department, The George Institute for Global Health, New Delhi, India
  378. 378 School of Medicine, University of New South Wales, Sydney, NSW, Australia
  379. 379 Department of Public Health, Mekelle University, Mekelle, Ethiopia
  380. 380 Department of Nursing, Arba Minch University, Arba Minch, Ethiopia
  381. 381 Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD, USA
  382. 382 Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
  383. 383 Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  384. 384 College of Health Science, Department of Midwifery, Adigrat University, Adigrat, Ethiopia
  385. 385 Department of Epidemiology and Biostatistics, Haramaya University, Harar, Ethiopia
  386. 386 Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
  387. 387 University of Helsinki, Helsinki, Finland
  388. 388 Neurocenter, Helsinki University Hospital, Helsinki, Finland
  389. 389 School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
  390. 390 Clinical Microbiology and Parasitology Unit, ZoraProfozic Polyclinic, Zagreb, Croatia
  391. 391 University Centre Varazdin, University North, Varazdin, Croatia
  392. 392 Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
  393. 393 Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland
  394. 394 Pacific Institute for Research & Evaluation, Calverton, MD, USA
  395. 395 Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
  396. 396 Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India
  397. 397 Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
  398. 398 President’s Office, National Institute of Statistics Romania, Bucharest, Romania
  399. 399 Faculty of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
  400. 400 Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
  401. 401 Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
  402. 402 Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
  403. 403 Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  404. 404 Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  405. 405 Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
  406. 406 Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia
  407. 407 Research Center, Salahaddin University, Erbil, Iraq
  408. 408 Ishik University, Erbil, Iraq
  409. 409 Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
  410. 410 Department of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran
  411. 411 Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
  412. 412 Department of Clinical Biochemistry, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
  413. 413 Department of Nursing, Shahroud University of Medical Sciences, Shahroud, Iran
  414. 414 Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
  415. 415 Department of Public Health, Samara University, Samara, Ethiopia
  416. 416 Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
  417. 417 Faculty of Life Sciences and Medicine, King’s College London, London, UK
  418. 418 Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
  419. 419 Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
  420. 420 Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  421. 421 Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
  422. 422 Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
  423. 423 Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
  424. 424 Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  425. 425 International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
  426. 426 Gorgas Memorial Institute for Health Studies, Panama City, Panama
  427. 427 Department of Social Medicine, National Center for Child Health and Development, Setagaya, Japan
  428. 428 Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
  429. 429 Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
  430. 430 School of Medical Sciences, Science University of Malaysia, Kubang Kerian, Malaysia
  431. 431 Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
  432. 432 Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
  433. 433 Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
  434. 434 Knowledge Translation and Utilization, Egyptian Center for Evidence Based Medicine, Egypt
  435. 435 Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India
  436. 436 Research and Analytics, Bioinsilico Technologies, Chennai, India
  437. 437 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
  438. 438 Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
  439. 439 Experimental Surgery and Oncology Laboratory, Kursk State Medical University of the Ministry of Health of the Russian Federation, Kursk, Russia
  440. 440 Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
  441. 441 Suraj Eye Institute, Nagpur, India
  442. 442 Hospital of the Federal University of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
  443. 443 Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  444. 444 Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
  445. 445 Cochrane Unit, South African Medical Research Council, Cape Town, South Africa
  446. 446 Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  447. 447 Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
  448. 448 Department of Biological Sciences, University of Embu, Embu, Kenya
  449. 449 Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
  450. 450 Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  451. 451 Heidelberg University Hospital, Heidelberg, Germany
  452. 452 Public Health Department, Universitas Negeri Semarang, Kota Semarang, Indonesia
  453. 453 Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
  454. 454 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  455. 455 Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
  456. 456 Reproductive Health Sciences, Department Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
  457. 457 Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
  458. 458 Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya
  459. 459 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
  460. 460 Department of Psychiatry, University of Lagos, Lagos, Nigeria
  461. 461 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
  462. 462 Diplomacy and Public Relations Department, University of Human Development, Sulaimaniyah, Iraq
  463. 463 Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria
  464. 464 Department of Psychology, University of Ghana, Accra, Ghana
  465. 465 Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
  466. 466 Applied Research Division, Public Health Agency of Canada, Ottawa, ON, Canada
  467. 467 School of Psychology, University of Ottawa, Ottawa, ON, Canada
  468. 468 Department of Global Health Nursing, St Luke’s International University, Chuo-ku, Japan
  469. 469 Academic department, Unium Ltd, Moscow, Russia
  470. 470 Department of Project Management, National Research University Higher School of Economics, Moscow, Russia
  471. 471 Department of Respiratory Medicine, Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India
  472. 472 Department of Forensic Medicine, Manipal Academy of Higher Education, Manipal, India
  473. 473 Department of Medicine, Ottawa Hospital Research Institute, Ottawa ON, Canada
  474. 474 Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, Iran
  475. 475 Augenpraxis Jonas, Heidelberg University, Heidelberg, Germany
  476. 476 Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
  477. 477 Research and Evaluation, Population Council, New Delhi, India
  478. 478 Indian Institute of Health Management Research University Delhi, Jaipur, India
  479. 479 Department of Pediatircs, RD Gardi Medical College, Ujjain, India
  480. 480 Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
  481. 481 Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
  482. 482 Population Health Theme, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
  483. 483 Department of Midwifery, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  484. 484 School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  485. 485 Center for Research and Innovation, Ateneo De Manila University, Pasig City, Philippines
  486. 486 Department of Orthopedics, Yenepoya Medical College, Mangalore, India
  487. 487 Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
  488. 488 Department of Psychiatry, Department of Epidemiology, Columbia University, New York City, NY, USA
  489. 489 Department of Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal
  490. 490 Department of Epidemiology and Evidence-Based Medicine, Sechenon University, Moscow, Russia
  491. 491 Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  492. 492 Health Sciences Department, Muhammadiyah University of Surakarta, Sukoharjo, Indonesia
  493. 493 Department of Population Studies, International Institute for Population Sciences, Mumbai, India
  494. 494 Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
  495. 495 Department of Chemistry, Sharif University of Technology, Tehran, Iran
  496. 496 College of Medicine, University of Central Florida, Orlando, FL, USA
  497. 497 College of Graduate Health Sciences, A T Still University, Mesa, AZ, USA
  498. 498 Department of Epidemiology & Biostatistics, Contech School of Public Health, Lahore, Pakistan
  499. 499 Department of Medicine, University of Alberta, Edmonton, AB, Canada
  500. 500 Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
  501. 501 Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  502. 502 Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  503. 503 Metabolomics and Genomics Research Center, Tehran University of Medical Sciences, Tehran, Iran
  504. 504 Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
  505. 505 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  506. 506 School of Nursing and Healthcare Professions, Federation University Australia, Berwick, VIC, Australia
  507. 507 School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
  508. 508 Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
  509. 509 European Office for the Prevention and Control of Noncommunicable Diseases, World Health Organization (WHO), Moscow, Russia
  510. 510 Department of Surgery, University of Michigan, Ann Arbor, MI, USA
  511. 511 Department of Oral Pathology, Srinivas Institute of Dental Sciences, Mangalore, India
  512. 512 School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Tehran, Iran
  513. 513 Forensic Medicine, Manipal Academy of Higher Education, Mangalore, India
  514. 514 Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
  515. 515 Academic Public Health Department, Public Health England, London, UK
  516. 516 School of Health, Medical and Applied Sciences, CQ University, Sydney, NSW, Australia
  517. 517 Department of Computer Science, Metropolitan College, Boston University, Boston, USA
  518. 518 Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
  519. 519 School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
  520. 520 Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
  521. 521 Brien Holden Vision Institute, Sydney, NSW, Australia
  522. 522 Organization for the Prevention of Blindness, Paris, France
  523. 523 EPIUnit - Public Health Institute University Porto (ISPUP), University of Porto, Porto, Portugal
  524. 524 Surgery Department, University of Minnesota, Minneapolis, MN, USA
  525. 525 Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
  526. 526 Research Directorate, Nihon Gakko University, Fernando de la Mora, Paraguay
  527. 527 Research Direction, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay
  528. 528 Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
  529. 529 Faculty of Medicine, Ain Shams University, Cairo, Egypt
  530. 530 National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
  531. 531 Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  532. 532 College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
  533. 533 Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  534. 534 Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
  535. 535 Department of Health in Disasters and Emergencies, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  536. 536 Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
  537. 537 Nanobiotechnology Center, Soran University, Soran, Iraq
  538. 538 Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
  539. 539 Radiology and Nuclear Medicine Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
  540. 540 Research Deputy, Taleghani Hospital, Kermanshah, Iran
  541. 541 Public Health and Community Medicine Department, Cairo University, Giza, Egypt
  542. 542 Department of Urology, Cairo University, Cairo, Egypt
  543. 543 Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
  544. 544 Global Health Institute, American University of Beirut, Beirut, Lebanon
  545. 545 Health and Disability Intelligence Group, Ministry of Health, Wellington, New Zealand
  546. 546 Department of Entomology, Ain Shams University, Cairo, Egypt
  547. 547 Department of Surgery, Marshall University, Huntington, WV, USA
  548. 548 Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, OH, USA
  549. 549 Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  550. 550 Institute of Bone and Joint Research, University of Sydney, Syndey, NSW, Australia
  551. 551 Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
  552. 552 Centre-School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
  553. 553 Health Economics, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
  554. 554 Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
  555. 555 Surgery Department, Hamad Medical Corporation, Doha, Qatar
  556. 556 Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
  557. 557 Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
  558. 558 Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
  559. 559 Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia
  560. 560 School of Public Health, Imperial College London, London, UK
  561. 561 Faculty member of Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  562. 562 Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
  563. 563 Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
  564. 564 Emergency Department, Manian Medical Centre, Erode, India
  565. 565 Microbiology Service, National Institutes of Health, Bethesda, MD, USA
  566. 566 Center for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
  567. 567 Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
  568. 568 Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  569. 569 Independent Consultant, Karachi, Pakistan
  570. 570 School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
  571. 571 Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
  572. 572 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
  573. 573 Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
  574. 574 Division of General Internal Medicine, Harvard University, Boston, MA, USA
  575. 575 National Institute of Infectious Diseases, Tokyo, Japan
  576. 576 College of Medicine, Yonsei University, Seodaemun-gu, South Korea
  577. 577 Division of Cardiology, Emory University, Atlanta, GA, USA
  578. 578 Finnish Institute of Occupational Health, Helsinki, Finland
  579. 579 Department of Health Education & Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
  580. 580 School of Health, University of Technology Sydney, Sydney, NSW, Australia
  581. 581 Department of Psychology, Reykjavik University, Reykjavik, Iceland
  582. 582 Department of Health and Behavior Studies, Columbia University, New York, NY, USA
  583. 583 Department of Forensic Medicine, Kathmandu University, Dhulikhel, Nepal
  584. 584 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
  585. 585 Medicine Service, US Department of Veterans Affairs (VA), Birmingham, AL, USA
  586. 586 Department of Epidemiology, School of Preventive Oncology, Patna, India
  587. 587 Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
  588. 588 2nd Department of Surgery-SUUB, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  589. 589 2nd Surgery Department, Bucharest Emergency Hospital, Bucharest, Romania
  590. 590 Pain Management Research Institute (PMRI), Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
  591. 591 Michael J Cousins Pain Management & Research Centre, Northern Sydney Local Health District, St Leonards, NSW, Australia
  592. 592 Department of Medical Surgical Nursing, Urmia University of Medical Science, Urmia, Iran
  593. 593 Emergency Nursing Department, Semnan University of Medical Sciences, Semnan, Iran
  594. 594 Department of Biostatistics, Hamedan University of Medical Sciences, Hamadan, Iran
  595. 595 Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
  596. 596 Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
  597. 597 Department of Public Health, Arba Minch University, Arba Minch, Ethiopia
  598. 598 Hull York Medical School, University of Hull, Hull City, UK
  599. 599 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  600. 600 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
  601. 601 South African Medical Research Council, Cape Town, South Africa
  602. 602 Department of Psychology, Deakin University, Burwood, VIC, Australia
  603. 603 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
  604. 604 Department of Agriculture and Food Systems, University of Melbourne, Melbourne, VIC, Australia
  605. 605 Department of Criminology, Law and Society, University of California Irvine, Irvine, CA, USA
  606. 606 Department of Medicine, University of Valencia, Valencia, Spain
  607. 607 Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
  608. 608 School of Social Work, University of Illinois, Urbana, IL, USA
  609. 609 Department of Public Health, Arbaminch College of Health Sciences, Arbaminch town sikela, Ethiopia
  610. 610 Axum College of Health Science, mekelle, Ethiopia
  611. 611 School of Midwifery, University of Gondar, Gondar, Ethiopia
  612. 612 School of Public Health, University of Adelaide, Adelaide, SA, Australia
  613. 613 Department of Environmental Health, Wollo University, Dessie, Ethiopia
  614. 614 Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran
  615. 615 Department of Pharmacognosy, Mekelle University, Mekelle, Ethiopia
  616. 616 Institute of Public Health, University of Gondar, Gondar, Ethiopia
  617. 617 Department of Public Health, Adigrat University, Adigrat, Ethiopia
  618. 618 Psychiatry Department, Hawassa University, Hawassa, Ethiopia
  619. 619 Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
  620. 620 The Agency for Health Technology Assessment and Tariff System, Warszawa, Poland
  621. 621 Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
  622. 622 Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
  623. 623 Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
  624. 624 Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
  625. 625 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
  626. 626 Mbarara University of Science and Technology, Mbarara, Uganda
  627. 627 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  628. 628 Institute of Soil and Environmental Sciences, A T Still University, Faisalabad, Pakistan
  629. 629 Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
  630. 630 TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
  631. 631 Research Department, National Institute of Population Studies (NIPS), Islamabad, Pakistan
  632. 632 Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, India
  633. 633 Division of Health Sciences, University of Warwick, Coventry, UK
  634. 634 Argentine Society of Medicine, Buenos Aires, Argentina
  635. 635 Velez Sarsfield Hospital, Buenos Aires, Argentina
  636. 636 UKK Institute, Tampere, Finland
  637. 637 Raffles Neuroscience Centre, Raffles Hospital, Singapore
  638. 638 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  639. 639 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  640. 640 Occupational Health Unit, Sant’Orsola Malpighi Hospital, Bologna, Italy
  641. 641 Department of Health Care Administration and Economics, National Research University Higher School of Economics, Moscow, Russia
  642. 642 Foundation University Medical College, Foundation University, Islamabad, Pakistan
  643. 643 Demographic Change and Ageing Research Area, Federal Institute for Population Research, Wiesbaden, Germany
  644. 644 Center of Population and Health, Wiesbaden, Germany
  645. 645 Department of Physical Therapy, Naresuan University, Meung District, Thailand
  646. 646 Department of Human Anatomy, Histology, Embryology, Bahir Dar University, Bahir Dar, Ethiopia
  647. 647 Department of Pharmacology and Toxicology, Mekelle University, Mekelle, Ethiopia
  648. 648 Department of Pharmacology, Addis Ababa University, Addis ababa, Ethiopia
  649. 649 Department of Nursing, Wollo University, Dessie, Ethiopia
  650. 650 Department of Orthopaedics, Wenzhou Medical University, Wenzhou, China
  651. 651 Medical Physics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  652. 652 Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
  653. 653 School of International Development and Global Studies, University of Ottawa, Ottawa ON, Canada
  654. 654 Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
  655. 655 Department of Health Management, Policy and Economics, Kerman University of Medical Sciences, Kerman, Iran
  656. 656 Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
  657. 657 Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
  658. 658 School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  659. 659 Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
  660. 660 Department of Sociology, Yonsei University, Seoul, South Korea
  661. 661 Department of Health Policy & Management, Jackson State University, Jackson, MS, USA
  662. 662 School of Medicine, Tsinghua University, Beijing, China
  663. 663 Department of Environmental Health, Mazandaran University of Medical Sciences, Sari, Iran
  664. 664 Department of Environmental Health, Academy of Medical Science, Sari, Iran
  665. 665 School of Public Health and Management, Hubei University of Medicine, Shiyan, China
  666. 666 Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
  667. 667 Global Health Institute, Wuhan University, Wuhan, China
  668. 668 Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
  669. 669 Department of Epidemiology, University Hospital of Setif, Setif, Algeria
  670. 670 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
  671. 671 Student Research Committee, Babol University of Medical Sciences, Babol, Iran
  672. 672 Department of Community Medicine, Ardabil University of Medical Science, Ardabil, Iran
  673. 673 Department of Environment Health Engineering, Gonabad University of Medical Sciences, Gonabad, Iran
  674. 674 Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
  675. 675 Department of Preventive Medicine, Wuhan University, Wuhan, China
  676. 676 School of Public Health, Wuhan University of Science and Technology, Wuhan, China
  677. 677 Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
  678. 678 Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
  679. 679 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
  680. 680 Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  681. 681 Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Spencer L James, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA; spencj{at}uw.edu

Abstract

Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

  • burden of disease
  • global
  • descriptive epidemiology
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

View Full Text

Statistics from Altmetric.com

Introduction

Injury burden assessments are a critical component of population health measurement. Across the global landscape of population health research, injuries are unique in that they are almost universally avertable yet can cause death or disability at any age. Even common injuries such as concussion resulting from falls, violence or road injuries may cause longer term sequelae, and injuries such as spinal cord injuries or limb amputations can cause long-term disability.1 As a result, injuries are recognised as being a source of lost health and human capital that could be averted with improved safety and prevention programmes as well as ensuring access to care resources.2 Across geographies, certain injuries such as envenomation may be relevant in specific locations where venomous creatures live, while injuries such as those occurring from adverse medical events are an increasing area of research in higher income areas of the world.3–5 Bolstering such programmes, however, requires detailed measurement of when, where and to whom injuries are occurring, necessitating focused research studies to add insight and context to broader geographical trends. Across all domains of injury prevention research, it is important to measure the causes of injury, such as road injuries, and the resulting disability, such as fractures, burns or traumatic brain injury, that can occur as a result. Such detailed measurement lends perspective for understanding burden and anticipating resources needed to care for and hopefully prevent future injury burden. Detailed measurements and assessments of this nature are critical for empowering policy makers and health system planners to appropriately plan and invest for mitigating future health loss from injuries. Reducing injury burden is an important component in global efforts such as the Sustainable Development Goal 3 to ‘ensure healthy lives and promote well-being for all at all ages’.6

While some research has focused on a certain type of injury or outcome from injury or specific area of the world,7–10 it has become important in an era of more sophisticated population health measurement to measure health loss from injuries comprehensively with detailed fatal and non-fatal estimates for different ages, sexes, across time periods and accounting for multiple different types of morbidity that can occur in an injury. Previously published literature on global injury burden through 2015 has provided comprehensive measurements of health loss due to injuries but still require regular updates to help inform research and policy, as new years of estimates are added and as new injuries and injury outcomes are incorporated.11 Comprehensive research of this nature shows how injury burden varies dynamically by age, sex, year, area of the world and type of injury, and hence, it is important to maintain close monitoring of injury burden every year in all parts of the world. In addition, as new datasets and statistical modelling methods become available, producing regular updates to burden estimation also ensures that results are as accurate as possible.

While the burden of injuries is widely studied and monitored through various methods of research, the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study is the only study framework that routinely provides estimates of morbidity and mortality from an exhaustive list of injuries in all areas of the world across ages and sexes. The most recent update to GBD was published in 2018 and provided morbidity and mortality estimates for 30 mutually exclusive causes of injury for 195 countries from 1990 to 2017.12–17 As part of this regular update, new datasets on cause of death and incidence are incorporated into the study, and additional geographical detail is added to better measure heterogeneity in burden estimates at a subnational level. In addition, updates such as reporting both nature of injury and cause of injury (described in more detail below) are incorporated. In this study, we describe key components in the GBD injury methodology and provide results from key trends in injury burden in terms of incidence, prevalence, years lived with disability (YLDs), cause-specific mortality, years of life lost (YLLs) and disability-adjusted life years (DALYs) by country, age groups, sex, year and injury type.

Methods

The methods and results in this study are the same as are provided in GBD capstone publications, and a detailed description of GBD data and methods used for all processes related to GBD 2017 is provided in associated studies.12–17 Overall, GBD methods are also summarised in online supplementary appendix 1. Below, we summarise the specific methods used for measurement of injuries morbidity and mortality in GBD 2017.

Key components of GBD study design

The GBD study incorporates several key components to allow for internally consistent estimates across all burden measures and metrics. First, population is measured to ensure consistent denominators for all population-level measurement. Second, all-cause mortality is measured using demographic methods. Third, cause-specific mortality for a mutually exclusive, collectively exhaustive hierarchy of diseases and injuries is measured, such that every death has one underlying cause of death and such that estimates for every possible cause of death are included, which requires the use of residual causes like ‘other transport injuries’. This results in the sum of cause-specific mortality equalling total all-cause mortality. Fourth, non-fatal health loss is measured for individuals living with a disease or injury that detracts from their full health status. Fifth, a composite measure of mortality and morbidity is computed. These steps are conducted within an age, sex and location hierarchy constructed such that demographic detail is available but where all estimates are internally consistent with all other estimates. GBD produces estimates for all causes, ages, sexes, years and locations. Risk factors and attributable burden for different are also measured, but those results are not included in this study.

Case definition and cause hierarchy

The GBD case definition for an injury death is a death where the injury was the underlying cause of death. For example, if an individual falls on ice and sustains an epidural haematoma and dies after a seizure, the fall is the underlying cause. If an individual sustains a myocardial infarction and then falls and sustains the same epidural haematoma, then the myocardial infarction is the underlying cause of death. For non-fatal injuries, we define a case as an injury that warranted medical care. For example, if an individual slips and falls but does not sustain any bodily injury, it is not considered an injury. Online supplementary appendix table 1 provides the International Classification of Disease (ICD) codes used to identify causes of injury.

Cause-specific mortality estimation

Cause-specific mortality from injuries is measured using the Cause of Death Ensemble model (CODEm). CODEm is described in more detail elsewhere; a summary of its use for injuries is as follows.18 First, all available data that can be used for cause of death estimation are identified. For injuries, this includes vital registration, verbal autopsy, police records, mortuary data and census data. These data are processed for use in the GBD cause and demographic hierarchy via a series of data processing steps including a process whereby ill-defined causes of death are reassigned to true underlying causes of death, which is described in more detail elsewhere but essentially is the process by which ill-defined causes of death are reclassified to causes of death in the GBD cause hierarchy.19 20 Next, a cause-specific mortality model is developed for each one of the 30 different causes of injury. For example, falls are modelled differently than road injuries, though both use the same CODEm modelling architecture. For each cause of injury, covariates that may be associated with the cause are identified and added as candidate covariates. CODEm runs different combinations of models using different covariates and outcome variables, specifically cause fraction models and cause-specific mortality rate models. Ensembles of models are also conducted to test performance of overall models formed from submodels. Once all models have been run, the top-performing models are selected based on out-of-sample predictive validity, wherein the model makes predictions on data that were not included in developing the model. The top-performing models are then weighted according to performance, and the final estimates form the penultimate estimate for cause-specific mortality from that injury. Those estimates are then adjusted to fit within the all-cause mortality estimate, so that cause-specific deaths sum up to the overall mortality estimate for each population and demographic. YLLs are computed as the cause-specific mortality rate at a given age multiplied by the residual life expectancy at that age, which is based on the observed maximum global life expectancy.

Non-fatal injury estimation

Non-fatal injury estimation is also described in more detail in GBD literature. Key components in this process are as follows. First, data on incidence of non-fatal injury causes (eg, road injuries) is obtained from the GBD collaborator network and other injury research groups and researchers around the world. Data are cleaned and organised according to GBD study guidelines. Next, incidence of each cause of injury is modelled in DisMod-MR 2.1, which is a Bayesian meta-analysis tool used extensively in GBD research. Incidence estimates of injuries requiring medical care for each cause of injury then stream through an analytical pipeline. During this process, injury incidence is split into inpatient and outpatient to account for the different severity that is expected to occur. The coefficient that determines this split is derived from locations where both inpatient and outpatient data are available. After this, we measure the proportion of each cause of injury that leads to one of 47 different natures of injury using clinical data where both cause and nature are coded as well a Dirichlet statistical modelling process. Based on these steps, the incidence of each cause is also split into incidence of each cause-nature, which is the proportion of a given cause’s incidence leading to some specific nature of injury being the most severe injury sustained as estimated by the Dirichlet regression. These estimates are then converted to short-term and long-term injuries based on probability of each injury becoming long term, as determined by long-term follow-up injury surveys.21–27 For short-term injuries, incidence is converted to prevalence based on multiplying incidence by an expected duration of injury as determined by physicians and injury experts involved in the GBD study. For long-term injuries, incidence is converted to prevalence using differential equations that take into account the increased mortality for certain types of injury, for example, traumatic brain injury.1 Disability weights as derived elsewhere in the GBD study are then used to measure disability based on nature of injury.28 These measures are then summed across natures of injury for each cause to calculate YLDs. Each of these steps is conducted for every cause, age, sex, year and location in the GBD study design. Associated literature provides more detail on each of these steps.12–17

DALY measurement

DALYs are calculated by summing YLLs and YLDs for each cause, age, sex, year and location.

Uncertainty measurement

Uncertainty is measured at each step of the analytical process based on the sample size, SE or original uncertainty interval (UI) from each input to the study. Uncertainty is propagated through each step of the analysis by maintaining distributions of 1000 draws on which each analytical step is conducted. Final 95% UIs are determined based on the 25th and 975th values of the ordered values across draws.

Code and results

Steps of the analytical process were conducted in Python version 2.7, Stata V.13.1 or R version 3.3. All steps of the analytical process are available online at ghdx.healthdata.org. This study reports a subset of measures and metrics for every cause of injury. All results and results with additional detail by age, sex, year and location can be downloaded at ghdx.healthdata.org.

Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) statement

This study is adherent with guidelines from the GATHER (described in more detail in online supplementary appendix 2).29

Results

Online supplementary appendix table 2 shows age-standardised incidence, prevalence, YLDs, deaths, YLLs and DALYs in 2017 by country as well as percentage change and UI from 1990 for each metric. Online supplementary appendix table 3 shows all-age numbers (ie, not divided by population) of incidence, prevalence, YLDs, deaths, YLLs and DALYs in 2017 by country as well as percentage change from 1990 and UI for each metric. In some instances, the UI for the per cent change crosses zero, meaning that statistically there was no significant difference. Online supplementary appendix figures 1–6, show the incidence and mortality from transport injuries, unintentional injuries, and interpersonal violence and self-harm by country for 2017 as well as the percentage change for both incidence and mortality between 1990 and 2017. All other results including age-specific and sex-specific results can be viewed and downloaded via freely and publicly available tools at ghdx.healthdata.org.

Global trends in overall injury burden

In terms of fatal outcomes, deaths due to all injuries increased from 4 260 493 (4 085 700 to 4 396 138) in 1990 to 4 484 722 (4 332 010 to 4 585 554) in 2017, while YLLs decreased from 232 104 206 (219 920 058 to 241 973 733) to 195 231 148 (188 807 653 to 199 825 464) and age-standardised mortality rates decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In terms of non-fatal outcomes, all-injury incidence (new cases) increased from 354 064 302 (338 174 876 to 371 610 802) in 1990 to 520 710 288 (493 430 247 to 547 988 635) in 2017, and YLDs increased from 37 452 031 (27 805 854 to 49 010 103) to 57 174 469 (42 073 855 to 75 427 036), while age-standardised incidence rates decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. In terms of DALYs, age-standardised DALY rates decreased from 4947 (4655 to 5233) per 100 000 in 1990 to 3267 (3058 to 3505) in 2017.

Figure 1 shows age-standardised DALY rates by country for 2017. While certain countries—specifically, Syria, Central African Republic and Iraq—have much higher DALY rates than most other countries, there still exists considerable heterogeneity across countries that are not among these countries with the highest burden. South Sudan, Somalia and Yemen have much higher injury burden than much of the rest of the world, for example, with age-standardised DALY rates of 7391.51 per 100 000 (6536.44 to 8440.14), 7364.66 per 100 000 (6143.11 to 8960.58) and 7297.88 per 100 000 (6525.7 to 8438.15), respectively. Papua New Guinea also demonstrates high all-injury burden with 6803.33 DALYs per 100 000 (5652.2 to 8040.89) in 2017.

Figure 1

Age-standardised DALY rates by country, 2017. DALYs, disability-adjusted life years.

Figure 2 presents deaths as a stacked graph for overall injury groups and population from 1990 to 2017 with labelled fatal discontinuities, defined as changes in deaths due to sudden, unexpected spikes in mortality that depart from the underlying mortality trend.13 Although population has steadily increased in the 28 years of the study, deaths per year due to injuries have remained relatively consistent over time. Natural disasters, such as earthquakes, have caused pronounced spikes in unintentional injuries deaths, while conflict and genocide have caused spikes in deaths in the interpersonal violence injury category.

Figure 2

Global deaths for level 2 injuries and population from 1990 to 2017 with labelled fatal discontinuities.

All-injury YLDs and YLLs by country in 2017

Figure 3 shows the percentage of total all-age, combined-sex YLDs by country in 2017. This figure shows several geographical patterns that help depict the non-fatal burden of injuries globally in terms of their relative contribution to overall disability. First, the percentage of total disability caused by injuries varies widely by country. Mauritius experiences only 3.04% (2.79% to 3.29%) of non-fatal burden from injuries, while Slovenia experiences 19.11% (17.11% to 21.27%) of non-fatal burden from injuries. In other words, if all disability in these two populations is combined in 2017, there is over sixfold variation in how much of this disability was caused by injuries. These patterns also reflect burden from non-injury conditions, since locations with higher burden from communicable disease may have correspondingly lower proportion due to injuries. As an extension of these geographical trends, this map makes it evident that there are striking regional patterns in non-fatal injury burden. Eastern and Central Europe and Central Asia as well as Australasia have a notably higher percentage of total non-fatal burden from injuries than countries in other regions, while these percentages are relatively lower in most areas of Africa, the Americas and areas of South, East and Southeast Asia. To some extent, this map also reflects the underlying burden from non-injury causes, too, since areas of the world with high non-fatal disability from conditions such as anaemia, communicable diseases and other types of health loss could have correspondingly higher percentages of disability from these conditions instead of injuries. This map also shows examples of positive deviations from global trends; Indonesia, for example, has a relatively low percentage of non-fatal health loss due to injuries compared with many other countries.

Figure 3

Percentage of YLDs in all ages due to injuries in 2017. YLDs, years lived with disability.

Figure 4 similarly shows the percentage of total all-age, combined-sex YLLs by country in 2017. This figure interestingly shows how mortality patterns demonstrate different geographical trends than the non-fatal burden, as depicted in figure 2, though it should be noted that YLLs will also be disproportionately higher in younger populations, all else being equal. In particular, the locations with the highest percentage of YLLs due to injuries are in certain countries in North Africa and the Middle East, including Syria, where 59.51% (56.59% to 62.35%) of YLLs were due to injuries in 2017, and Iraq, where 41.34% of YLLs were due to injuries in 2017. Areas of Latin America including Venezuela, Honduras and Belize also have a relatively high percentage of total YLLs due to injuries. Conversely, certain areas of the world also demonstrate a relatively low percentage of total YLLs due to injuries, specifically, certain countries in Africa such as Nigeria and Madagascar have relatively lower percentages, though this also reflects relatively higher mortality from other non-injury causes in these countries.

Figure 4

Percentage of YLLs in all ages due to injuries in 2017. YLLs, years of life lost.

Cause-specific DALY rates by sex

Figure 5 shows cause-specific DALY rates by sex for 17 injuries in 2017 as well as percentage change from 1990 to 2017 by cause and sex. The black and dark blue bars show causes with greater relative improvement over the time period of this study, while lighter blue, orange and red show injuries that have had lesser improvements, no improvements or increasing burden over time.

Figure 5

Age-standardised DALY rates by sex for injuries in level 3 of the GBD cause hierarchy in 2017 and percentage change from 1990 to 2017. DALY, disability-adjusted life year; GBD, Global Burden of Disease.

In 2017, men experienced higher age-standardised DALY rates than women for all injuries except fire, heat and hot substances. The most marked differences, where DALY rates for men are more than double those of women, can be seen in self-harm, interpersonal violence, road injuries, other transport injuries, exposure to mechanical forces, environmental heat and cold exposure, and executions and police violence. Road injuries (1272 (1209 to 1331) per 100 000), self-harm (577 (525 to 604)) and falls (550 (462 to 653)) were the causes with the highest DALY rates for men in 2017. Women had the highest DALY rates due to the same injuries, but at a lesser magnitude, with rates of 467 (432 to 502) per 100 000 for road injuries, 367 (304 to 442) for falls and 282 (268 to 293) for self-harm.

The causes with the largest decreases in DALY rates for men from 1990 to 2017 were exposure to forces of nature (72.4% (63.8% to 79.1%)), drowning (62.7% (58.8% to 65.4%)) and fire, heat and hot substances (43.6% (26.4% to 49.9%)). For women, exposure to forces of nature (72.8% (63.8% to 79.6%)), drowning (65.8% (58.6% to 69.2%)) and self-harm (50.8% (48.2% to 55.9%)) had the largest decreases in DALY rates. The only increases in DALY rates were seen in executions and police conflict for both women (298.0% (257.1% to 389.0%)) and men (46.4% (31.2% to 173.0%)).

Comparative regional DALY rates in 2017

Figure 6 shows a heatmap of the number of standard deviations (SD) above or below the mean of a row (ie, a Z-score) of age-standardised DALY rates for select injuries by GBD region in 2017. For example, the figure shows that the rate of age-standardised DALYs in Eastern Europe is approximately three SD higher than the across mean age-standardised DALY rates of environmental heat and cold exposure across all regions. Poisonings is also a cause with an age-standardised DALY rate that is approximately three SD higher than in other regions. Positive deviance is seen in high-income Asia Pacific for road injuries, where age-standardised DALYs are one SD lower than the mean across regions. Conversely, Central sub-Saharan Africa has age-standardised DALY rates that are two SD higher than the mean across regions. This figure also demonstrates how certain causes have relatively less variation across regions, for example, most regions do not deviate from the mean age-standardised DALY rates across regions for exposure to forces of nature, with the exception of the Caribbean, which had an age-standardised DALY rate that was approximately four SD above the mean across regions in 2017. Oceania and Eastern Europe stand out as having higher DALY rates for select injuries than other regions, while East Asia, high-income Asia Pacific, high-income North America, Western Europe and Southern Latin America experienced less than average burden of injuries in 2017.

Figure 6

Heatmap showing the Z-score of age-standardised mean DALY rates for select injuries by GBD region in 2017. GBD, Global Burden of Disease.

Discussion

Measuring, understanding and acting on the global burden of injuries should be considered a foundational component of population health research. While this study has reviewed injury burden trends from GBD 2017, it is also evident that these trends are sufficiently different by injury type and geography that it becomes difficult to succinctly generalise the findings in this study. Nevertheless, this study reveals themes and principles germane to the state of global injury burden in 2017 that are relevant to injury burden and prevention research.

First, it should be recognised that despite global population growth with increases in injury cases and deaths, age-standardised death rates from injuries declined from 1990 to 2017. More research into successful improvements for specific injuries in specific countries should be more investigated to help guide efforts towards future improvements. In general terms, the reduction in injury mortality likely represent the combined effects of improvements in healthcare systems, investments in injury prevention programmes and, in certain circumstances, safety improvement such as vehicle safety testing, helmet, seatbelt and drinking and driving laws. While burden trends across all diseases and injuries vary by geography and time, these improvements in injury burden are generally consistent with reporting of communicable and non-communicable disease trends reported in GBD 2017.

Despite improvements in terms of rates, however, it is important to consider the impact of absolute injury burden in younger and adult ages on the social capital and workforce in a country. Second, in reviewing temporal trends in figure 2, it becomes evident that war and conflict and environmental disasters can cause profound increases in deaths over a short period of time. This unfortunate and tragic reality should be made more broadly visible as issues such as war, conflict and climate change continue to threaten the populations of the 21st century. Third, sex differentials in the burden of different injury types are large, with men experiencing significantly higher burden from the four leading causes of injury DALYs in 2017. Preventive research and focused interventions into why this is occurring in road injuries, falls, self-harm, interpersonal violence and drowning is critical. It is also critical to address injuries such as fire, heat and hot substance and sexual violence where females experience greater burden and to better understand the factors that drive sex differences. As a fourth theme, we observed that there are cases of both positive and negative deviance from cross-region trends for each injury, as shown in figure 6, which appear to occur even outside of expected differences by income group. For example, understanding why high-income Asia Pacific and Western Europe are performing better than high-income North America in road injury burden could help improve road injury burden even in this higher income setting.

Beyond these four themes, there are evidently a great deal of nuances and specific outcomes to measure and understand in future injury research. While every cause of health loss in a population is important to measure and understand, injuries are unique in that understanding burden requires investigation of an array of circumstances such as infrastructure, the built environment, rates of interpersonal violence in a population and individual behaviours such as alcohol intoxication or drug use. The findings in this paper also demonstrate how it is critical to measure and understand the spectrum of health loss due to injuries ranging from relatively silent injuries to injuries that profoundly affect functional status. An incident as elemental as a trip and fall can lead to profoundly disabling health consequences such as spinal cord injury, which can have lifelong disability. The disability caused by shorter term injuries, such as an arm fracture, in addition to causing suffering and disability, can cause loss of human capital.30 While this study focused more on the causes of injury as defined in the GBD cause hierarchy, future GBD studies should focus also on depicting the distribution of nature of injury results to better understand how these types of disability affect an individual’s functional status. Such analyses become increasingly meaningful as research emerges on, for example, the increased risk of dementia that traumatic brain injury patients may experience.31 The findings in this paper also demonstrate how measuring injury burden necessitates review of the population factors that affect injury risk. For example, an event as disastrous as an earthquake may have radically different impacts on a population depending on infrastructure and access to care resources. Understanding how populations can protect themselves against future, unanticipated catastrophe could lead to averted death and disability in the future. As was shown in figure 2, catastrophic events both in terms of natural disasters and war and conflict can significantly add to the death and disability experienced by a population in a short period of time.

The geographical trends shown in this paper are also critical to review and understand by the broader global health community. As shown in figure 6, considerable heterogeneity exists across regions for certain causes. While vehicles were driven in nearly every populated area of earth in 2017, this study shows that different regions of the world have markedly different rates of death and disability resulting from road injuries, underscoring the importance of measuring and understanding the effects of specific factors on injury burden.32 It is not necessarily surprising to observe that countries or regions with relatively lower healthcare access and quality, less road safety infrastructure and lower utilisation of vehicles with modern safety standards would have higher rates of road injuries DALYs. The question that extends from this observation, however, is the extent to which burden from this type of injury cause could be avoided were every country to have the safety and prevention factors available in higher income settings. The injury and safety research communities should consider future investigation of counterfactual analyses to better measure and understand the impact that road safety legislation, modernisation of roads and vehicles and improving first response medical care could have on road injury burden, as an example, though parallel examples can be developed for other injury causes as well. This research could help cost-effectiveness analyses and guide investment in safer infrastructure.

These observations converge on a common theme: much of the injury burden may be largely preventable and understanding the success or failure of different prevention efforts should be a prioritised area of health research. Moreover, it is critical for there to be continued engagement across different areas of the world for the purposes of discussing effective and ineffective injury prevention strategies. Dialogue focused on findings across injury prevention efforts via forums such as global safety conferences as well as studies published in research journals should continue to help policy makers and public health planners make strategic investments for preventing future injury burden.33 In addition, more research into the cause of injury and resulting bodily injury and environmental and contextual features where injuries occur such type of road in a road injury or fires in factories versus in residences may provide further insight into preventing future injury burden.

Known limitations of injury burden estimation in the GBD framework have been reported previously in peer-reviewed literature.1 11 13 16 Generally, identified limitations include data sparsity and correspondingly greater uncertainty in certain geographies, limited geographical coverage of data informing long-term disability estimates and cause–nature relationships, and potential reporting biases for injuries such as self-harm and interpersonal violence. These limitations have been discussed in the aforementioned literature, and this overview study was additionally limited in scope due to the extensive size of the GBD cause hierarchy and location hierarchy. Indeed, over 1400 different cause–nature combinations are available for reporting in the GBD cause hierarchy, and future research would benefit from examining results in the detailed cause hierarchy and across the detailed location, age and sex hierarchy. The GBD Study platform and collaborator network provide a constructive collaborative platform on which future assessments can be conducted and published.

Conclusion

Injury burden is complex but foundational in formulating global health loss. We have identified four broad trends in global injury burden that converge on the principle that injuries should be considered largely preventable but that detailed burden estimates through recent years are a critical global resource to inform meaningful policy. It will be important accurate measurement to continue into the future to guide injury prevention policy.

What is already known on the subject

  • Injury burden globally varies across many dimensions but remains as an important component of global health loss. Regular updates in injury burden measurement are critical.

  • Injuries can be largely preventable, but prevention efforts must be guided by up-to-date estimates of injury burden that can be used on an age-specific, sex-specific, year-specific, location-specific and injury-specific basis.

What this study adds

  • This study incorporates updated data and methods that were used in Global Burden of Disease 2017 with updated burden estimates for the year 2017, as well as newly available results in terms of nature of injury.

  • Global age-standardised mortality and disability-adjusted life years decreased between 1990 and 2017. Decreases in age-standardised incidence were not statistically significant.

  • Trends over time vary depending on the specific injury, sex and location.

  • Injury burden in a population can be radically affected by war, civil conflict and natural disasters.

Acknowledgments

Syed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and for the approval and support to participate in this research project. Alaa Badawi acknowledges support from the Public Health Agency of Canada. Till Bärnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Felix Carvalho acknowledges UID/MULTI/04378/2019 support with funding from FCT/MCTES through national funds. Vera M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. Kebede Deribe acknowledges support from a grant from the Wellcome Trust [grant number 201900] as part of his International Intermediate Fellowship. Tim Driscoll acknowledges the work on occupational risk factors was partially supported by funds from the World Health Organization. Eduarda Fernandes acknowledges UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Yuming Guo acknowledges support from Career Development Fellowships of the Australian National Health and Medical Research Council (numbers APP1107107 and APP1163693). Sheikh Mohammed Shariful Islam acknowledges funding by a Fellowship from National Heart Foundation of Australia and Institute for Physical Activity and Nutrition, Deakin University.Mihajlo Jakovljevic acknowledges support by the Ministry of Education Science and Technological Development of the Republic of Serbia through the Grant number OI175014; publication of results was not contingent upon Ministry's censorship or approval. Sudha Jayaraman acknowledges support from: NIH R21: 1R21TW010439-01A1 (PI); Rotary Foundation Global Grant #GG1749568 (PI); NIH P20: 1P20CA210284-01A1 (Co-PI); DOD grant W81XWH-16-2-0040 (Co-I) during the submitted work. Yun Jin Kim acknowledges support from a grant from the Research Management Centre, Xiamen University Malaysia [grant number: XMUMRF/2018-C2/ITCM/0001]. Kewal Krishan acknowledges support by UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges FIC/NIH funding from grant K43 1K43MH114320-01. Amanda Mason-Jones acknowledges institutional support from the University of York. Walter Mendoza is currently Program Analyst Population and Development at the Peru Country Office of the United Nations Population Fund-UNFPA, which not necessarily endorses this study. Mariam Molokhia acknowledges support from the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. Ilais Moreno Velásquez acknowledges support by the Sistema Nacional de Investigación (SNI, Senacyt, Panama). Mukhammad David Naimzada acknowledges support from Government of the Russian Federation (Agreement No – 075-02-2019-967). Stanislav S. Otstavnov acknowledges the support from the Government of the Russian Federation (Agreement No – 075-02-2019-967). Ashish Pathak acknowledges support from the Indian Council of Medical Research (ICMR), New Delhi, India (Grant number 2013-1253). Michael R Phillips acknowledges support in part by a grant from the National Science Foundation of China (No. 81761128031). Marina Pinheiro acknowledges FCT for funding support through program DL 57/2016-Norma transitória. Abdallah M. Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena Santric Milicevic acknowledges the support from the Ministry of Education, Science and Technological Development, the Republic of Serbia (Contract No. 175087). Seyedmojtaba Seyedmousavi acknowledges support from the Intramural Research Program of the National Institutes of Health, Clinical Center, Department of Laboratory Medicine, Bethesda, MD, USA. Rafael Tabarés-Seisdedos acknowledges support in part by the national grant PI17/00719 from ISCIII-FEDER. Sojib Bin Zaman acknowledges support from an "Australian Government Research Training Program (RTP) Scholarship." Louisa Degenhardt acknowledges support from an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship (#1135991) and by a National Institute of Health (NIH) National Institute on Drug Abuse (NIDA) grant (R01DA1104470).

References

View Abstract

Footnotes

  • Funding Bill and Melinda Gates Foundation OPP1152504.

  • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests Dr. James reports grants from Sanofi Pasteur, outside the submitted work. Dr. Driscoll reports grants from World Health Organization, during the conduct of the study. Dr. Ivers reports grants from National Health and Medical Research Council of Australia, during the conduct of the study. Dr. Jozwiak reports personal fees from TEVA, personal fees from ALAB, personal fees from BOEHRINGER INGELHEIM, personal fees from SYNEXUS, non-financial support from SERVIER, non-financial support from MICROLIFE, non-financial support from MEDICOVER, outside the submitted work. Dr. Rakovac reports grants from World Health Organization, during the conduct of the study. Dr Shariful Islam is funded by National Heart Foundation of Australia and Institute for Physical Activity and Nutrition, Deakin University. Dr. Sheikh reports grants from Health Data Research UK, outside the submitted work. Dr. Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Spherix, Practice Point communications, the National Institutes of Health and the American College of Rheumatology, and Speaker’s bureau of Simply Speaking, owns stock options in Amarin pharmaceuticals and Viking pharmaceuticals, serves on the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, serves on the FDA Arthritis Advisory Committee, is a member of the Veterans Affairs Rheumatology Field Advisory Committee, and is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside the submitted work. Dr. Stein reports personal fees from Lundbeck, personal fees from Sun, outside the submitted work. Dr. Degenhardt reports grants from Indivior, Seqirus, Reckitt Benckiser, outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Availability of input data depends on original source. Select data are available in a public, open access repository. Select data are available on reasonable request. Select data may be obtained from a third party and are not publicly available. All results relevant to the study are included in the article or uploaded as supplementary information or are available online.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles